|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$707.48
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$636.73
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: ASR ASR |
$686.26
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$583.32
|
| Rate for Payer: BCN Commercial |
$583.32
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cofinity Commercial |
$665.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$686.26
|
| Rate for Payer: Healthscope Whirlpool |
$707.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.35
|
| Rate for Payer: Mclaren Commercial |
$636.73
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.36
|
| Rate for Payer: Nomi Health Commercial |
$580.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.61
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow Network |
$0.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHCCP DNSP |
$0.35
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: VA VA |
$0.35
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$1,020.35
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$765.26 |
| Max. Negotiated Rate |
$1,020.35 |
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Commercial |
$918.33
|
| Rate for Payer: ASR ASR |
$989.74
|
| Rate for Payer: ASR ASR |
$989.75
|
| Rate for Payer: BCBS Trust/PPO |
$837.91
|
| Rate for Payer: BCBS Trust/PPO |
$837.92
|
| Rate for Payer: BCN Commercial |
$837.91
|
| Rate for Payer: BCN Commercial |
$837.92
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cofinity Commercial |
$959.14
|
| Rate for Payer: Cofinity Commercial |
$959.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.29
|
| Rate for Payer: Healthscope Commercial |
$989.74
|
| Rate for Payer: Healthscope Commercial |
$989.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.35
|
| Rate for Payer: Mclaren Commercial |
$918.33
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.30
|
| Rate for Payer: Nomi Health Commercial |
$836.70
|
| Rate for Payer: Nomi Health Commercial |
$836.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$765.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$765.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.91
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,020.35
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1,020.35 |
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Commercial |
$918.33
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: ASR ASR |
$989.74
|
| Rate for Payer: ASR ASR |
$989.75
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$841.29
|
| Rate for Payer: BCBS Trust/PPO |
$841.28
|
| Rate for Payer: BCN Commercial |
$841.29
|
| Rate for Payer: BCN Commercial |
$841.28
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cofinity Commercial |
$959.13
|
| Rate for Payer: Cofinity Commercial |
$959.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$989.74
|
| Rate for Payer: Healthscope Commercial |
$989.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.35
|
| Rate for Payer: Mclaren Commercial |
$918.33
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.19
|
| Rate for Payer: Meridian Medicaid |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.31
|
| Rate for Payer: Nomi Health Commercial |
$836.70
|
| Rate for Payer: Nomi Health Commercial |
$836.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$765.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$765.27
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicaid |
$0.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow Network |
$0.24
|
| Rate for Payer: Priority Health Narrow Network |
$0.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHCCP DNSP |
$0.35
|
| Rate for Payer: UHCCP DNSP |
$0.35
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: VA VA |
$0.35
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
NDC 57237006230
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$100.81 |
| Rate for Payer: Aetna Commercial |
$90.73
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: ASR ASR |
$97.79
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$83.12
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.65
|
| Rate for Payer: Healthscope Commercial |
$97.79
|
| Rate for Payer: Healthscope Whirlpool |
$100.81
|
| Rate for Payer: Mclaren Commercial |
$90.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.69
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.33
|
| Rate for Payer: Priority Health Narrow Network |
$70.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.34 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: BCBS Trust/PPO |
$164.61
|
| Rate for Payer: BCN Commercial |
$164.61
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$194.44
|
| Rate for Payer: Healthscope Whirlpool |
$200.45
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Medicare |
$74.17
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS Trust/PPO |
$165.27
|
| Rate for Payer: BCN Commercial |
$165.27
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$194.44
|
| Rate for Payer: Healthscope Whirlpool |
$200.45
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.63
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$283.20
|
|
|
Service Code
|
NDC 60687042801
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$254.88
|
| Rate for Payer: ASR ASR |
$274.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.56
|
| Rate for Payer: BCN Commercial |
$232.56
|
| Rate for Payer: Cash Price |
$226.56
|
| Rate for Payer: Cofinity Commercial |
$266.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.56
|
| Rate for Payer: Healthscope Commercial |
$274.70
|
| Rate for Payer: Healthscope Whirlpool |
$283.20
|
| Rate for Payer: Mclaren Commercial |
$254.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.72
|
| Rate for Payer: Nomi Health Commercial |
$232.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.22
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
NDC 60687042811
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.83
|
| Rate for Payer: Mclaren Commercial |
$2.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.48
|
| Rate for Payer: Priority Health Narrow Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.49
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
NDC 60687042811
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.83
|
| Rate for Payer: Mclaren Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.49
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
NDC 57237006230
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$100.81 |
| Rate for Payer: Aetna Commercial |
$90.73
|
| Rate for Payer: ASR ASR |
$97.79
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.65
|
| Rate for Payer: Healthscope Commercial |
$97.79
|
| Rate for Payer: Healthscope Whirlpool |
$100.81
|
| Rate for Payer: Mclaren Commercial |
$90.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.69
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$283.20
|
|
|
Service Code
|
NDC 60687042801
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$254.88
|
| Rate for Payer: Aetna Medicare |
$104.78
|
| Rate for Payer: ASR ASR |
$274.70
|
| Rate for Payer: BCBS Complete |
$113.28
|
| Rate for Payer: BCBS Trust/PPO |
$233.50
|
| Rate for Payer: BCN Commercial |
$233.50
|
| Rate for Payer: Cash Price |
$226.56
|
| Rate for Payer: Cofinity Commercial |
$266.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.56
|
| Rate for Payer: Healthscope Commercial |
$274.70
|
| Rate for Payer: Healthscope Whirlpool |
$283.20
|
| Rate for Payer: Mclaren Commercial |
$254.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.72
|
| Rate for Payer: Nomi Health Commercial |
$232.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$248.14
|
| Rate for Payer: Priority Health Narrow Network |
$198.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.22
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$19.82
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCN Commercial |
$44.18
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Healthscope Whirlpool |
$53.58
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.95
|
| Rate for Payer: Priority Health Narrow Network |
$37.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: BCBS Trust/PPO |
$44.00
|
| Rate for Payer: BCN Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Healthscope Whirlpool |
$53.58
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$251.14
|
|
|
Service Code
|
NDC 54001121
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.35 |
| Max. Negotiated Rate |
$251.14 |
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: ASR ASR |
$243.60
|
| Rate for Payer: BCBS Trust/PPO |
$206.23
|
| Rate for Payer: BCN Commercial |
$206.23
|
| Rate for Payer: Cash Price |
$200.91
|
| Rate for Payer: Cofinity Commercial |
$236.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.91
|
| Rate for Payer: Healthscope Commercial |
$243.60
|
| Rate for Payer: Healthscope Whirlpool |
$251.14
|
| Rate for Payer: Mclaren Commercial |
$226.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: Nomi Health Commercial |
$205.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.00
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$251.14
|
|
|
Service Code
|
NDC 54001121
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$251.14 |
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: Aetna Medicare |
$92.92
|
| Rate for Payer: ASR ASR |
$243.60
|
| Rate for Payer: BCBS Complete |
$100.45
|
| Rate for Payer: BCBS Trust/PPO |
$207.06
|
| Rate for Payer: BCN Commercial |
$207.06
|
| Rate for Payer: Cash Price |
$200.91
|
| Rate for Payer: Cofinity Commercial |
$236.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.91
|
| Rate for Payer: Healthscope Commercial |
$243.60
|
| Rate for Payer: Healthscope Whirlpool |
$251.14
|
| Rate for Payer: Mclaren Commercial |
$226.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: Nomi Health Commercial |
$205.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.05
|
| Rate for Payer: Priority Health Narrow Network |
$176.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.00
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: Aetna Medicare |
$123.47
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.14
|
| Rate for Payer: BCN Commercial |
$275.14
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$323.69
|
| Rate for Payer: Healthscope Whirlpool |
$333.70
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.39
|
| Rate for Payer: Priority Health Narrow Network |
$233.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.28 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: BCBS Trust/PPO |
$274.03
|
| Rate for Payer: BCN Commercial |
$274.03
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$323.69
|
| Rate for Payer: Healthscope Whirlpool |
$333.70
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$582.24
|
|
|
Service Code
|
NDC 904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.68 |
| Max. Negotiated Rate |
$582.24 |
| Rate for Payer: Aetna Commercial |
$524.02
|
| Rate for Payer: ASR ASR |
$564.77
|
| Rate for Payer: BCBS Trust/PPO |
$478.14
|
| Rate for Payer: BCN Commercial |
$478.14
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$547.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$564.77
|
| Rate for Payer: Healthscope Whirlpool |
$582.24
|
| Rate for Payer: Mclaren Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Nomi Health Commercial |
$477.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.37
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$76.03
|
|
|
Service Code
|
NDC 49342030
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$28.13
|
| Rate for Payer: ASR ASR |
$73.75
|
| Rate for Payer: BCBS Complete |
$30.41
|
| Rate for Payer: BCBS Trust/PPO |
$62.69
|
| Rate for Payer: BCN Commercial |
$62.69
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.83
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Healthscope Whirlpool |
$76.03
|
| Rate for Payer: Mclaren Commercial |
$68.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.63
|
| Rate for Payer: Nomi Health Commercial |
$62.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.62
|
| Rate for Payer: Priority Health Narrow Network |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.91
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
NDC 904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: BCBS Trust/PPO |
$212.66
|
| Rate for Payer: BCN Commercial |
$212.66
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$251.19
|
| Rate for Payer: Healthscope Whirlpool |
$258.96
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna Commercial |
$105.68
|
| Rate for Payer: ASR ASR |
$113.90
|
| Rate for Payer: BCBS Trust/PPO |
$96.43
|
| Rate for Payer: BCN Commercial |
$96.43
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Commercial |
$110.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$113.90
|
| Rate for Payer: Healthscope Whirlpool |
$117.42
|
| Rate for Payer: Mclaren Commercial |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.81
|
| Rate for Payer: Nomi Health Commercial |
$96.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.33
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$582.24
|
|
|
Service Code
|
NDC 904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.43 |
| Max. Negotiated Rate |
$582.24 |
| Rate for Payer: Aetna Commercial |
$524.02
|
| Rate for Payer: Aetna Medicare |
$215.43
|
| Rate for Payer: ASR ASR |
$564.77
|
| Rate for Payer: BCBS Complete |
$232.90
|
| Rate for Payer: BCBS Trust/PPO |
$480.06
|
| Rate for Payer: BCN Commercial |
$480.06
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$547.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$564.77
|
| Rate for Payer: Healthscope Whirlpool |
$582.24
|
| Rate for Payer: Mclaren Commercial |
$524.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Nomi Health Commercial |
$477.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$510.16
|
| Rate for Payer: Priority Health Narrow Network |
$408.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.37
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna Commercial |
$105.68
|
| Rate for Payer: Aetna Medicare |
$43.45
|
| Rate for Payer: ASR ASR |
$113.90
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS Trust/PPO |
$96.81
|
| Rate for Payer: BCN Commercial |
$96.81
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Commercial |
$110.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$113.90
|
| Rate for Payer: Healthscope Whirlpool |
$117.42
|
| Rate for Payer: Mclaren Commercial |
$105.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.81
|
| Rate for Payer: Nomi Health Commercial |
$96.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.88
|
| Rate for Payer: Priority Health Narrow Network |
$82.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.33
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
NDC 904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.82 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Medicare |
$95.82
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: BCBS Complete |
$103.58
|
| Rate for Payer: BCBS Trust/PPO |
$213.51
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$251.19
|
| Rate for Payer: Healthscope Whirlpool |
$258.96
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.90
|
| Rate for Payer: Priority Health Narrow Network |
$181.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$76.03
|
|
|
Service Code
|
NDC 49342030
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: ASR ASR |
$73.75
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$62.44
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.83
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Healthscope Whirlpool |
$76.03
|
| Rate for Payer: Mclaren Commercial |
$68.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.63
|
| Rate for Payer: Nomi Health Commercial |
$62.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.91
|
|
