|
FLUOXETINE HCL 20 MG PO CAPS [10070]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
00904734661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
FLUOXETINE HCL 20 MG PO CAPS [10070]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
00904578561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Brighton Health Commercial |
$1.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.61
|
|
|
FLUOXYMESTERONE 10 MG TAB
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41644052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
FLUOXYMESTERONE 10 MG TAB
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41654052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
FLUPHENAZINE 10 MG TAB
|
Facility
|
OP
|
$0.39
|
|
| Hospital Charge Code |
41641187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
FLUPHENAZINE 10 MG TAB
|
Facility
|
OP
|
$0.39
|
|
| Hospital Charge Code |
41651187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
FLUPHENAZINE 1 MG TAB
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
41642602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
FLUPHENAZINE 1 MG TAB
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
41652602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
FLUPHENAZINE 2.5MG 5ML ELIXIR
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41658043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 2.5MG/5ML ELIXIR
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41648043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 2.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650778
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 2.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640778
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 5 MG/ML ELIXIR
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 5 MG/ML ELIXIR
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]
|
Facility
|
OP
|
$32.34
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
42023012989
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$25.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$24.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.99
|
| Rate for Payer: Group Health Inc Commercial |
$16.17
|
| Rate for Payer: Group Health Inc Medicare |
$11.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.02
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
42023012901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$14.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.73
|
| Rate for Payer: Group Health Inc Commercial |
$9.36
|
| Rate for Payer: Group Health Inc Medicare |
$6.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.17
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
55150026705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.48
|
| Rate for Payer: Group Health Inc Commercial |
$18.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.40
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]
|
Facility
|
OP
|
$37.19
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
67457035959
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$27.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.29
|
| Rate for Payer: Group Health Inc Commercial |
$18.60
|
| Rate for Payer: Group Health Inc Medicare |
$13.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.17
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
00143952901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$21.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.75
|
| Rate for Payer: Group Health Inc Commercial |
$14.52
|
| Rate for Payer: Group Health Inc Medicare |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.88
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML
|
Facility
|
IP
|
$146.46
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
41640342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$73.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.23
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML
|
Facility
|
OP
|
$146.46
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
41640342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$87.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$84.21
|
| Rate for Payer: Group Health Inc Commercial |
$73.23
|
| Rate for Payer: Group Health Inc Medicare |
$51.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.30
|
| Rate for Payer: SOMOS Essential |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.20
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML
|
Facility
|
IP
|
$146.46
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
41650342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$73.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.23
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML
|
Facility
|
OP
|
$146.46
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
41650342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
| Rate for Payer: Aetna Government |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$87.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$84.21
|
| Rate for Payer: Group Health Inc Commercial |
$73.23
|
| Rate for Payer: Group Health Inc Medicare |
$51.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.30
|
| Rate for Payer: SOMOS Essential |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.20
|
|
