|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$394.01
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.23 |
| Max. Negotiated Rate |
$354.61 |
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Aetna Commercial |
$606.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.11
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cofinity Commercial |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$499.81
|
| Rate for Payer: Cofinity Commercial |
$614.05
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.21
|
| Rate for Payer: Healthscope Commercial |
$354.61
|
| Rate for Payer: Healthscope Commercial |
$642.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.91
|
| Rate for Payer: PHP Commercial |
$334.91
|
| Rate for Payer: PHP Commercial |
$606.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.11
|
| Rate for Payer: Priority Health SBD |
$449.83
|
| Rate for Payer: Priority Health SBD |
$248.23
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$714.01
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$642.61 |
| Rate for Payer: Aetna Commercial |
$606.91
|
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$378.95
|
| Rate for Payer: BCBS Trust/PPO |
$378.95
|
| Rate for Payer: BCN Commercial |
$378.95
|
| Rate for Payer: BCN Commercial |
$378.95
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cofinity Commercial |
$499.81
|
| Rate for Payer: Cofinity Commercial |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$614.05
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$642.61
|
| Rate for Payer: Healthscope Commercial |
$354.61
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.91
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$606.91
|
| Rate for Payer: PHP Commercial |
$334.91
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health SBD |
$449.83
|
| Rate for Payer: Priority Health SBD |
$248.23
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$94.75
|
| Rate for Payer: UHCCP Medicaid |
$94.75
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: VA VA |
$168.30
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.72 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna Medicare |
$188.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.92
|
| Rate for Payer: BCBS Complete |
$150.72
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health SBD |
$237.38
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health SBD |
$2.38
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna Medicare |
$131.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: BCBS Complete |
$105.22
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.92
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health SBD |
$237.38
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.72 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health SBD |
$2.38
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.67
|
|
|
Service Code
|
NDC 36000014910
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$31.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.84
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.17
|
| Rate for Payer: PHP Commercial |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.84
|
| Rate for Payer: Priority Health SBD |
$23.10
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
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 Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| 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: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.27 |
| 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 Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| 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: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.67
|
|
|
Service Code
|
NDC 36000014901
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$31.17
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.84
|
| Rate for Payer: BCBS Complete |
$14.67
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.17
|
| Rate for Payer: PHP Commercial |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.84
|
| Rate for Payer: Priority Health SBD |
$23.10
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.67
|
|
|
Service Code
|
NDC 36000014910
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$31.17
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.84
|
| Rate for Payer: BCBS Complete |
$14.67
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.17
|
| Rate for Payer: PHP Commercial |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.84
|
| Rate for Payer: Priority Health SBD |
$23.10
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.67
|
|
|
Service Code
|
NDC 36000014901
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$31.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.84
|
| Rate for Payer: Cash Price |
$29.34
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.17
|
| Rate for Payer: PHP Commercial |
$31.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.84
|
| Rate for Payer: Priority Health SBD |
$23.10
|
|
|
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 Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| 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: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
|
|
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 |
$12.27 |
| 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 Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| 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: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$39.96
|
|
|
Service Code
|
NDC 51672138601
|
| Hospital Charge Code |
3187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$34.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: PHP Commercial |
$33.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$39.96
|
|
|
Service Code
|
NDC 51672138601
|
| Hospital Charge Code |
3187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$34.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: PHP Commercial |
$33.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
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 |
$228.42 |
| Max. Negotiated Rate |
$513.94 |
| 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 Commercial |
$399.74
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$399.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health SBD |
$359.76
|
|
