|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$3,686.68
|
|
|
Service Code
|
NDC 68084084601
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,474.67 |
| Max. Negotiated Rate |
$3,318.01 |
| Rate for Payer: Aetna Commercial |
$3,133.68
|
| Rate for Payer: Aetna Medicare |
$1,843.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,396.34
|
| Rate for Payer: BCBS Complete |
$1,474.67
|
| Rate for Payer: Cash Price |
$2,949.34
|
| Rate for Payer: Cofinity Commercial |
$2,580.68
|
| Rate for Payer: Cofinity Commercial |
$3,170.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,580.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,949.34
|
| Rate for Payer: Healthscope Commercial |
$3,318.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,133.68
|
| Rate for Payer: PHP Commercial |
$3,133.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,396.34
|
| Rate for Payer: Priority Health SBD |
$2,322.61
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,253.56
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$789.74 |
| Max. Negotiated Rate |
$1,128.20 |
| Rate for Payer: Aetna Commercial |
$1,065.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.81
|
| Rate for Payer: Cash Price |
$1,002.85
|
| Rate for Payer: Cofinity Commercial |
$1,078.06
|
| Rate for Payer: Cofinity Commercial |
$877.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$877.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.85
|
| Rate for Payer: Healthscope Commercial |
$1,128.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.53
|
| Rate for Payer: PHP Commercial |
$1,065.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.81
|
| Rate for Payer: Priority Health SBD |
$789.74
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$36.87
|
|
|
Service Code
|
NDC 68084084611
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$18.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.97
|
| Rate for Payer: Priority Health SBD |
$23.23
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$432.16 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna Medicare |
$540.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: BCBS Complete |
$432.16
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$756.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health SBD |
$680.65
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,253.56
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$1,128.20 |
| Rate for Payer: Aetna Commercial |
$1,065.53
|
| Rate for Payer: Aetna Medicare |
$626.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.81
|
| Rate for Payer: BCBS Complete |
$501.42
|
| Rate for Payer: Cash Price |
$1,002.85
|
| Rate for Payer: Cofinity Commercial |
$1,078.06
|
| Rate for Payer: Cofinity Commercial |
$877.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$877.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.85
|
| Rate for Payer: Healthscope Commercial |
$1,128.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.53
|
| Rate for Payer: PHP Commercial |
$1,065.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.81
|
| Rate for Payer: Priority Health SBD |
$789.74
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$36.87
|
|
|
Service Code
|
NDC 68084084611
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.97
|
| Rate for Payer: Priority Health SBD |
$23.23
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$3,686.68
|
|
|
Service Code
|
NDC 68084084601
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,322.61 |
| Max. Negotiated Rate |
$3,318.01 |
| Rate for Payer: Aetna Commercial |
$3,133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,396.34
|
| Rate for Payer: Cash Price |
$2,949.34
|
| Rate for Payer: Cofinity Commercial |
$2,580.68
|
| Rate for Payer: Cofinity Commercial |
$3,170.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,580.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,949.34
|
| Rate for Payer: Healthscope Commercial |
$3,318.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,133.68
|
| Rate for Payer: PHP Commercial |
$3,133.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,396.34
|
| Rate for Payer: Priority Health SBD |
$2,322.61
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$680.65 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$756.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health SBD |
$680.65
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$199.98
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$179.98 |
| Rate for Payer: Aetna Commercial |
$169.98
|
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.19
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$139.99
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Cofinity Commercial |
$171.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$179.98
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: PHP Commercial |
$169.98
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.99
|
| Rate for Payer: Priority Health SBD |
$209.54
|
| Rate for Payer: Priority Health SBD |
$125.99
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$199.98
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$179.98 |
| Rate for Payer: Aetna Commercial |
$169.98
|
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna Medicare |
$166.30
|
| Rate for Payer: Aetna Medicare |
$99.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.19
|
| Rate for Payer: BCBS Complete |
$133.04
|
| Rate for Payer: BCBS Complete |
$79.99
|
| Rate for Payer: BCBS Trust/PPO |
$28.83
|
| Rate for Payer: BCBS Trust/PPO |
$28.83
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$171.98
|
| Rate for Payer: Cofinity Commercial |
$139.99
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Healthscope Commercial |
$179.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.98
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: PHP Commercial |
$169.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.99
|
| Rate for Payer: Priority Health SBD |
$209.54
|
| Rate for Payer: Priority Health SBD |
$125.99
|
|
|
FLURBIPROFEN 0.03 % EYE DROPS
|
Facility
|
OP
|
$117.15
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
10080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$105.44 |
| Rate for Payer: Aetna Commercial |
$99.58
|
| Rate for Payer: Aetna Medicare |
$58.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.15
|
| Rate for Payer: BCBS Complete |
$46.86
|
| Rate for Payer: Cash Price |
$93.72
|
| Rate for Payer: Cofinity Commercial |
$100.75
|
| Rate for Payer: Cofinity Commercial |
$82.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.72
|
| Rate for Payer: Healthscope Commercial |
$105.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.58
|
| Rate for Payer: PHP Commercial |
$99.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.15
|
| Rate for Payer: Priority Health SBD |
$73.80
|
|
|
FLURBIPROFEN 0.03 % EYE DROPS
|
Facility
|
IP
|
$117.15
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
10080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$105.44 |
| Rate for Payer: Aetna Commercial |
$99.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.15
|
| Rate for Payer: Cash Price |
$93.72
|
| Rate for Payer: Cofinity Commercial |
$100.75
|
| Rate for Payer: Cofinity Commercial |
$82.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.72
|
| Rate for Payer: Healthscope Commercial |
$105.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.58
|
| Rate for Payer: PHP Commercial |
$99.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.15
|
| Rate for Payer: Priority Health SBD |
$73.80
|
|
|
FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$794.31
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
300060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.72 |
| Max. Negotiated Rate |
$714.88 |
| Rate for Payer: Aetna Commercial |
$675.16
|
| Rate for Payer: Aetna Medicare |
$397.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.30
|
| Rate for Payer: BCBS Complete |
$317.72
|
| Rate for Payer: Cash Price |
$635.45
|
| Rate for Payer: Cofinity Commercial |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$683.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.45
|
| Rate for Payer: Healthscope Commercial |
$714.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.16
|
| Rate for Payer: PHP Commercial |
$675.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.30
|
| Rate for Payer: Priority Health SBD |
$500.42
|
|
|
FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$794.31
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
300060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$500.42 |
| Max. Negotiated Rate |
$714.88 |
| Rate for Payer: Aetna Commercial |
$675.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.30
|
| Rate for Payer: Cash Price |
$635.45
|
| Rate for Payer: Cofinity Commercial |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$683.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.45
|
| Rate for Payer: Healthscope Commercial |
$714.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.16
|
| Rate for Payer: PHP Commercial |
$675.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.30
|
| Rate for Payer: Priority Health SBD |
$500.42
|
|
|
FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$1,045.44
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
300060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.18 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$888.62
|
| Rate for Payer: Aetna Medicare |
$522.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.54
|
| Rate for Payer: BCBS Complete |
$418.18
|
| Rate for Payer: Cash Price |
$836.35
|
| Rate for Payer: Cofinity Commercial |
$731.81
|
| Rate for Payer: Cofinity Commercial |
$899.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.35
|
| Rate for Payer: Healthscope Commercial |
$940.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.62
|
| Rate for Payer: PHP Commercial |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.54
|
| Rate for Payer: Priority Health SBD |
$658.63
|
|
|
FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$1,045.44
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
300060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$658.63 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$888.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.54
|
| Rate for Payer: Cash Price |
$836.35
|
| Rate for Payer: Cofinity Commercial |
$731.81
|
| Rate for Payer: Cofinity Commercial |
$899.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.35
|
| Rate for Payer: Healthscope Commercial |
$940.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.62
|
| Rate for Payer: PHP Commercial |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.54
|
| Rate for Payer: Priority Health SBD |
$658.63
|
|
|
FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$951.50
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
300061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.60 |
| Max. Negotiated Rate |
$856.35 |
| Rate for Payer: Aetna Commercial |
$808.78
|
| Rate for Payer: Aetna Medicare |
$475.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.48
|
| Rate for Payer: BCBS Complete |
$380.60
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cofinity Commercial |
$666.05
|
| Rate for Payer: Cofinity Commercial |
$818.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.20
|
| Rate for Payer: Healthscope Commercial |
$856.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.78
|
| Rate for Payer: PHP Commercial |
$808.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.48
|
| Rate for Payer: Priority Health SBD |
$599.44
|
|
|
FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$951.50
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
300061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.44 |
| Max. Negotiated Rate |
$856.35 |
| Rate for Payer: Aetna Commercial |
$808.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.48
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cofinity Commercial |
$666.05
|
| Rate for Payer: Cofinity Commercial |
$818.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.20
|
| Rate for Payer: Healthscope Commercial |
$856.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.78
|
| Rate for Payer: PHP Commercial |
$808.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.48
|
| Rate for Payer: Priority Health SBD |
$599.44
|
|
|
FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$1,243.20
|
|
|
Service Code
|
NDC 00173072020
|
| Hospital Charge Code |
300061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$783.22 |
| Max. Negotiated Rate |
$1,118.88 |
| Rate for Payer: Aetna Commercial |
$1,056.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.08
|
| Rate for Payer: Cash Price |
$994.56
|
| Rate for Payer: Cofinity Commercial |
$1,069.15
|
| Rate for Payer: Cofinity Commercial |
$870.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$870.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.56
|
| Rate for Payer: Healthscope Commercial |
$1,118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,056.72
|
| Rate for Payer: PHP Commercial |
$1,056.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.08
|
| Rate for Payer: Priority Health SBD |
$783.22
|
|
|
FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$1,243.20
|
|
|
Service Code
|
NDC 00173072020
|
| Hospital Charge Code |
300061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.28 |
| Max. Negotiated Rate |
$1,118.88 |
| Rate for Payer: Aetna Commercial |
$1,056.72
|
| Rate for Payer: Aetna Medicare |
$621.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.08
|
| Rate for Payer: BCBS Complete |
$497.28
|
| Rate for Payer: Cash Price |
$994.56
|
| Rate for Payer: Cofinity Commercial |
$1,069.15
|
| Rate for Payer: Cofinity Commercial |
$870.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$870.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.56
|
| Rate for Payer: Healthscope Commercial |
$1,118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,056.72
|
| Rate for Payer: PHP Commercial |
$1,056.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.08
|
| Rate for Payer: Priority Health SBD |
$783.22
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$1,045.44
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$658.63 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$888.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.54
|
| Rate for Payer: Cash Price |
$836.35
|
| Rate for Payer: Cofinity Commercial |
$731.81
|
| Rate for Payer: Cofinity Commercial |
$899.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.35
|
| Rate for Payer: Healthscope Commercial |
$940.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.62
|
| Rate for Payer: PHP Commercial |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.54
|
| Rate for Payer: Priority Health SBD |
$658.63
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$794.31
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.72 |
| Max. Negotiated Rate |
$714.88 |
| Rate for Payer: Aetna Commercial |
$675.16
|
| Rate for Payer: Aetna Medicare |
$397.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.30
|
| Rate for Payer: BCBS Complete |
$317.72
|
| Rate for Payer: Cash Price |
$635.45
|
| Rate for Payer: Cofinity Commercial |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$683.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.45
|
| Rate for Payer: Healthscope Commercial |
$714.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.16
|
| Rate for Payer: PHP Commercial |
$675.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.30
|
| Rate for Payer: Priority Health SBD |
$500.42
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$1,045.44
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.18 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$888.62
|
| Rate for Payer: Aetna Medicare |
$522.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.54
|
| Rate for Payer: BCBS Complete |
$418.18
|
| Rate for Payer: Cash Price |
$836.35
|
| Rate for Payer: Cofinity Commercial |
$731.81
|
| Rate for Payer: Cofinity Commercial |
$899.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.35
|
| Rate for Payer: Healthscope Commercial |
$940.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.62
|
| Rate for Payer: PHP Commercial |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.54
|
| Rate for Payer: Priority Health SBD |
$658.63
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$794.31
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$500.42 |
| Max. Negotiated Rate |
$714.88 |
| Rate for Payer: Aetna Commercial |
$675.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.30
|
| Rate for Payer: Cash Price |
$635.45
|
| Rate for Payer: Cofinity Commercial |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$683.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.45
|
| Rate for Payer: Healthscope Commercial |
$714.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.16
|
| Rate for Payer: PHP Commercial |
$675.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.30
|
| Rate for Payer: Priority Health SBD |
$500.42
|
|
|
FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$951.50
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
40699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.44 |
| Max. Negotiated Rate |
$856.35 |
| Rate for Payer: Aetna Commercial |
$808.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.48
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cofinity Commercial |
$666.05
|
| Rate for Payer: Cofinity Commercial |
$818.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.20
|
| Rate for Payer: Healthscope Commercial |
$856.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.78
|
| Rate for Payer: PHP Commercial |
$808.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.48
|
| Rate for Payer: Priority Health SBD |
$599.44
|
|
