|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.65
|
| Rate for Payer: Priority Health Narrow Network |
$3.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.34 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$355.97
|
| Rate for Payer: Aetna Medicare |
$146.34
|
| Rate for Payer: ASR ASR |
$383.65
|
| Rate for Payer: BCBS Complete |
$158.21
|
| Rate for Payer: BCBS Trust/PPO |
$326.11
|
| Rate for Payer: BCN Commercial |
$326.11
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Commercial |
$371.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$383.65
|
| Rate for Payer: Healthscope Whirlpool |
$395.52
|
| Rate for Payer: Mclaren Commercial |
$355.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Nomi Health Commercial |
$324.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$346.55
|
| Rate for Payer: Priority Health Narrow Network |
$277.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.06
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$212.33
|
|
|
Service Code
|
NDC 904731706
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.56 |
| Max. Negotiated Rate |
$212.32 |
| Rate for Payer: Aetna Commercial |
$191.09
|
| Rate for Payer: Aetna Medicare |
$78.56
|
| Rate for Payer: ASR ASR |
$205.96
|
| Rate for Payer: BCBS Complete |
$84.93
|
| Rate for Payer: BCBS Trust/PPO |
$175.06
|
| Rate for Payer: BCN Commercial |
$175.06
|
| Rate for Payer: Cash Price |
$169.86
|
| Rate for Payer: Cofinity Commercial |
$199.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.86
|
| Rate for Payer: Healthscope Commercial |
$205.96
|
| Rate for Payer: Healthscope Whirlpool |
$212.32
|
| Rate for Payer: Mclaren Commercial |
$191.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.48
|
| Rate for Payer: Nomi Health Commercial |
$174.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$186.04
|
| Rate for Payer: Priority Health Narrow Network |
$148.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.85
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.21 |
| Max. Negotiated Rate |
$232.28 |
| Rate for Payer: Aetna Commercial |
$209.05
|
| Rate for Payer: ASR ASR |
$225.31
|
| Rate for Payer: BCBS Trust/PPO |
$190.74
|
| Rate for Payer: BCN Commercial |
$190.74
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Healthscope Commercial |
$225.31
|
| Rate for Payer: Healthscope Whirlpool |
$232.28
|
| Rate for Payer: Mclaren Commercial |
$209.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.43
|
| Rate for Payer: Nomi Health Commercial |
$190.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.40
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.94 |
| Max. Negotiated Rate |
$232.28 |
| Rate for Payer: Aetna Commercial |
$209.05
|
| Rate for Payer: Aetna Medicare |
$85.94
|
| Rate for Payer: ASR ASR |
$225.31
|
| Rate for Payer: BCBS Complete |
$92.91
|
| Rate for Payer: BCBS Trust/PPO |
$191.51
|
| Rate for Payer: BCN Commercial |
$191.51
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Healthscope Commercial |
$225.31
|
| Rate for Payer: Healthscope Whirlpool |
$232.28
|
| Rate for Payer: Mclaren Commercial |
$209.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.43
|
| Rate for Payer: Nomi Health Commercial |
$190.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.52
|
| Rate for Payer: Priority Health Narrow Network |
$162.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.40
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$212.33
|
|
|
Service Code
|
NDC 904731706
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$212.32 |
| Rate for Payer: Aetna Commercial |
$191.09
|
| Rate for Payer: ASR ASR |
$205.96
|
| Rate for Payer: BCBS Trust/PPO |
$174.36
|
| Rate for Payer: BCN Commercial |
$174.36
|
| Rate for Payer: Cash Price |
$169.86
|
| Rate for Payer: Cofinity Commercial |
$199.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.86
|
| Rate for Payer: Healthscope Commercial |
$205.96
|
| Rate for Payer: Healthscope Whirlpool |
$212.32
|
| Rate for Payer: Mclaren Commercial |
$191.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.48
|
| Rate for Payer: Nomi Health Commercial |
$174.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.85
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.65
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.07
|
| Rate for Payer: Priority Health Narrow Network |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: ASR ASR |
$3.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$3.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.48
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: ASR ASR |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$3.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.47
|
| Rate for Payer: Priority Health Narrow Network |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.48
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.65
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.64 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$355.97
|
| Rate for Payer: ASR ASR |
$383.65
|
| Rate for Payer: BCBS Trust/PPO |
$324.80
|
| Rate for Payer: BCN Commercial |
$324.80
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Commercial |
$371.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$383.65
|
| Rate for Payer: Healthscope Whirlpool |
$395.52
|
| Rate for Payer: Mclaren Commercial |
$355.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Nomi Health Commercial |
$324.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.06
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.87
|
|
|
Service Code
|
NDC 143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.87
|
|
|
Service Code
|
NDC 143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.87
|
|
|
Service Code
|
NDC 143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.87
|
|
|
Service Code
|
NDC 143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.87
|
|
|
Service Code
|
NDC 143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 143978410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Whirlpool |
$18.87
|
| Rate for Payer: Mclaren Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
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 |
$428.29 |
| Max. Negotiated Rate |
$571.05 |
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: ASR ASR |
$553.92
|
| Rate for Payer: BCBS Trust/PPO |
$468.95
|
| Rate for Payer: BCN Commercial |
$468.95
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$536.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$553.92
|
| Rate for Payer: Healthscope Whirlpool |
$571.05
|
| Rate for Payer: Mclaren Commercial |
$513.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Nomi Health Commercial |
$468.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.52
|
|
|
FLUORESCEIN 0.6 MG EYE STRIPS
|
Facility
|
OP
|
$571.05
|
|
|
Service Code
|
NDC 17478040303
|
| Hospital Charge Code |
27662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$211.29 |
| Max. Negotiated Rate |
$571.05 |
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: Aetna Medicare |
$211.29
|
| Rate for Payer: ASR ASR |
$553.92
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: BCBS Trust/PPO |
$470.83
|
| Rate for Payer: BCN Commercial |
$470.83
|
| Rate for Payer: Cash Price |
$456.84
|
| Rate for Payer: Cofinity Commercial |
$536.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.84
|
| Rate for Payer: Healthscope Commercial |
$553.92
|
| Rate for Payer: Healthscope Whirlpool |
$571.05
|
| Rate for Payer: Mclaren Commercial |
$513.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.39
|
| Rate for Payer: Nomi Health Commercial |
$468.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$500.35
|
| Rate for Payer: Priority Health Narrow Network |
$400.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.52
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$413.60
|
|
|
Service Code
|
NDC 51801000940
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$372.24
|
| Rate for Payer: ASR ASR |
$401.19
|
| Rate for Payer: BCBS Trust/PPO |
$339.65
|
| Rate for Payer: BCN Commercial |
$339.65
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cofinity Commercial |
$388.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.88
|
| Rate for Payer: Healthscope Commercial |
$401.19
|
| Rate for Payer: Healthscope Whirlpool |
$413.60
|
| Rate for Payer: Mclaren Commercial |
$372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.56
|
| Rate for Payer: Nomi Health Commercial |
$339.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.97
|
|
