|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.14
|
|
|
Service Code
|
NDC 51801000901
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: ASR ASR |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Healthscope Whirlpool |
$4.14
|
| Rate for Payer: Mclaren Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.64
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.02
|
| Rate for Payer: Priority Health Narrow Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$343.69 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$376.31
|
| Rate for Payer: BCN Commercial |
$376.31
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.25
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
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
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: Aetna Medicare |
$169.55
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$377.83
|
| Rate for Payer: BCN Commercial |
$377.83
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.25
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$413.60
|
|
|
Service Code
|
NDC 51801000940
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$372.24
|
| Rate for Payer: Aetna Medicare |
$153.03
|
| Rate for Payer: ASR ASR |
$401.19
|
| Rate for Payer: BCBS Complete |
$165.44
|
| Rate for Payer: BCBS Trust/PPO |
$341.01
|
| Rate for Payer: BCN Commercial |
$341.01
|
| 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: MI Amish Medical Board Commercial |
$330.88
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$362.40
|
| Rate for Payer: Priority Health Narrow Network |
$289.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.97
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.15 |
| Max. Negotiated Rate |
$548.21 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: ASR ASR |
$531.76
|
| Rate for Payer: BCBS Trust/PPO |
$450.19
|
| Rate for Payer: BCN Commercial |
$450.19
|
| Rate for Payer: Cash Price |
$438.56
|
| Rate for Payer: Cofinity Commercial |
$515.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.56
|
| Rate for Payer: Healthscope Commercial |
$531.76
|
| Rate for Payer: Healthscope Whirlpool |
$548.21
|
| Rate for Payer: Mclaren Commercial |
$493.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.97
|
| Rate for Payer: Nomi Health Commercial |
$449.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.42
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$548.21
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$548.21 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: Aetna Medicare |
$202.84
|
| Rate for Payer: ASR ASR |
$531.76
|
| Rate for Payer: BCBS Complete |
$219.28
|
| Rate for Payer: BCBS Trust/PPO |
$452.00
|
| Rate for Payer: BCN Commercial |
$452.00
|
| Rate for Payer: Cash Price |
$438.56
|
| Rate for Payer: Cofinity Commercial |
$515.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.56
|
| Rate for Payer: Healthscope Commercial |
$531.76
|
| Rate for Payer: Healthscope Whirlpool |
$548.21
|
| Rate for Payer: Mclaren Commercial |
$493.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.97
|
| Rate for Payer: Nomi Health Commercial |
$449.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$480.34
|
| Rate for Payer: Priority Health Narrow Network |
$384.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.42
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: ASR ASR |
$18.46
|
| Rate for Payer: BCBS Trust/PPO |
$15.63
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$18.46
|
| Rate for Payer: Healthscope Whirlpool |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$17.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.75
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.54 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.39
|
| Rate for Payer: BCN Commercial |
$44.39
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Healthscope Whirlpool |
$54.05
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: ASR ASR |
$18.46
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$18.46
|
| Rate for Payer: Healthscope Whirlpool |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$17.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.68
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.75
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$44.56
|
| Rate for Payer: BCN Commercial |
$44.56
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Healthscope Whirlpool |
$54.05
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.36
|
| Rate for Payer: Priority Health Narrow Network |
$37.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Mclaren Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.20
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Mclaren Commercial |
$18.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.20
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$194.58
|
| Rate for Payer: Aetna Medicare |
$79.99
|
| Rate for Payer: ASR ASR |
$209.71
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: BCBS Trust/PPO |
$178.26
|
| Rate for Payer: BCN Commercial |
$178.26
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$203.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$209.71
|
| Rate for Payer: Healthscope Whirlpool |
$216.20
|
| Rate for Payer: Mclaren Commercial |
$194.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.43
|
| Rate for Payer: Priority Health Narrow Network |
$151.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.26
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$194.58
|
| Rate for Payer: ASR ASR |
$209.71
|
| Rate for Payer: BCBS Trust/PPO |
$177.54
|
| Rate for Payer: BCN Commercial |
$177.54
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$203.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$209.71
|
| Rate for Payer: Healthscope Whirlpool |
$216.20
|
| Rate for Payer: Mclaren Commercial |
$194.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.26
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$1,080.40 |
| Rate for Payer: Aetna Commercial |
$972.36
|
| Rate for Payer: Aetna Medicare |
$399.75
|
| Rate for Payer: ASR ASR |
$1,047.99
|
| Rate for Payer: BCBS Complete |
$432.16
|
| Rate for Payer: BCBS Trust/PPO |
$890.79
|
| Rate for Payer: BCN Commercial |
$890.79
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$1,015.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$1,047.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.40
|
| Rate for Payer: Mclaren Commercial |
$972.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$864.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Nomi Health Commercial |
$885.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$946.65
|
| Rate for Payer: Priority Health Narrow Network |
$757.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.75
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$810.30 |
| Max. Negotiated Rate |
$1,080.40 |
| Rate for Payer: Aetna Commercial |
$972.36
|
| Rate for Payer: ASR ASR |
$1,047.99
|
| Rate for Payer: BCBS Trust/PPO |
$887.22
|
| Rate for Payer: BCN Commercial |
$887.22
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$1,015.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$1,047.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.40
|
| Rate for Payer: Mclaren Commercial |
$972.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Nomi Health Commercial |
$885.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.75
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$332.60
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.45 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$299.34
|
| Rate for Payer: ASR ASR |
$322.62
|
| Rate for Payer: BCBS Trust/PPO |
$273.13
|
| Rate for Payer: BCN Commercial |
$273.13
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$312.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$322.62
|
| Rate for Payer: Healthscope Whirlpool |
$332.60
|
| Rate for Payer: Mclaren Commercial |
$299.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Nomi Health Commercial |
$272.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.69
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$332.60
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$299.34
|
| Rate for Payer: Aetna Medicare |
$123.06
|
| Rate for Payer: ASR ASR |
$322.62
|
| Rate for Payer: BCBS Complete |
$133.04
|
| Rate for Payer: BCBS Trust/PPO |
$274.23
|
| Rate for Payer: BCN Commercial |
$274.23
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$312.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$322.62
|
| Rate for Payer: Healthscope Whirlpool |
$332.60
|
| Rate for Payer: Mclaren Commercial |
$299.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Nomi Health Commercial |
$272.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.43
|
| Rate for Payer: Priority Health Narrow Network |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.69
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$237.06
|
|
|
Service Code
|
NDC 173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$237.06 |
| Rate for Payer: Aetna Commercial |
$213.35
|
| Rate for Payer: Aetna Medicare |
$87.71
|
| Rate for Payer: ASR ASR |
$229.94
|
| Rate for Payer: BCBS Complete |
$94.82
|
| Rate for Payer: BCBS Trust/PPO |
$195.45
|
| Rate for Payer: BCN Commercial |
$195.45
|
| Rate for Payer: Cash Price |
$189.64
|
| Rate for Payer: Cofinity Commercial |
$222.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.64
|
| Rate for Payer: Healthscope Commercial |
$229.94
|
| Rate for Payer: Healthscope Whirlpool |
$237.06
|
| Rate for Payer: Mclaren Commercial |
$213.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$207.71
|
| Rate for Payer: Priority Health Narrow Network |
$166.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.61
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$237.06
|
|
|
Service Code
|
NDC 173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.79 |
| Max. Negotiated Rate |
$237.06 |
| Rate for Payer: Aetna Commercial |
$213.35
|
| Rate for Payer: ASR ASR |
$229.94
|
| Rate for Payer: BCBS Trust/PPO |
$194.67
|
| Rate for Payer: BCN Commercial |
$194.67
|
| Rate for Payer: Cash Price |
$189.64
|
| Rate for Payer: Cofinity Commercial |
$222.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.64
|
| Rate for Payer: Healthscope Commercial |
$229.94
|
| Rate for Payer: Healthscope Whirlpool |
$237.06
|
| Rate for Payer: Mclaren Commercial |
$213.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.61
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$317.38
|
|
|
Service Code
|
NDC 173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$317.38 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$117.43
|
| Rate for Payer: ASR ASR |
$307.86
|
| Rate for Payer: BCBS Complete |
$126.95
|
| Rate for Payer: BCBS Trust/PPO |
$261.68
|
| Rate for Payer: BCN Commercial |
$261.68
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$298.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$307.86
|
| Rate for Payer: Healthscope Whirlpool |
$317.38
|
| Rate for Payer: Mclaren Commercial |
$285.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$222.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.29
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.03 |
| Max. Negotiated Rate |
$317.38 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: ASR ASR |
$307.86
|
| Rate for Payer: BCBS Trust/PPO |
$260.63
|
| Rate for Payer: BCN Commercial |
$260.63
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$298.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$307.86
|
| Rate for Payer: Healthscope Whirlpool |
$317.38
|
| Rate for Payer: Mclaren Commercial |
$285.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.29
|
|
