|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
NDC 57237006230
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$50.41
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: ASR Commercial |
$97.80
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS Trust/PPO |
$82.56
|
| Rate for Payer: BCN Commercial |
$78.17
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$100.82
|
| Rate for Payer: Healthscope Whirlpool |
$97.80
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.34
|
| 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
|
$2.84
|
|
|
Service Code
|
NDC 60687042811
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: ASR Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$251.14
|
|
|
Service Code
|
NDC 00054001121
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$251.14 |
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: ASR ASR |
$243.61
|
| Rate for Payer: ASR Commercial |
$243.61
|
| Rate for Payer: BCBS Trust/PPO |
$204.65
|
| Rate for Payer: BCN Commercial |
$194.71
|
| 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 |
$251.14
|
| Rate for Payer: Healthscope Whirlpool |
$243.61
|
| Rate for Payer: Mclaren Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: Nomi Health Commercial |
$205.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.00
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$247.46
|
| Rate for Payer: Aetna Medicare |
$137.48
|
| Rate for Payer: ASR ASR |
$266.70
|
| Rate for Payer: ASR Commercial |
$266.70
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS Trust/PPO |
$225.16
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$258.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.70
|
| Rate for Payer: Mclaren Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.91
|
| Rate for Payer: Priority Health Narrow Network |
$192.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.96
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$247.46
|
| Rate for Payer: ASR ASR |
$266.70
|
| Rate for Payer: ASR Commercial |
$266.70
|
| Rate for Payer: BCBS Trust/PPO |
$224.06
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$258.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.70
|
| Rate for Payer: Mclaren Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.96
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$251.14
|
|
|
Service Code
|
NDC 00054001121
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$251.14 |
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna Medicare |
$125.57
|
| Rate for Payer: ASR ASR |
$243.61
|
| Rate for Payer: ASR Commercial |
$243.61
|
| Rate for Payer: BCBS Complete |
$100.46
|
| Rate for Payer: BCBS Trust/PPO |
$205.66
|
| Rate for Payer: BCN Commercial |
$194.71
|
| 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 |
$251.14
|
| Rate for Payer: Healthscope Whirlpool |
$243.61
|
| Rate for Payer: Mclaren Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: Nomi Health Commercial |
$205.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.24
|
| Rate for Payer: 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
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna Commercial |
$105.68
|
| Rate for Payer: Aetna Medicare |
$58.71
|
| Rate for Payer: ASR ASR |
$113.90
|
| Rate for Payer: ASR Commercial |
$113.90
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS Trust/PPO |
$96.16
|
| Rate for Payer: BCN Commercial |
$91.04
|
| 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 |
$117.42
|
| Rate for Payer: Healthscope Whirlpool |
$113.90
|
| 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: Priority Health Cigna Priority Health |
$76.32
|
| Rate for Payer: 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
|
$554.40
|
|
|
Service Code
|
NDC 00904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Aetna Medicare |
$277.20
|
| Rate for Payer: ASR ASR |
$537.77
|
| Rate for Payer: ASR Commercial |
$537.77
|
| Rate for Payer: BCBS Complete |
$221.76
|
| Rate for Payer: BCBS Trust/PPO |
$454.00
|
| Rate for Payer: BCN Commercial |
$429.83
|
| Rate for Payer: Cash Price |
$443.52
|
| Rate for Payer: Cofinity Commercial |
$521.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.52
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Healthscope Whirlpool |
$537.77
|
| Rate for Payer: Mclaren Commercial |
$498.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.24
|
| Rate for Payer: Nomi Health Commercial |
$454.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.77
|
| Rate for Payer: Priority Health Narrow Network |
$388.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.87
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$76.03
|
|
|
Service Code
|
NDC 00049342030
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$38.02
|
| Rate for Payer: ASR ASR |
$73.75
|
| Rate for Payer: ASR Commercial |
$73.75
|
| Rate for Payer: BCBS Complete |
$30.41
|
| Rate for Payer: BCBS Trust/PPO |
$62.26
|
| Rate for Payer: BCN Commercial |
$58.95
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.82
|
| Rate for Payer: Healthscope Commercial |
$76.03
|
| Rate for Payer: Healthscope Whirlpool |
$73.75
|
| Rate for Payer: Mclaren Commercial |
$68.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.63
|
| Rate for Payer: Nomi Health Commercial |
$62.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.42
|
| Rate for Payer: 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
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna Commercial |
$105.68
|
| Rate for Payer: ASR ASR |
$113.90
|
| Rate for Payer: ASR Commercial |
$113.90
|
| Rate for Payer: BCBS Trust/PPO |
$95.69
|
| Rate for Payer: BCN Commercial |
$91.04
|
| 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 |
$117.42
|
| Rate for Payer: Healthscope Whirlpool |
$113.90
|
| 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: Priority Health Cigna Priority Health |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.33
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$76.03
|
|
|
Service Code
|
NDC 00049342030
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: ASR ASR |
$73.75
|
| Rate for Payer: ASR Commercial |
$73.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.96
|
| Rate for Payer: BCN Commercial |
$58.95
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.82
|
| Rate for Payer: Healthscope Commercial |
$76.03
|
| Rate for Payer: Healthscope Whirlpool |
$73.75
|
| Rate for Payer: Mclaren Commercial |
$68.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.63
|
| Rate for Payer: Nomi Health Commercial |
$62.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.91
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$256.08
|
|
|
Service Code
|
NDC 00904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Aetna Commercial |
$230.47
|
| Rate for Payer: Aetna Medicare |
$128.04
|
| Rate for Payer: ASR ASR |
$248.40
|
| Rate for Payer: ASR Commercial |
$248.40
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS Trust/PPO |
$209.70
|
| Rate for Payer: BCN Commercial |
$198.54
|
| Rate for Payer: Cash Price |
$204.86
|
| Rate for Payer: Cofinity Commercial |
$240.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.86
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$248.40
|
| Rate for Payer: Mclaren Commercial |
$230.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.67
|
| Rate for Payer: Nomi Health Commercial |
$209.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.38
|
| Rate for Payer: Priority Health Narrow Network |
$179.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.35
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$554.40
|
|
|
Service Code
|
NDC 00904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: ASR ASR |
$537.77
|
| Rate for Payer: ASR Commercial |
$537.77
|
| Rate for Payer: BCBS Trust/PPO |
$451.78
|
| Rate for Payer: BCN Commercial |
$429.83
|
| Rate for Payer: Cash Price |
$443.52
|
| Rate for Payer: Cofinity Commercial |
$521.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.52
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Healthscope Whirlpool |
$537.77
|
| Rate for Payer: Mclaren Commercial |
$498.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.24
|
| Rate for Payer: Nomi Health Commercial |
$454.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.87
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$256.08
|
|
|
Service Code
|
NDC 00904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.45 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Aetna Commercial |
$230.47
|
| Rate for Payer: ASR ASR |
$248.40
|
| Rate for Payer: ASR Commercial |
$248.40
|
| Rate for Payer: BCBS Trust/PPO |
$208.68
|
| Rate for Payer: BCN Commercial |
$198.54
|
| Rate for Payer: Cash Price |
$204.86
|
| Rate for Payer: Cofinity Commercial |
$240.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.86
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$248.40
|
| Rate for Payer: Mclaren Commercial |
$230.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.67
|
| Rate for Payer: Nomi Health Commercial |
$209.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.35
|
|
|
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 |
$2.97 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| 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 |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| 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: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
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 |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| 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 |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| 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: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$230.38 |
| Rate for Payer: Aetna Commercial |
$207.34
|
| Rate for Payer: Aetna Medicare |
$115.19
|
| Rate for Payer: ASR ASR |
$223.47
|
| Rate for Payer: ASR Commercial |
$223.47
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: BCBS Trust/PPO |
$188.66
|
| Rate for Payer: BCN Commercial |
$178.61
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$216.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$230.38
|
| Rate for Payer: Healthscope Whirlpool |
$223.47
|
| Rate for Payer: Mclaren Commercial |
$207.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: Nomi Health Commercial |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.86
|
| Rate for Payer: Priority Health Narrow Network |
$161.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.73
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.75 |
| Max. Negotiated Rate |
$230.38 |
| Rate for Payer: Aetna Commercial |
$207.34
|
| Rate for Payer: ASR ASR |
$223.47
|
| Rate for Payer: ASR Commercial |
$223.47
|
| Rate for Payer: BCBS Trust/PPO |
$187.74
|
| Rate for Payer: BCN Commercial |
$178.61
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$216.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$230.38
|
| Rate for Payer: Healthscope Whirlpool |
$223.47
|
| Rate for Payer: Mclaren Commercial |
$207.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: Nomi Health Commercial |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.73
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: ASR Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.47
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.04
|
| Rate for Payer: Priority Health Narrow Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.92 |
| Max. Negotiated Rate |
$376.80 |
| Rate for Payer: Aetna Commercial |
$339.12
|
| Rate for Payer: ASR ASR |
$365.50
|
| Rate for Payer: ASR Commercial |
$365.50
|
| Rate for Payer: BCBS Trust/PPO |
$307.05
|
| Rate for Payer: BCN Commercial |
$292.13
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$354.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$376.80
|
| Rate for Payer: Healthscope Whirlpool |
$365.50
|
| Rate for Payer: Mclaren Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.58
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.72 |
| Max. Negotiated Rate |
$376.80 |
| Rate for Payer: Aetna Commercial |
$339.12
|
| Rate for Payer: Aetna Medicare |
$188.40
|
| Rate for Payer: ASR ASR |
$365.50
|
| Rate for Payer: ASR Commercial |
$365.50
|
| Rate for Payer: BCBS Complete |
$150.72
|
| Rate for Payer: BCBS Trust/PPO |
$308.56
|
| Rate for Payer: BCN Commercial |
$292.13
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$354.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$376.80
|
| Rate for Payer: Healthscope Whirlpool |
$365.50
|
| Rate for Payer: Mclaren Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.15
|
| Rate for Payer: Priority Health Narrow Network |
$264.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.58
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: ASR ASR |
$3.66
|
| Rate for Payer: ASR Commercial |
$3.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Mclaren Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.32
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: ASR ASR |
$3.66
|
| Rate for Payer: ASR Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Mclaren Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.30
|
| Rate for Payer: Priority Health Narrow Network |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.32
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: ASR Commercial |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.47
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$18.30
|
| Rate for Payer: ASR Commercial |
$18.30
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$14.63
|
| 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 |
$18.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.30
|
| 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: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: 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
|
|
