|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$432.16 |
| Max. Negotiated Rate |
$1,080.40 |
| Rate for Payer: Aetna Commercial |
$972.36
|
| Rate for Payer: Aetna Medicare |
$540.20
|
| Rate for Payer: ASR ASR |
$1,047.99
|
| Rate for Payer: ASR Commercial |
$1,047.99
|
| Rate for Payer: BCBS Complete |
$432.16
|
| Rate for Payer: BCBS Trust/PPO |
$884.74
|
| Rate for Payer: BCN Commercial |
$837.63
|
| 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 |
$1,080.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.99
|
| 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: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: 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 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$702.26 |
| Max. Negotiated Rate |
$1,080.40 |
| Rate for Payer: Aetna Commercial |
$972.36
|
| Rate for Payer: ASR ASR |
$1,047.99
|
| Rate for Payer: ASR Commercial |
$1,047.99
|
| Rate for Payer: BCBS Trust/PPO |
$880.42
|
| Rate for Payer: BCN Commercial |
$837.63
|
| 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 |
$1,080.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.99
|
| 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: Priority Health Cigna Priority Health |
$702.26
|
| 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 |
$216.19 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$299.34
|
| Rate for Payer: ASR ASR |
$322.62
|
| Rate for Payer: ASR Commercial |
$322.62
|
| Rate for Payer: BCBS Trust/PPO |
$271.04
|
| Rate for Payer: BCN Commercial |
$257.86
|
| 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 |
$332.60
|
| Rate for Payer: Healthscope Whirlpool |
$322.62
|
| 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: Priority Health Cigna Priority Health |
$216.19
|
| 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 |
$7.33 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$299.34
|
| Rate for Payer: Aetna Medicare |
$166.30
|
| Rate for Payer: ASR ASR |
$322.62
|
| Rate for Payer: ASR Commercial |
$322.62
|
| Rate for Payer: BCBS Complete |
$133.04
|
| Rate for Payer: BCBS Trust/PPO |
$272.37
|
| Rate for Payer: BCN Commercial |
$257.86
|
| 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 |
$332.60
|
| Rate for Payer: Healthscope Whirlpool |
$322.62
|
| 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: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.16
|
| Rate for Payer: Priority Health Narrow Network |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.69
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$332.01
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$298.81
|
| Rate for Payer: Aetna Medicare |
$166.00
|
| Rate for Payer: ASR ASR |
$322.05
|
| Rate for Payer: ASR Commercial |
$322.05
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS Trust/PPO |
$271.88
|
| Rate for Payer: BCN Commercial |
$257.41
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cofinity Commercial |
$312.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.61
|
| Rate for Payer: Healthscope Commercial |
$332.01
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$298.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.21
|
| Rate for Payer: Nomi Health Commercial |
$272.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.91
|
| Rate for Payer: Priority Health Narrow Network |
$232.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.17
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$332.01
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.81 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$298.81
|
| Rate for Payer: ASR ASR |
$322.05
|
| Rate for Payer: ASR Commercial |
$322.05
|
| Rate for Payer: BCBS Trust/PPO |
$270.55
|
| Rate for Payer: BCN Commercial |
$257.41
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cofinity Commercial |
$312.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.61
|
| Rate for Payer: Healthscope Commercial |
$332.01
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$298.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.21
|
| Rate for Payer: Nomi Health Commercial |
$272.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.17
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$444.50
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$444.50 |
| Rate for Payer: Aetna Commercial |
$400.05
|
| Rate for Payer: Aetna Medicare |
$222.25
|
| Rate for Payer: ASR ASR |
$431.16
|
| Rate for Payer: ASR Commercial |
$431.16
|
| Rate for Payer: BCBS Complete |
$177.80
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$344.62
|
| Rate for Payer: Cash Price |
$355.60
|
| Rate for Payer: Cofinity Commercial |
$417.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$431.16
|
| Rate for Payer: Mclaren Commercial |
$400.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.82
|
| Rate for Payer: Nomi Health Commercial |
$364.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.47
|
| Rate for Payer: Priority Health Narrow Network |
$311.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.16
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$444.50
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.92 |
| Max. Negotiated Rate |
$444.50 |
| Rate for Payer: Aetna Commercial |
$400.05
|
| Rate for Payer: ASR ASR |
$431.16
|
| Rate for Payer: ASR Commercial |
$431.16
|
| Rate for Payer: BCBS Trust/PPO |
$362.22
|
| Rate for Payer: BCN Commercial |
$344.62
|
| Rate for Payer: Cash Price |
$355.60
|
| Rate for Payer: Cofinity Commercial |
$417.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$431.16
|
| Rate for Payer: Mclaren Commercial |
$400.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.82
|
| Rate for Payer: Nomi Health Commercial |
$364.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.16
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: ASR ASR |
$25.36
|
| Rate for Payer: ASR Commercial |
$25.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Healthscope Whirlpool |
$25.36
|
| Rate for Payer: Mclaren Commercial |
$23.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.00
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$13.07
|
| Rate for Payer: ASR ASR |
$25.36
|
| Rate for Payer: ASR Commercial |
$25.36
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Healthscope Whirlpool |
$25.36
|
| Rate for Payer: Mclaren Commercial |
$23.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.90
|
| Rate for Payer: Priority Health Narrow Network |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.00
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.59
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.01
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Aetna Commercial |
$32.41
|
| Rate for Payer: ASR ASR |
$34.93
|
| Rate for Payer: ASR Commercial |
$34.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$33.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Healthscope Commercial |
$36.01
|
| Rate for Payer: Healthscope Whirlpool |
$34.93
|
| Rate for Payer: Mclaren Commercial |
$32.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.61
|
| Rate for Payer: Nomi Health Commercial |
$29.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.69
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.01
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Aetna Commercial |
$32.41
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: ASR ASR |
$34.93
|
| Rate for Payer: ASR Commercial |
$34.93
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$33.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Healthscope Commercial |
$36.01
|
| Rate for Payer: Healthscope Whirlpool |
$34.93
|
| Rate for Payer: Mclaren Commercial |
$32.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.61
|
| Rate for Payer: Nomi Health Commercial |
$29.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.55
|
| Rate for Payer: Priority Health Narrow Network |
$25.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.69
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Medicare |
$18.28
|
| Rate for Payer: ASR ASR |
$35.47
|
| Rate for Payer: ASR Commercial |
$35.47
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$28.35
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$34.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$36.57
|
| Rate for Payer: Healthscope Whirlpool |
$35.47
|
| Rate for Payer: Mclaren Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.04
|
| Rate for Payer: Priority Health Narrow Network |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.18
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: ASR ASR |
$35.47
|
| Rate for Payer: ASR Commercial |
$35.47
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$28.35
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$34.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$36.57
|
| Rate for Payer: Healthscope Whirlpool |
$35.47
|
| Rate for Payer: Mclaren Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Nomi Health Commercial |
$29.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.18
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Aetna Commercial |
$205.06
|
| Rate for Payer: ASR ASR |
$221.00
|
| Rate for Payer: ASR Commercial |
$221.00
|
| Rate for Payer: BCBS Trust/PPO |
$185.67
|
| Rate for Payer: BCN Commercial |
$176.64
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$214.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Healthscope Commercial |
$227.84
|
| Rate for Payer: Healthscope Whirlpool |
$221.00
|
| Rate for Payer: Mclaren Commercial |
$205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: Nomi Health Commercial |
$186.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.50
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Aetna Commercial |
$205.06
|
| Rate for Payer: Aetna Medicare |
$113.92
|
| Rate for Payer: ASR ASR |
$221.00
|
| Rate for Payer: ASR Commercial |
$221.00
|
| Rate for Payer: BCBS Complete |
$91.14
|
| Rate for Payer: BCBS Trust/PPO |
$186.58
|
| Rate for Payer: BCN Commercial |
$176.64
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$214.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Healthscope Commercial |
$227.84
|
| Rate for Payer: Healthscope Whirlpool |
$221.00
|
| Rate for Payer: Mclaren Commercial |
$205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: Nomi Health Commercial |
$186.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.50
|
| Rate for Payer: Priority Health Narrow Network |
$66.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.50
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$81.35 |
| Rate for Payer: Aetna Commercial |
$73.22
|
| Rate for Payer: ASR ASR |
$78.91
|
| Rate for Payer: ASR Commercial |
$78.91
|
| Rate for Payer: BCBS Trust/PPO |
$66.29
|
| Rate for Payer: BCN Commercial |
$63.07
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$81.35
|
| Rate for Payer: Healthscope Whirlpool |
$78.91
|
| Rate for Payer: Mclaren Commercial |
$73.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: Nomi Health Commercial |
$66.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.59
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$81.35 |
| Rate for Payer: Aetna Commercial |
$73.22
|
| Rate for Payer: Aetna Medicare |
$40.68
|
| Rate for Payer: ASR ASR |
$78.91
|
| Rate for Payer: ASR Commercial |
$78.91
|
| Rate for Payer: BCBS Complete |
$32.54
|
| Rate for Payer: BCBS Trust/PPO |
$66.62
|
| Rate for Payer: BCN Commercial |
$63.07
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$81.35
|
| Rate for Payer: Healthscope Whirlpool |
$78.91
|
| Rate for Payer: Mclaren Commercial |
$73.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: Nomi Health Commercial |
$66.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.35
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.59
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: ASR ASR |
$1.46
|
| Rate for Payer: ASR Commercial |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Healthscope Whirlpool |
$1.46
|
| Rate for Payer: Mclaren Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.32
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$147.40
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$147.40 |
| Rate for Payer: Aetna Commercial |
$132.66
|
| Rate for Payer: Aetna Medicare |
$73.70
|
| Rate for Payer: ASR ASR |
$142.98
|
| Rate for Payer: ASR Commercial |
$142.98
|
| Rate for Payer: BCBS Complete |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$120.71
|
| Rate for Payer: BCN Commercial |
$114.28
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cofinity Commercial |
$138.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.92
|
| Rate for Payer: Healthscope Commercial |
$147.40
|
| Rate for Payer: Healthscope Whirlpool |
$142.98
|
| Rate for Payer: Mclaren Commercial |
$132.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.29
|
| Rate for Payer: Nomi Health Commercial |
$120.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.15
|
| Rate for Payer: Priority Health Narrow Network |
$103.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.71
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 62584089711
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: ASR ASR |
$1.46
|
| Rate for Payer: ASR Commercial |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.23
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.20
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Healthscope Whirlpool |
$1.46
|
| Rate for Payer: Mclaren Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.31
|
| Rate for Payer: Priority Health Narrow Network |
$1.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.32
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: ASR ASR |
$159.08
|
| Rate for Payer: ASR Commercial |
$159.08
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$134.30
|
| Rate for Payer: BCN Commercial |
$127.15
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$154.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$164.00
|
| Rate for Payer: Healthscope Whirlpool |
$159.08
|
| Rate for Payer: Mclaren Commercial |
$147.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: Nomi Health Commercial |
$134.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.70
|
| Rate for Payer: Priority Health Narrow Network |
$114.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.32
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$147.40
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$147.40 |
| Rate for Payer: Aetna Commercial |
$132.66
|
| Rate for Payer: ASR ASR |
$142.98
|
| Rate for Payer: ASR Commercial |
$142.98
|
| Rate for Payer: BCBS Trust/PPO |
$120.12
|
| Rate for Payer: BCN Commercial |
$114.28
|
| Rate for Payer: Cash Price |
$117.92
|
| Rate for Payer: Cofinity Commercial |
$138.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.92
|
| Rate for Payer: Healthscope Commercial |
$147.40
|
| Rate for Payer: Healthscope Whirlpool |
$142.98
|
| Rate for Payer: Mclaren Commercial |
$132.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.29
|
| Rate for Payer: Nomi Health Commercial |
$120.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.71
|
|
