|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health SBD |
$34.05
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| 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: 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
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.13
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Exchange |
$21.24
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 23155002901
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Advantage |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.36
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.85
|
| Rate for Payer: UHC Core |
$59.99
|
| Rate for Payer: UHC Exchange |
$45.25
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 23155002901
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Advantage |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.36
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health SBD |
$72.54
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.44
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Advantage |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health SBD |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.44
|
| Rate for Payer: UHC Core |
$10.77
|
| Rate for Payer: UHC Exchange |
$8.13
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.30
|
| Rate for Payer: UHC Core |
$35.51
|
| Rate for Payer: UHC Exchange |
$26.78
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.44
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Advantage |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health SBD |
$13.03
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.97 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$108.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.53
|
| Rate for Payer: UHC Core |
$112.64
|
| Rate for Payer: UHC Exchange |
$84.97
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
IP
|
$962.19
|
|
|
Service Code
|
NDC 50268036915
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$606.18 |
| Max. Negotiated Rate |
$865.97 |
| Rate for Payer: Aetna Commercial |
$817.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.42
|
| Rate for Payer: Cash Price |
$769.75
|
| Rate for Payer: Cofinity Advantage |
$673.53
|
| Rate for Payer: Cofinity Commercial |
$827.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$769.75
|
| Rate for Payer: Healthscope Commercial |
$865.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$721.64
|
| Rate for Payer: PHP Commercial |
$817.86
|
| Rate for Payer: Priority Health SBD |
$606.18
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
IP
|
$19.25
|
|
|
Service Code
|
NDC 50268036911
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cofinity Advantage |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.44
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: Priority Health SBD |
$12.13
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
OP
|
$962.19
|
|
|
Service Code
|
NDC 50268036915
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.14 |
| Max. Negotiated Rate |
$865.97 |
| Rate for Payer: Aetna Commercial |
$817.86
|
| Rate for Payer: Aetna Medicare |
$481.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.42
|
| Rate for Payer: BCBS Complete |
$384.88
|
| Rate for Payer: Cash Price |
$769.75
|
| Rate for Payer: Cofinity Advantage |
$673.53
|
| Rate for Payer: Cofinity Commercial |
$827.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$769.75
|
| Rate for Payer: Healthscope Commercial |
$865.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$769.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$721.64
|
| Rate for Payer: PHP Commercial |
$817.86
|
| Rate for Payer: Priority Health SBD |
$606.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.42
|
| Rate for Payer: UHC Core |
$501.30
|
| Rate for Payer: UHC Exchange |
$378.14
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
OP
|
$19.25
|
|
|
Service Code
|
NDC 50268036911
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cofinity Advantage |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.44
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.51
|
| Rate for Payer: UHC Core |
$10.03
|
| Rate for Payer: UHC Exchange |
$7.57
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.51
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Exchange |
$1.32
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna Medicare |
$334.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: BCBS Complete |
$267.65
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Advantage |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.84
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health SBD |
$421.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.93
|
| Rate for Payer: UHC Core |
$348.61
|
| Rate for Payer: UHC Exchange |
$262.96
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.55 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Advantage |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.84
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health SBD |
$421.55
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.51
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.11
|
|
|
FLUPHENAZINE 2.5 MG TABLET
|
Facility
|
OP
|
$12.44
|
|
|
Service Code
|
NDC 50268036711
|
| Hospital Charge Code |
3220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.98
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: Cofinity Advantage |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$10.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$11.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.33
|
| Rate for Payer: PHP Commercial |
$10.57
|
| Rate for Payer: Priority Health SBD |
$7.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.09
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: UHC Exchange |
$4.89
|
|
|
FLUPHENAZINE 2.5 MG TABLET
|
Facility
|
OP
|
$621.97
|
|
|
Service Code
|
NDC 50268036715
|
| Hospital Charge Code |
3220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.43 |
| Max. Negotiated Rate |
$559.77 |
| Rate for Payer: Aetna Commercial |
$528.67
|
| Rate for Payer: Aetna Medicare |
$310.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.28
|
| Rate for Payer: BCBS Complete |
$248.79
|
| Rate for Payer: Cash Price |
$497.58
|
| Rate for Payer: Cofinity Advantage |
$435.38
|
| Rate for Payer: Cofinity Commercial |
$534.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.58
|
| Rate for Payer: Healthscope Commercial |
$559.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.48
|
| Rate for Payer: PHP Commercial |
$528.67
|
| Rate for Payer: Priority Health SBD |
$391.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.28
|
| Rate for Payer: UHC Core |
$324.05
|
| Rate for Payer: UHC Exchange |
$244.43
|
|
|
FLUPHENAZINE 2.5 MG TABLET
|
Facility
|
IP
|
$12.44
|
|
|
Service Code
|
NDC 50268036711
|
| Hospital Charge Code |
3220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.09
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: Cofinity Advantage |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$10.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.33
|
| Rate for Payer: PHP Commercial |
$10.57
|
| Rate for Payer: Priority Health SBD |
$7.84
|
|
|
FLUPHENAZINE 2.5 MG TABLET
|
Facility
|
IP
|
$621.97
|
|
|
Service Code
|
NDC 50268036715
|
| Hospital Charge Code |
3220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.84 |
| Max. Negotiated Rate |
$559.77 |
| Rate for Payer: Aetna Commercial |
$528.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.28
|
| Rate for Payer: Cash Price |
$497.58
|
| Rate for Payer: Cofinity Advantage |
$435.38
|
| Rate for Payer: Cofinity Commercial |
$534.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.58
|
| Rate for Payer: Healthscope Commercial |
$559.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.48
|
| Rate for Payer: PHP Commercial |
$528.67
|
| Rate for Payer: Priority Health SBD |
$391.84
|
|
