|
FLUOROMETHOLONE 0.1% OPHTHALMIC SUSP
|
Facility
OP
|
$16.68
|
|
| Hospital Charge Code |
41654083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.34
|
| Rate for Payer: Aetna Government |
$8.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.34
|
| Rate for Payer: Group Health Inc Commercial |
$8.34
|
| Rate for Payer: Group Health Inc Medicare |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.84
|
|
|
FLUOROURACIL 1000 MG/20 ML INJ
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41643744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
FLUOROURACIL 1000 MG/20 ML INJ
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41653744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| 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 |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| 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 |
$5.85
|
|
|
FLUOROURACIL 1000 MG/20 ML INJ
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41643744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| 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 |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| 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 |
$5.85
|
|
|
FLUOROURACIL 1000 MG/20 ML INJ
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41653744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
FLUOROURACIL 2500 MG/50 ML INJ
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41642373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| 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 |
$6.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| 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 |
$8.45
|
|
|
FLUOROURACIL 2500 MG/50 ML INJ
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41652373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| 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 |
$6.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| 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 |
$8.45
|
|
|
FLUOROURACIL 2500 MG/50 ML INJ
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41642373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
|
|
FLUOROURACIL 2500 MG/50 ML INJ
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41652373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
|
|
FLUOROURACIL 5000 MG/100 ML INJ
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41643616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| 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 |
$12.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| 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 |
$16.25
|
|
|
FLUOROURACIL 5000 MG/100 ML INJ
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41643616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
FLUOROURACIL 5000 MG/100 ML INJ
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41653616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
FLUOROURACIL 5000 MG/100 ML INJ
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41653616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| 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 |
$12.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| 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 |
$16.25
|
|
|
FLUOROURACIL 500 MG/10 ML INJ
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41642875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
FLUOROURACIL 500 MG/10 ML INJ
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41642875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| 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 |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| 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 |
$7.80
|
|
|
FLUOROURACIL 500 MG/10 ML INJ
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41652875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| 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 |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| 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 |
$7.80
|
|
|
FLUOROURACIL 500 MG/10 ML INJ
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
41652875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
FLUOROURACIL CR 5% CREAM
|
Facility
OP
|
$643.48
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
41650316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.22 |
| Max. Negotiated Rate |
$418.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$353.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$321.74
|
| Rate for Payer: Aetna Government |
$321.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$370.00
|
| Rate for Payer: Group Health Inc Commercial |
$321.74
|
| Rate for Payer: Group Health Inc Medicare |
$225.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.26
|
|
|
FLUOROURACIL CR 5% CREAM
|
Facility
IP
|
$643.48
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
41640316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$321.74 |
| Max. Negotiated Rate |
$321.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.74
|
|
|
FLUOROURACIL CR 5% CREAM
|
Facility
IP
|
$643.48
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
41650316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$321.74 |
| Max. Negotiated Rate |
$321.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.74
|
|
|
FLUOROURACIL CR 5% CREAM
|
Facility
OP
|
$643.48
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
41640316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.22 |
| Max. Negotiated Rate |
$418.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$353.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$321.74
|
| Rate for Payer: Aetna Government |
$321.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$370.00
|
| Rate for Payer: Group Health Inc Commercial |
$321.74
|
| Rate for Payer: Group Health Inc Medicare |
$225.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.26
|
|
|
FLUOXETINE 10 MG CAP
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41653787
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUOXETINE 10 MG CAP
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41643787
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUOXETINE 20 MG/5 ML LIQUID
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41652454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FLUOXETINE 20 MG/5 ML LIQUID
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41642454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
