|
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 |
$228.42 |
| Max. Negotiated Rate |
$571.05 |
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: Aetna Medicare |
$285.52
|
| Rate for Payer: ASR ASR |
$553.92
|
| Rate for Payer: ASR Commercial |
$553.92
|
| Rate for Payer: BCBS Complete |
$228.42
|
| Rate for Payer: BCBS Trust/PPO |
$467.63
|
| Rate for Payer: BCN Commercial |
$442.74
|
| 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 |
$571.05
|
| Rate for Payer: Healthscope Whirlpool |
$553.92
|
| 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: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: 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
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.01
|
| 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
|
$4.58
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| 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 |
$297.86 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$373.43
|
| Rate for Payer: BCN Commercial |
$355.28
|
| 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 |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| 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: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$355.28
|
| 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 |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| 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: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: 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
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$548.20
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.28 |
| Max. Negotiated Rate |
$548.20 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: Aetna Medicare |
$274.10
|
| Rate for Payer: ASR ASR |
$531.75
|
| Rate for Payer: ASR Commercial |
$531.75
|
| Rate for Payer: BCBS Complete |
$219.28
|
| Rate for Payer: BCBS Trust/PPO |
$448.92
|
| Rate for Payer: BCN Commercial |
$425.02
|
| 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 |
$548.20
|
| Rate for Payer: Healthscope Whirlpool |
$531.75
|
| Rate for Payer: Mclaren Commercial |
$493.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.97
|
| Rate for Payer: Nomi Health Commercial |
$449.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.33
|
| Rate for Payer: Priority Health Narrow Network |
$384.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.42
|
|
|
FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$548.20
|
|
|
Service Code
|
NDC 11980021105
|
| Hospital Charge Code |
3208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.33 |
| Max. Negotiated Rate |
$548.20 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: ASR ASR |
$531.75
|
| Rate for Payer: ASR Commercial |
$531.75
|
| Rate for Payer: BCBS Trust/PPO |
$446.73
|
| Rate for Payer: BCN Commercial |
$425.02
|
| 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 |
$548.20
|
| Rate for Payer: Healthscope Whirlpool |
$531.75
|
| Rate for Payer: Mclaren Commercial |
$493.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.97
|
| Rate for Payer: Nomi Health Commercial |
$449.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.42
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: ASR Commercial |
$18.47
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.59
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.68
|
| Rate for Payer: Priority Health Narrow Network |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: ASR Commercial |
$52.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$41.90
|
| 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 |
$54.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| 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: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: ASR ASR |
$18.47
|
| Rate for Payer: ASR Commercial |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Whirlpool |
$18.47
|
| Rate for Payer: Mclaren Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.76
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: ASR Commercial |
$52.43
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$44.26
|
| Rate for Payer: BCN Commercial |
$41.90
|
| 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 |
$54.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.43
|
| 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: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: 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
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna Commercial |
$186.12
|
| Rate for Payer: Aetna Medicare |
$103.40
|
| Rate for Payer: ASR ASR |
$200.60
|
| Rate for Payer: ASR Commercial |
$200.60
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: BCBS Trust/PPO |
$169.35
|
| Rate for Payer: BCN Commercial |
$160.33
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$194.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$206.80
|
| Rate for Payer: Healthscope Whirlpool |
$200.60
|
| Rate for Payer: Mclaren Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.20
|
| Rate for Payer: Priority Health Narrow Network |
$144.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.98
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna Commercial |
$186.12
|
| Rate for Payer: ASR ASR |
$200.60
|
| Rate for Payer: ASR Commercial |
$200.60
|
| Rate for Payer: BCBS Trust/PPO |
$168.52
|
| Rate for Payer: BCN Commercial |
$160.33
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$194.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$206.80
|
| Rate for Payer: Healthscope Whirlpool |
$200.60
|
| Rate for Payer: Mclaren Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.98
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: ASR Commercial |
$20.06
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS Trust/PPO |
$16.93
|
| Rate for Payer: BCN Commercial |
$16.03
|
| 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 |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$20.06
|
| 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: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: 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
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: ASR Commercial |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.85
|
| Rate for Payer: BCN Commercial |
$16.03
|
| 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 |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$20.06
|
| 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: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.20
|
|
|
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 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 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 |
$133.04 |
| 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: 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 |
$291.42
|
| Rate for Payer: Priority Health Narrow Network |
$233.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.69
|
|
|
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
|
|
|
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 |
$431.17
|
| Rate for Payer: ASR Commercial |
$431.17
|
| 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 |
$431.17
|
| 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 |
$288.93
|
| 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 |
$288.93 |
| Max. Negotiated Rate |
$444.50 |
| Rate for Payer: Aetna Commercial |
$400.05
|
| Rate for Payer: ASR ASR |
$431.17
|
| Rate for Payer: ASR Commercial |
$431.17
|
| 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 |
$431.17
|
| 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 |
$288.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.16
|
|
|
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
|
$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
|
|
