|
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 |
$21.23
|
| 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
|
|
|
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
|
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
|
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
|
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
|
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 |
$18.29
|
| 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
|
|
|
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 |
$91.14 |
| 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: 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 |
$199.63
|
| Rate for Payer: Priority Health Narrow Network |
$159.72
|
| 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
|
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 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 |
$32.54 |
| Max. Negotiated Rate |
$81.35 |
| Rate for Payer: Aetna Commercial |
$73.22
|
| Rate for Payer: Aetna Medicare |
$40.67
|
| 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: 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 |
$71.28
|
| Rate for Payer: Priority Health Narrow Network |
$57.03
|
| 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
|
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
|
|
|
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
|
|
|
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 |
$1.27
|
| 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
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: ASR ASR |
$159.08
|
| Rate for Payer: ASR Commercial |
$159.08
|
| Rate for Payer: BCBS Trust/PPO |
$133.64
|
| 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: UHC All Payor (Choice/PPO) + Core |
$144.32
|
|
|
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
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: ASR Commercial |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$153.20
|
| Rate for Payer: BCN Commercial |
$145.76
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$188.00
|
| Rate for Payer: Healthscope Whirlpool |
$182.36
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: ASR Commercial |
$182.36
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$153.95
|
| Rate for Payer: BCN Commercial |
$145.76
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$188.00
|
| Rate for Payer: Healthscope Whirlpool |
$182.36
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.73
|
| Rate for Payer: Priority Health Narrow Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
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 |
$1.27
|
| 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 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$158.58
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$158.58 |
| Rate for Payer: Aetna Commercial |
$142.72
|
| Rate for Payer: ASR ASR |
$153.82
|
| Rate for Payer: ASR Commercial |
$153.82
|
| Rate for Payer: BCBS Trust/PPO |
$129.23
|
| Rate for Payer: BCN Commercial |
$122.95
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$149.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.86
|
| Rate for Payer: Healthscope Commercial |
$158.58
|
| Rate for Payer: Healthscope Whirlpool |
$153.82
|
| Rate for Payer: Mclaren Commercial |
$142.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.79
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.55
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$158.58
|
|
|
Service Code
|
NDC 63323018410
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$158.58 |
| Rate for Payer: Aetna Commercial |
$142.72
|
| Rate for Payer: Aetna Medicare |
$79.29
|
| Rate for Payer: ASR ASR |
$153.82
|
| Rate for Payer: ASR Commercial |
$153.82
|
| Rate for Payer: BCBS Complete |
$63.43
|
| Rate for Payer: BCBS Trust/PPO |
$129.86
|
| Rate for Payer: BCN Commercial |
$122.95
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$149.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.86
|
| Rate for Payer: Healthscope Commercial |
$158.58
|
| Rate for Payer: Healthscope Whirlpool |
$153.82
|
| Rate for Payer: Mclaren Commercial |
$142.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.79
|
| Rate for Payer: Nomi Health Commercial |
$130.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.95
|
| Rate for Payer: Priority Health Narrow Network |
$111.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.55
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: ASR Commercial |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$168.24
|
| Rate for Payer: BCN Commercial |
$160.07
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$206.46
|
| Rate for Payer: Healthscope Whirlpool |
$200.27
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: ASR Commercial |
$200.27
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS Trust/PPO |
$169.07
|
| Rate for Payer: BCN Commercial |
$160.07
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$206.46
|
| Rate for Payer: Healthscope Whirlpool |
$200.27
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.90
|
| Rate for Payer: Priority Health Narrow Network |
$144.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: ASR Commercial |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$168.24
|
| Rate for Payer: BCN Commercial |
$160.07
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$206.46
|
| Rate for Payer: Healthscope Whirlpool |
$200.27
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$174.82
|
| Rate for Payer: ASR ASR |
$188.42
|
| Rate for Payer: ASR Commercial |
$188.42
|
| Rate for Payer: BCBS Trust/PPO |
$158.29
|
| Rate for Payer: BCN Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$194.25
|
| Rate for Payer: Healthscope Whirlpool |
$188.42
|
| Rate for Payer: Mclaren Commercial |
$174.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.94
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: ASR Commercial |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$168.24
|
| Rate for Payer: BCN Commercial |
$160.07
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$206.46
|
| Rate for Payer: Healthscope Whirlpool |
$200.27
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
