|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 0527179001
|
| Hospital Charge Code |
0527179001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna Government |
$4.60
|
| Rate for Payer: Brighton Health Commercial |
$6.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.26
|
| Rate for Payer: EmblemHealth Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Medicare |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.98
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
NDC 5167242351
|
| Hospital Charge Code |
5167242351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 0527179001
|
| Hospital Charge Code |
0527179001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 2497913801
|
| Hospital Charge Code |
2497913801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
NDC 0904715961
|
| Hospital Charge Code |
0904715961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.11
|
| Rate for Payer: Aetna Government |
$6.11
|
| Rate for Payer: Brighton Health Commercial |
$9.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.31
|
| Rate for Payer: EmblemHealth Commercial |
$6.11
|
| Rate for Payer: Group Health Inc Commercial |
$6.11
|
| Rate for Payer: Group Health Inc Medicare |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.94
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 2497913801
|
| Hospital Charge Code |
2497913801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna Government |
$4.60
|
| Rate for Payer: Brighton Health Commercial |
$6.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.26
|
| Rate for Payer: EmblemHealth Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Medicare |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.98
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
NDC 5167242351
|
| Hospital Charge Code |
5167242351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.87
|
| Rate for Payer: Aetna Government |
$0.87
|
| Rate for Payer: Brighton Health Commercial |
$1.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.13
|
|
|
FLUTAMIDE 125 MG PO CAPS
|
Facility
|
IP
|
$35.94
|
|
|
Service Code
|
NDC 8072560018
|
| Hospital Charge Code |
8072560018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$17.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.97
|
|
|
FLUTAMIDE 125 MG PO CAPS
|
Facility
|
OP
|
$35.94
|
|
|
Service Code
|
NDC 8072560018
|
| Hospital Charge Code |
8072560018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$28.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.97
|
| Rate for Payer: Aetna Government |
$17.97
|
| Rate for Payer: Brighton Health Commercial |
$26.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.44
|
| Rate for Payer: EmblemHealth Commercial |
$17.97
|
| Rate for Payer: Group Health Inc Commercial |
$17.97
|
| Rate for Payer: Group Health Inc Medicare |
$12.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.36
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$5.33
|
|
|
Service Code
|
NDC 6043226415
|
| Hospital Charge Code |
6043226415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$5.33
|
|
|
Service Code
|
NDC 6050508291
|
| Hospital Charge Code |
6050508291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
NDC 6043226415
|
| Hospital Charge Code |
6043226415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.66
|
| Rate for Payer: Aetna Government |
$2.66
|
| Rate for Payer: Brighton Health Commercial |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.62
|
| Rate for Payer: EmblemHealth Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.46
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$5.83
|
|
|
Service Code
|
NDC 0054327099
|
| Hospital Charge Code |
0054327099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.92
|
| Rate for Payer: Aetna Government |
$2.92
|
| Rate for Payer: Brighton Health Commercial |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.97
|
| Rate for Payer: EmblemHealth Commercial |
$2.92
|
| Rate for Payer: Group Health Inc Commercial |
$2.92
|
| Rate for Payer: Group Health Inc Medicare |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.79
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 0536118399
|
| Hospital Charge Code |
0536118399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$5.27
|
|
|
Service Code
|
NDC 5038370016
|
| Hospital Charge Code |
5038370016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.63
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 7000001101
|
| Hospital Charge Code |
7000001101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
NDC 6050508291
|
| Hospital Charge Code |
6050508291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.66
|
| Rate for Payer: Aetna Government |
$2.66
|
| Rate for Payer: Brighton Health Commercial |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.62
|
| Rate for Payer: EmblemHealth Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.46
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
IP
|
$5.83
|
|
|
Service Code
|
NDC 0054327099
|
| Hospital Charge Code |
0054327099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 7000001101
|
| Hospital Charge Code |
7000001101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.61
|
| Rate for Payer: Aetna Government |
$0.61
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.83
|
| Rate for Payer: EmblemHealth Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.79
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$5.27
|
|
|
Service Code
|
NDC 5038370016
|
| Hospital Charge Code |
5038370016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.63
|
| Rate for Payer: Aetna Government |
$2.63
|
| Rate for Payer: Brighton Health Commercial |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.58
|
| Rate for Payer: EmblemHealth Commercial |
$2.63
|
| Rate for Payer: Group Health Inc Commercial |
$2.63
|
| Rate for Payer: Group Health Inc Medicare |
$1.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.43
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 0536118399
|
| Hospital Charge Code |
0536118399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
FOLIC ACID 1 MG PO TABS
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 5462912800
|
| Hospital Charge Code |
5462912800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FOLIC ACID 1 MG PO TABS
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6931512710
|
| Hospital Charge Code |
6931512710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
FOLIC ACID 1 MG PO TABS
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 0904722461
|
| Hospital Charge Code |
0904722461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
FOLIC ACID 1 MG PO TABS
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 5374636110
|
| Hospital Charge Code |
5374636110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
