|
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 |
$219.28 |
| 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 Commercial |
$383.75
|
| Rate for Payer: Cofinity Commercial |
$471.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$383.75
|
| 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: PHP Commercial |
$465.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.34
|
| 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 |
$225.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Cofinity Commercial |
$201.78
|
| Rate for Payer: Cofinity Commercial |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.60
|
| Rate for Payer: Healthscope Commercial |
$259.43
|
| Rate for Payer: Healthscope Commercial |
$239.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: PHP Commercial |
$245.01
|
| Rate for Payer: PHP Commercial |
$225.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.36
|
| Rate for Payer: Priority Health SBD |
$167.38
|
| Rate for Payer: Priority Health SBD |
$181.60
|
|
|
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 |
$49.95 |
| Max. Negotiated Rate |
$112.39 |
| Rate for Payer: Aetna Commercial |
$106.15
|
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: Aetna Medicare |
$144.12
|
| Rate for Payer: Aetna Medicare |
$62.44
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.69
|
| Rate for Payer: BCBS Complete |
$106.27
|
| Rate for Payer: BCBS Complete |
$49.95
|
| Rate for Payer: BCBS Complete |
$115.30
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Cofinity Commercial |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$201.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.54
|
| 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 |
$239.11
|
| Rate for Payer: Healthscope Commercial |
$112.39
|
| Rate for Payer: Healthscope Commercial |
$259.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.15
|
| Rate for Payer: PHP Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$106.15
|
| Rate for Payer: PHP Commercial |
$245.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.69
|
| Rate for Payer: Priority Health SBD |
$181.60
|
| Rate for Payer: Priority Health SBD |
$167.38
|
| Rate for Payer: Priority Health SBD |
$78.67
|
|
|
FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$269.58
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.84 |
| Max. Negotiated Rate |
$242.62 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Commercial |
$240.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.88
|
| Rate for Payer: Cash Price |
$215.66
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Cofinity Commercial |
$198.03
|
| Rate for Payer: Cofinity Commercial |
$243.29
|
| Rate for Payer: Cofinity Commercial |
$231.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.32
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Commercial |
$254.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.47
|
| Rate for Payer: PHP Commercial |
$229.14
|
| Rate for Payer: PHP Commercial |
$240.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.23
|
| Rate for Payer: Priority Health SBD |
$178.23
|
| Rate for Payer: Priority Health SBD |
$169.84
|
|
|
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 |
$113.16 |
| Max. Negotiated Rate |
$254.61 |
| Rate for Payer: Aetna Commercial |
$240.47
|
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare |
$134.79
|
| 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) |
$175.23
|
| Rate for Payer: BCBS Complete |
$113.16
|
| Rate for Payer: BCBS Complete |
$107.83
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cash Price |
$215.66
|
| Rate for Payer: Cofinity Commercial |
$243.29
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Cofinity Commercial |
$231.84
|
| Rate for Payer: Cofinity Commercial |
$198.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.32
|
| Rate for Payer: Healthscope Commercial |
$254.61
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.14
|
| Rate for Payer: PHP Commercial |
$240.47
|
| Rate for Payer: PHP Commercial |
$229.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.88
|
| Rate for Payer: Priority Health SBD |
$169.84
|
| Rate for Payer: Priority Health SBD |
$178.23
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.18
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$117.16 |
| Rate for Payer: Aetna Commercial |
$110.65
|
| Rate for Payer: Aetna Medicare |
$65.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.62
|
| Rate for Payer: BCBS Complete |
$52.07
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cofinity Commercial |
$111.95
|
| Rate for Payer: Cofinity Commercial |
$91.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.14
|
| Rate for Payer: Healthscope Commercial |
$117.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.65
|
| Rate for Payer: PHP Commercial |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.62
|
| Rate for Payer: Priority Health SBD |
$82.01
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.18
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$117.16 |
| Rate for Payer: Aetna Commercial |
$110.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.62
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cofinity Commercial |
$111.95
|
| Rate for Payer: Cofinity Commercial |
$91.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.14
|
| Rate for Payer: Healthscope Commercial |
$117.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.65
|
| Rate for Payer: PHP Commercial |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.62
|
| Rate for Payer: Priority Health SBD |
$82.01
|
|
|
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 Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| 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: PHP Commercial |
$845.15
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.29
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: Priority Health SBD |
$626.41
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$793.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Commercial |
$3,079.89
|
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Medicare |
$497.15
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: Aetna Medicare |
$1,811.70
|
| Rate for Payer: Aetna Medicare |
$1,647.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,141.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.29
|
| Rate for Payer: BCBS Complete |
$1,317.60
|
| Rate for Payer: BCBS Complete |
$397.72
|
| Rate for Payer: BCBS Complete |
$1,449.36
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cofinity Commercial |
$3,116.12
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Commercial |
$2,305.80
|
| Rate for Payer: Cofinity Commercial |
$2,832.84
|
| Rate for Payer: Cofinity Commercial |
$2,536.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,305.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,536.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| 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 |
$2,898.72
|
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$3,079.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,799.90
|
| Rate for Payer: PHP Commercial |
$3,079.89
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$2,799.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,355.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.29
|
| Rate for Payer: Priority Health SBD |
$2,075.22
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: Priority Health SBD |
$2,282.74
|
| Rate for Payer: Priority Health SBD |
$626.41
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| 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 Commercial |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.33
|
| 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: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
|
|
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 Commercial |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.33
|
| 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: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084060511
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.80
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.66
|
| Rate for Payer: Priority Health SBD |
$35.53
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 23155002901
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.06 |
| 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 Commercial |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.61
|
| 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: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| 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 |
$8.27 |
| 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 Commercial |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.48
|
| 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: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: Priority Health SBD |
$13.03
|
|
|
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 Commercial |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.61
|
| 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: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.66
|
| Rate for Payer: Priority Health SBD |
$35.53
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084060511
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.80
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 68084060501
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084060501
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
|
|
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 Commercial |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.48
|
| 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: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: Priority Health SBD |
$13.03
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
IP
|
$19.36
|
|
|
Service Code
|
NDC 50268036911
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Aetna Commercial |
$16.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.58
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cofinity Commercial |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$16.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.46
|
| Rate for Payer: PHP Commercial |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.58
|
| Rate for Payer: Priority Health SBD |
$12.20
|
|
|
FLUPHENAZINE 10 MG TABLET
|
Facility
|
OP
|
$19.36
|
|
|
Service Code
|
NDC 50268036911
|
| Hospital Charge Code |
3219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$17.42 |
| Rate for Payer: Aetna Commercial |
$16.46
|
| Rate for Payer: Aetna Medicare |
$9.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.58
|
| Rate for Payer: BCBS Complete |
$7.74
|
| Rate for Payer: Cash Price |
$15.49
|
| Rate for Payer: Cofinity Commercial |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$16.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.46
|
| Rate for Payer: PHP Commercial |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.58
|
| Rate for Payer: Priority Health SBD |
$12.20
|
|
