|
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 |
$513.94 |
| 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 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
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$412.42 |
| 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 Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 17478040401
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| 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 Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| 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: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
|
|
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 Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.63
|
| 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: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health SBD |
$1.47
|
|
|
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 |
$412.42 |
| 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 Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.57
|
|
|
Service Code
|
NDC 00065009265
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.72
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.72
|
| Rate for Payer: Priority Health SBD |
$125.73
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.71
|
|
|
Service Code
|
NDC 81298866001
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.08 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Medicare |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: BCBS Complete |
$95.08
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.51
|
| Rate for Payer: Priority Health SBD |
$149.76
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.71
|
|
|
Service Code
|
NDC 81298866001
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.51
|
| Rate for Payer: Priority Health SBD |
$149.76
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.57
|
|
|
Service Code
|
NDC 00065009265
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: Aetna Medicare |
$99.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.72
|
| Rate for Payer: BCBS Complete |
$79.83
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.72
|
| Rate for Payer: Priority Health SBD |
$125.73
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.71
|
|
|
Service Code
|
NDC 81298866003
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.51
|
| Rate for Payer: Priority Health SBD |
$149.76
|
|
|
FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.71
|
|
|
Service Code
|
NDC 81298866003
|
| Hospital Charge Code |
10059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.08 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Medicare |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: BCBS Complete |
$95.08
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.51
|
| Rate for Payer: Priority Health SBD |
$149.76
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$158.76
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$158.76
|
|
|
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 |
$274.10
|
| 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
|
|
|
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 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
|
|
|
FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$169.10
|
|
|
Service Code
|
CPT 77002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: BCBS Trust/PPO |
$169.10
|
| Rate for Payer: BCN Commercial |
$169.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.30
|
|
|
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 |
$259.42 |
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.69
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Cofinity Commercial |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$201.78
|
| 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 |
$259.42
|
| Rate for Payer: Healthscope Commercial |
$239.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$245.01
|
| 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 |
$181.60
|
| Rate for Payer: Priority Health SBD |
$167.38
|
|
|
FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$288.25
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$259.42 |
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Commercial |
$106.15
|
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: Aetna Medicare |
$62.44
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Aetna Medicare |
$144.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.36
|
| Rate for Payer: BCBS Complete |
$106.27
|
| Rate for Payer: BCBS Complete |
$49.95
|
| Rate for Payer: BCBS Complete |
$115.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$230.60
|
| Rate for Payer: Cofinity Commercial |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$201.78
|
| Rate for Payer: Cofinity Commercial |
$247.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.90
|
| 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 |
$239.11
|
| Rate for Payer: Healthscope Commercial |
$112.39
|
| Rate for Payer: Healthscope Commercial |
$259.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.01
|
| Rate for Payer: PHP Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$245.01
|
| Rate for Payer: PHP Commercial |
$106.15
|
| 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 Cigna Priority Health |
$81.17
|
| Rate for Payer: Priority Health SBD |
$78.67
|
| Rate for Payer: Priority Health SBD |
$181.60
|
| Rate for Payer: Priority Health SBD |
$167.38
|
|
|
FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$269.58
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$242.62 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Commercial |
$240.46
|
| Rate for Payer: Aetna Medicare |
$141.45
|
| Rate for Payer: Aetna Medicare |
$134.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.88
|
| Rate for Payer: BCBS Complete |
$113.16
|
| Rate for Payer: BCBS Complete |
$107.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cash Price |
$215.66
|
| Rate for Payer: Cash Price |
$215.66
|
| Rate for Payer: Cash Price |
$226.32
|
| Rate for Payer: Cofinity Commercial |
$231.84
|
| 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 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 |
$240.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.14
|
| Rate for Payer: PHP Commercial |
$240.46
|
| Rate for Payer: PHP Commercial |
$229.14
|
| 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
|
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 |
$240.46
|
| 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 |
$240.46
|
| Rate for Payer: PHP Commercial |
$229.14
|
| Rate for Payer: PHP Commercial |
$240.46
|
| 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 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 |
$6.63 |
| 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: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: Cash Price |
$104.14
|
| 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
|
OP
|
$994.30
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$894.87 |
| Rate for Payer: Aetna Commercial |
$845.16
|
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Commercial |
$3,079.89
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: Aetna Medicare |
$1,647.00
|
| Rate for Payer: Aetna Medicare |
$497.15
|
| Rate for Payer: Aetna Medicare |
$1,811.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.30
|
| 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: BCBS Complete |
$317.20
|
| 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 Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.63
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$634.40
|
| 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 |
$795.44
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cofinity Commercial |
$2,536.38
|
| Rate for Payer: Cofinity Commercial |
$2,305.80
|
| Rate for Payer: Cofinity Commercial |
$2,832.84
|
| Rate for Payer: Cofinity Commercial |
$3,116.12
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,305.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,536.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,635.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| 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 |
$3,261.06
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Healthscope Commercial |
$713.70
|
| Rate for Payer: Healthscope Commercial |
$2,964.60
|
| 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: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.16
|
| Rate for Payer: PHP Commercial |
$845.16
|
| Rate for Payer: PHP Commercial |
$3,079.89
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$2,799.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,355.21
|
| Rate for Payer: Priority Health SBD |
$626.41
|
| Rate for Payer: Priority Health SBD |
$2,282.74
|
| Rate for Payer: Priority Health SBD |
$2,075.22
|
| Rate for Payer: Priority Health SBD |
$499.59
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$793.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$499.59 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Commercial |
$845.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| 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 |
$713.70
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$845.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: Priority Health SBD |
$626.41
|
|
|
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
|
|
