|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83.44
|
|
|
Service Code
|
NDC 36000014901
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$75.10 |
| Rate for Payer: Aetna Commercial |
$70.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.24
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cofinity Advantage |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.75
|
| Rate for Payer: Healthscope Commercial |
$75.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.58
|
| Rate for Payer: PHP Commercial |
$70.92
|
| Rate for Payer: Priority Health SBD |
$52.57
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83.44
|
|
|
Service Code
|
NDC 36000014910
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$75.10 |
| Rate for Payer: Aetna Commercial |
$70.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.24
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cofinity Advantage |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.75
|
| Rate for Payer: Healthscope Commercial |
$75.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.58
|
| Rate for Payer: PHP Commercial |
$70.92
|
| Rate for Payer: Priority Health SBD |
$52.57
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.94
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$12.05
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
OP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.42 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Medicare |
$285.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Advantage |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health SBD |
$359.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.18
|
| Rate for Payer: UHC Core |
$297.52
|
| Rate for Payer: UHC Exchange |
$224.42
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
IP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$359.76 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.18
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Advantage |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health SBD |
$359.76
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.09 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.86
|
| Rate for Payer: UHC Core |
$238.75
|
| Rate for Payer: UHC Exchange |
$180.09
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.51
|
| Rate for Payer: UHC Core |
$1.21
|
| Rate for Payer: UHC Exchange |
$0.92
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$288.70 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$189.50
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$170.55 |
| Rate for Payer: Aetna Commercial |
$161.07
|
| Rate for Payer: Aetna Commercial |
$152.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.17
|
| Rate for Payer: Cash Price |
$143.07
|
| Rate for Payer: Cash Price |
$151.60
|
| Rate for Payer: Cofinity Advantage |
$125.19
|
| Rate for Payer: Cofinity Advantage |
$132.65
|
| Rate for Payer: Cofinity Commercial |
$153.80
|
| Rate for Payer: Cofinity Commercial |
$162.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.07
|
| Rate for Payer: Healthscope Commercial |
$170.55
|
| Rate for Payer: Healthscope Commercial |
$160.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.12
|
| Rate for Payer: PHP Commercial |
$152.01
|
| Rate for Payer: PHP Commercial |
$161.07
|
| Rate for Payer: Priority Health SBD |
$112.67
|
| Rate for Payer: Priority Health SBD |
$119.39
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$189.50
|
|
|
Service Code
|
HCPCS A9612
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$170.55 |
| Rate for Payer: Aetna Commercial |
$161.07
|
| Rate for Payer: Aetna Commercial |
$152.01
|
| Rate for Payer: Aetna Medicare |
$89.42
|
| Rate for Payer: Aetna Medicare |
$94.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.17
|
| Rate for Payer: BCBS Complete |
$71.54
|
| Rate for Payer: BCBS Complete |
$75.80
|
| Rate for Payer: Cash Price |
$151.60
|
| Rate for Payer: Cash Price |
$143.07
|
| Rate for Payer: Cofinity Advantage |
$132.65
|
| Rate for Payer: Cofinity Advantage |
$125.19
|
| Rate for Payer: Cofinity Commercial |
$153.80
|
| Rate for Payer: Cofinity Commercial |
$162.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.60
|
| Rate for Payer: Healthscope Commercial |
$160.96
|
| Rate for Payer: Healthscope Commercial |
$170.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.12
|
| Rate for Payer: PHP Commercial |
$152.01
|
| Rate for Payer: PHP Commercial |
$161.07
|
| Rate for Payer: Priority Health SBD |
$112.67
|
| Rate for Payer: Priority Health SBD |
$119.39
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$256.66
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.87 |
| Max. Negotiated Rate |
$230.99 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Aetna Medicare |
$128.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.83
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: Cash Price |
$205.33
|
| Rate for Payer: Cofinity Advantage |
$179.66
|
| Rate for Payer: Cofinity Commercial |
$220.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.33
|
| Rate for Payer: Healthscope Commercial |
$230.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.50
|
| Rate for Payer: PHP Commercial |
$218.16
|
| Rate for Payer: Priority Health SBD |
$161.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.83
|
| Rate for Payer: UHC Core |
$133.72
|
| Rate for Payer: UHC Exchange |
$100.87
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.45 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna Medicare |
$274.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: BCBS Complete |
$219.28
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Advantage |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.16
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health SBD |
$345.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.34
|
| Rate for Payer: UHC Core |
$285.62
|
| Rate for Payer: UHC Exchange |
$215.45
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$256.66
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$230.99 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.83
|
| Rate for Payer: Cash Price |
$205.33
|
| Rate for Payer: Cofinity Advantage |
$179.66
|
| Rate for Payer: Cofinity Commercial |
$220.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.33
|
| Rate for Payer: Healthscope Commercial |
$230.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.50
|
| Rate for Payer: PHP Commercial |
$218.16
|
| Rate for Payer: Priority Health SBD |
$161.70
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.37 |
| Max. Negotiated Rate |
$493.39 |
| Rate for Payer: Aetna Commercial |
$465.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.34
|
| Rate for Payer: Cash Price |
$438.57
|
| Rate for Payer: Cofinity Advantage |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.57
|
| Rate for Payer: Healthscope Commercial |
$493.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.16
|
| Rate for Payer: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health SBD |
$345.37
|
|
|
FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$288.25
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$259.43 |
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Commercial |
$229.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cofinity Advantage |
$189.13
|
| Rate for Payer: Cofinity Advantage |
$201.78
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.15
|
| Rate for Payer: Healthscope Commercial |
$259.43
|
| Rate for Payer: Healthscope Commercial |
$243.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.19
|
| Rate for Payer: PHP Commercial |
$229.66
|
| Rate for Payer: PHP Commercial |
$245.01
|
| Rate for Payer: Priority Health SBD |
$181.60
|
| Rate for Payer: Priority Health SBD |
$170.22
|
|
|
FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$124.88
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$112.39 |
| Rate for Payer: Aetna Commercial |
$106.15
|
| Rate for Payer: Aetna Commercial |
$229.66
|
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Medicare |
$62.44
|
| Rate for Payer: Aetna Medicare |
$135.09
|
| Rate for Payer: Aetna Medicare |
$144.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: BCBS Complete |
$115.30
|
| Rate for Payer: BCBS Complete |
$49.95
|
| Rate for Payer: BCBS Complete |
$108.08
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Cofinity Advantage |
$189.13
|
| Rate for Payer: Cofinity Advantage |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$201.78
|
| Rate for Payer: Cofinity Commercial |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.90
|
| Rate for Payer: Healthscope Commercial |
$259.43
|
| Rate for Payer: Healthscope Commercial |
$243.17
|
| Rate for Payer: Healthscope Commercial |
$112.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.19
|
| Rate for Payer: PHP Commercial |
$106.15
|
| Rate for Payer: PHP Commercial |
$229.66
|
| Rate for Payer: PHP Commercial |
$245.01
|
| Rate for Payer: Priority Health SBD |
$78.67
|
| Rate for Payer: Priority Health SBD |
$181.60
|
| Rate for Payer: Priority Health SBD |
$170.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
|
|
FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$282.90
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.23 |
| Max. Negotiated Rate |
$254.61 |
| Rate for Payer: Aetna Commercial |
$240.47
|
| Rate for Payer: Aetna Commercial |
$116.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.28
|
| Rate for Payer: Cash Price |
$109.88
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cofinity Advantage |
$198.03
|
| Rate for Payer: Cofinity Advantage |
$96.14
|
| Rate for Payer: Cofinity Commercial |
$118.12
|
| Rate for Payer: Cofinity Commercial |
$243.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.88
|
| Rate for Payer: Healthscope Commercial |
$254.61
|
| Rate for Payer: Healthscope Commercial |
$123.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.18
|
| Rate for Payer: PHP Commercial |
$116.75
|
| Rate for Payer: PHP Commercial |
$240.47
|
| Rate for Payer: Priority Health SBD |
$178.23
|
| Rate for Payer: Priority Health SBD |
$86.53
|
|
|
FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$282.90
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$254.61 |
| Rate for Payer: Aetna Commercial |
$240.47
|
| Rate for Payer: Aetna Commercial |
$116.75
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna Medicare |
$141.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.28
|
| Rate for Payer: BCBS Complete |
$54.94
|
| Rate for Payer: BCBS Complete |
$113.16
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cash Price |
$109.88
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cash Price |
$109.88
|
| Rate for Payer: Cofinity Advantage |
$198.03
|
| Rate for Payer: Cofinity Advantage |
$96.14
|
| Rate for Payer: Cofinity Commercial |
$243.29
|
| Rate for Payer: Cofinity Commercial |
$118.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.32
|
| Rate for Payer: Healthscope Commercial |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$254.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.01
|
| Rate for Payer: PHP Commercial |
$240.47
|
| Rate for Payer: PHP Commercial |
$116.75
|
| Rate for Payer: Priority Health SBD |
$178.23
|
| Rate for Payer: Priority Health SBD |
$86.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$132.02
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$118.82 |
| Rate for Payer: Aetna Commercial |
$112.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.81
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cofinity Advantage |
$92.41
|
| Rate for Payer: Cofinity Commercial |
$113.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.62
|
| Rate for Payer: Healthscope Commercial |
$118.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.02
|
| Rate for Payer: PHP Commercial |
$112.22
|
| Rate for Payer: Priority Health SBD |
$83.17
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$132.02
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$118.82 |
| Rate for Payer: Aetna Commercial |
$112.22
|
| Rate for Payer: Aetna Medicare |
$66.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.81
|
| Rate for Payer: BCBS Complete |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cash Price |
$105.62
|
| Rate for Payer: Cofinity Advantage |
$92.41
|
| Rate for Payer: Cofinity Commercial |
$113.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.62
|
| Rate for Payer: Healthscope Commercial |
$118.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.02
|
| Rate for Payer: PHP Commercial |
$112.22
|
| Rate for Payer: Priority Health SBD |
$83.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,623.40
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$3,261.06 |
| Rate for Payer: Aetna Commercial |
$3,079.89
|
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Medicare |
$1,811.70
|
| Rate for Payer: Aetna Medicare |
$497.15
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: Aetna Medicare |
$1,647.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,141.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.21
|
| Rate for Payer: BCBS Complete |
$397.72
|
| Rate for Payer: BCBS Complete |
$1,449.36
|
| Rate for Payer: BCBS Complete |
$1,317.60
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cofinity Advantage |
$696.01
|
| Rate for Payer: Cofinity Advantage |
$2,305.80
|
| Rate for Payer: Cofinity Advantage |
$555.10
|
| Rate for Payer: Cofinity Advantage |
$2,536.38
|
| Rate for Payer: Cofinity Commercial |
$2,832.84
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$3,116.12
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,635.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,898.72
|
| Rate for Payer: Healthscope Commercial |
$713.70
|
| Rate for Payer: Healthscope Commercial |
$2,964.60
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Healthscope Commercial |
$3,261.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,898.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,635.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$795.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,799.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,079.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,717.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,470.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.73
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$3,079.89
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: PHP Commercial |
$2,799.90
|
| Rate for Payer: Priority Health SBD |
$2,075.22
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: Priority Health SBD |
$626.41
|
| Rate for Payer: Priority Health SBD |
$2,282.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$994.30
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.41 |
| Max. Negotiated Rate |
$894.87 |
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.29
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cofinity Advantage |
$555.10
|
| Rate for Payer: Cofinity Advantage |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Healthscope Commercial |
$713.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.73
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: Priority Health SBD |
$626.41
|
| Rate for Payer: Priority Health SBD |
$499.59
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Advantage |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$9.92
|
| Rate for Payer: UHC Exchange |
$7.48
|
|
