|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$361.44
|
|
|
Service Code
|
NDC 68084-288-01
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$325.30 |
| Rate for Payer: Aetna Commercial |
$307.22
|
| Rate for Payer: BCBS Trust/PPO |
$279.32
|
| Rate for Payer: BCN Commercial |
$279.32
|
| Rate for Payer: Cash Price |
$289.15
|
| Rate for Payer: Cofinity Commercial |
$310.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.15
|
| Rate for Payer: Healthscope Commercial |
$325.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.22
|
| Rate for Payer: PHP Commercial |
$307.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.07
|
| Rate for Payer: UHC Core |
$301.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.08
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$120.24
|
|
|
Service Code
|
NDC 50268-330-15
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$108.22 |
| Rate for Payer: Aetna Commercial |
$102.20
|
| Rate for Payer: BCBS Trust/PPO |
$92.92
|
| Rate for Payer: BCN Commercial |
$92.92
|
| Rate for Payer: Cash Price |
$96.19
|
| Rate for Payer: Cofinity Commercial |
$103.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.19
|
| Rate for Payer: Healthscope Commercial |
$108.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.20
|
| Rate for Payer: PHP Commercial |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.81
|
| Rate for Payer: UHC Core |
$100.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.18
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 68084-288-11
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.19
|
| Rate for Payer: UHC Core |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9784-10
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9684-01
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9684-10
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9784-01
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9684-10
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 0143-9684-01
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUOCINONIDE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$35.76
|
|
|
Service Code
|
NDC 51672-1386-1
|
| Hospital Charge Code |
3187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna Commercial |
$30.40
|
| Rate for Payer: BCBS Trust/PPO |
$27.64
|
| Rate for Payer: BCN Commercial |
$27.64
|
| Rate for Payer: Cash Price |
$28.61
|
| Rate for Payer: Cofinity Commercial |
$30.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.61
|
| Rate for Payer: Healthscope Commercial |
$32.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.40
|
| Rate for Payer: PHP Commercial |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.47
|
| Rate for Payer: UHC Core |
$29.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.82
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
IP
|
$571.05
|
|
|
Service Code
|
NDC 17478-403-03
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$348.28 |
| Max. Negotiated Rate |
$513.94 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: BCBS Trust/PPO |
$441.31
|
| Rate for Payer: BCN Commercial |
$441.31
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$491.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$513.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$485.39
|
| Rate for Payer: PHP Commercial |
$485.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.52
|
| Rate for Payer: UHC Core |
$476.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.29
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 17478-404-01
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 17238-900-99
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 17238-900-11
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.49 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$354.14
|
| Rate for Payer: BCN Commercial |
$354.14
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 0904-5784-61
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.71
|
| Rate for Payer: BCN Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.18
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$308.16
|
|
|
Service Code
|
NDC 54838-523-40
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: BCBS Trust/PPO |
$238.15
|
| Rate for Payer: BCN Commercial |
$238.15
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.94
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.18
|
| Rate for Payer: UHC Core |
$257.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 0904-5785-61
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.58
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.20
|
| Rate for Payer: UHC Core |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$669.12
|
|
|
Service Code
|
NDC 0527-1788-01
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.10 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: BCBS Trust/PPO |
$517.10
|
| Rate for Payer: BCN Commercial |
$517.10
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.75
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.83
|
| Rate for Payer: UHC Core |
$558.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$318.48
|
|
|
Service Code
|
NDC 50268-366-15
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.24 |
| Max. Negotiated Rate |
$286.63 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: BCBS Trust/PPO |
$246.12
|
| Rate for Payer: BCN Commercial |
$246.12
|
| Rate for Payer: Cash Price |
$254.78
|
| Rate for Payer: Cofinity Commercial |
$273.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.78
|
| Rate for Payer: Healthscope Commercial |
$286.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.71
|
| Rate for Payer: PHP Commercial |
$270.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.26
|
| Rate for Payer: UHC Core |
$265.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.86
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 51079-485-01
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.59
|
| Rate for Payer: BCN Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.85
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 50268-366-11
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.92
|
| Rate for Payer: BCN Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.41
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$334.40
|
|
|
Service Code
|
NDC 51079-485-20
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.95 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: BCBS Trust/PPO |
$258.42
|
| Rate for Payer: BCN Commercial |
$258.42
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.24
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.27
|
| Rate for Payer: UHC Core |
$279.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 0527-1790-01
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$658.94 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: BCBS Trust/PPO |
$834.93
|
| Rate for Payer: BCN Commercial |
$834.93
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.34
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$939.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$658.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.75
|
| Rate for Payer: UHC Core |
$902.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,209.53
|
|
|
Service Code
|
NDC 0904-7159-61
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$737.69 |
| Max. Negotiated Rate |
$1,088.58 |
| Rate for Payer: Aetna Commercial |
$1,028.10
|
| Rate for Payer: BCBS Trust/PPO |
$934.72
|
| Rate for Payer: BCN Commercial |
$934.72
|
| Rate for Payer: Cash Price |
$967.62
|
| Rate for Payer: Cofinity Commercial |
$1,040.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.62
|
| Rate for Payer: Healthscope Commercial |
$1,088.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$907.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.10
|
| Rate for Payer: PHP Commercial |
$1,028.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.39
|
| Rate for Payer: UHC Core |
$1,009.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$907.15
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$325.01
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.22 |
| Max. Negotiated Rate |
$292.51 |
| Rate for Payer: Aetna Commercial |
$276.26
|
| Rate for Payer: BCBS Trust/PPO |
$251.17
|
| Rate for Payer: BCN Commercial |
$251.17
|
| Rate for Payer: Cash Price |
$260.01
|
| Rate for Payer: Cofinity Commercial |
$279.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.01
|
| Rate for Payer: Healthscope Commercial |
$292.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.26
|
| Rate for Payer: PHP Commercial |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.01
|
| Rate for Payer: UHC Core |
$271.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.76
|
|
