|
FLOUROURACIL 500MG/10ML INJ
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41650748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: SOMOS Essential |
$3.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
FLOUROURACIL 500MG/10ML INJ
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41650748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
FLOW COUPLER 4MM
|
Facility
OP
|
$2,237.50
|
|
| Hospital Charge Code |
64904351
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$783.12 |
| Max. Negotiated Rate |
$1,790.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,230.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,118.75
|
| Rate for Payer: Aetna Government |
$1,118.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,790.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,521.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,118.75
|
| Rate for Payer: Group Health Inc Medicare |
$783.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,118.75
|
|
|
FLOWCYTOMETRY/READ 16 & >
|
Facility
OP
|
$212.96
|
|
|
Service Code
|
HCPCS 88189
|
| Hospital Charge Code |
30305420
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$117.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.82
|
| Rate for Payer: Aetna Government |
$68.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.52
|
| Rate for Payer: Group Health Inc Commercial |
$106.48
|
| Rate for Payer: Group Health Inc Medicare |
$74.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.02
|
|
|
FLOWTRON STOCKING
|
Facility
OP
|
$73.35
|
|
| Hospital Charge Code |
40204880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$58.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.68
|
| Rate for Payer: Aetna Government |
$36.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.88
|
| Rate for Payer: Group Health Inc Commercial |
$36.68
|
| Rate for Payer: Group Health Inc Medicare |
$25.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.68
|
|
|
FLOW VOL LOOP
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94375 TC
|
| Hospital Charge Code |
40402708
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.94
|
|
|
FL SMALL BOWEL SERIES
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74250 TC
|
| Hospital Charge Code |
41102122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.70
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.33
|
|
|
FLUARIX QUAD 0.5ML SYR
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41658165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
FLUARIX QUAD 0.5ML SYR
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41658165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
FLUARIX QUAD (VFC) 0.5ML SYR
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41658155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
FLUARIX QUAD (VFC) 0.5ML SYR
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41658155
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FLUCONAZOLE 100 MG/50 ML IVPB PREMIX
|
Facility
OP
|
$24.88
|
|
| Hospital Charge Code |
41645351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.44
|
| Rate for Payer: Aetna Government |
$12.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.92
|
| Rate for Payer: Group Health Inc Commercial |
$12.44
|
| Rate for Payer: Group Health Inc Medicare |
$8.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.17
|
|
|
FLUCONAZOLE 100 MG/50 ML IVPB PREMIX
|
Facility
OP
|
$24.88
|
|
| Hospital Charge Code |
41655351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.44
|
| Rate for Payer: Aetna Government |
$12.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.92
|
| Rate for Payer: Group Health Inc Commercial |
$12.44
|
| Rate for Payer: Group Health Inc Medicare |
$8.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.17
|
|
|
FLUCONAZOLE 100 MG TAB
|
Facility
OP
|
$0.25
|
|
| Hospital Charge Code |
41643754
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
FLUCONAZOLE 100 MG TAB
|
Facility
OP
|
$0.25
|
|
| Hospital Charge Code |
41653754
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
FLUCONAZOLE 10 MG/ML SUSP
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41654987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
|
|
FLUCONAZOLE 10 MG/ML SUSP
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41644987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
|
|
FLUCONAZOLE 150 MG TAB
|
Facility
OP
|
$0.89
|
|
| Hospital Charge Code |
41653755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
FLUCONAZOLE 150 MG TAB
|
Facility
OP
|
$0.89
|
|
| Hospital Charge Code |
41643755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
FLUCONAZOLE 200 MG/100 ML IVPB PREMIX
|
Facility
OP
|
$7.64
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
41644547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.94
|
| Rate for Payer: SOMOS Essential |
$2.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.97
|
|
|
FLUCONAZOLE 200 MG/100 ML IVPB PREMIX
|
Facility
IP
|
$7.64
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
41644547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
|
|
FLUCONAZOLE 200 MG/100 ML IVPB PREMIX
|
Facility
IP
|
$7.64
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
41654547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
|
|
FLUCONAZOLE 200 MG/100 ML IVPB PREMIX
|
Facility
OP
|
$7.64
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
41654547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.94
|
| Rate for Payer: SOMOS Essential |
$2.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.97
|
|
|
FLUCONAZOLE 200 MG TAB
|
Facility
OP
|
$0.35
|
|
| Hospital Charge Code |
41643756
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
FLUCONAZOLE 200 MG TAB
|
Facility
OP
|
$0.35
|
|
| Hospital Charge Code |
41653756
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
