|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5723715035
|
| Hospital Charge Code |
5723715035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 0049345019
|
| Hospital Charge Code |
0049345019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: EmblemHealth Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 1671469601
|
| Hospital Charge Code |
1671469601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$2.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.52
|
| Rate for Payer: EmblemHealth Commercial |
$1.85
|
| Rate for Payer: Group Health Inc Commercial |
$1.85
|
| Rate for Payer: Group Health Inc Medicare |
$1.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.40
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 5976250301
|
| Hospital Charge Code |
5976250301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Government |
$1.79
|
| Rate for Payer: Brighton Health Commercial |
$2.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.44
|
| Rate for Payer: EmblemHealth Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 1671469601
|
| Hospital Charge Code |
1671469601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 0049345019
|
| Hospital Charge Code |
0049345019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 5976250301
|
| Hospital Charge Code |
5976250301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
|
|
FLUCONAZOLE 40 MG/ML PO SUSR
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5723715035
|
| Hospital Charge Code |
5723715035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.86
|
| Rate for Payer: Aetna Government |
$1.86
|
| Rate for Payer: Brighton Health Commercial |
$2.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.42
|
|
|
FLUCONAZOLE 50 MG PO TABS
|
Facility
|
OP
|
$5.60
|
|
|
Service Code
|
NDC 6846210130
|
| Hospital Charge Code |
6846210130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.80
|
| Rate for Payer: Aetna Government |
$2.80
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.81
|
| Rate for Payer: EmblemHealth Commercial |
$2.80
|
| Rate for Payer: Group Health Inc Commercial |
$2.80
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.64
|
|
|
FLUCONAZOLE 50 MG PO TABS
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 6846210130
|
| Hospital Charge Code |
6846210130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.80
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
2502118482
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409468818
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
6978400206
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409343501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
2502118482
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409343501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409468818
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
6978400206
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409432101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409468812
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409468812
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
6978400306
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
6978400306
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
0409432101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
FLUCONAZOLE IV SYRINGE 2 MG/ML (NEO/PED)
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0338604648
|
| Hospital Charge Code |
0338604648
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
