|
FLUPHENAZINE HCL 10 MG PO TABS [3219]
|
Facility
|
OP
|
$15.31
|
|
|
Service Code
|
NDC 00904716061
|
| Hospital Charge Code |
00904716061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.66
|
| Rate for Payer: Aetna Government |
$7.66
|
| Rate for Payer: Brighton Health Commercial |
$11.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.41
|
| Rate for Payer: Group Health Inc Commercial |
$7.66
|
| Rate for Payer: Group Health Inc Medicare |
$5.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.95
|
|
|
FLUPHENAZINE HCL 10 MG PO TABS [3219]
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 00527179101
|
| Hospital Charge Code |
00527179101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.80
|
| Rate for Payer: Aetna Government |
$5.80
|
| Rate for Payer: Brighton Health Commercial |
$8.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.89
|
| Rate for Payer: Group Health Inc Commercial |
$5.80
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.54
|
|
|
FLUPHENAZINE HCL 10 MG PO TABS [3219]
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 43598003701
|
| Hospital Charge Code |
43598003701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.80
|
| Rate for Payer: Aetna Government |
$5.80
|
| Rate for Payer: Brighton Health Commercial |
$8.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.89
|
| Rate for Payer: Group Health Inc Commercial |
$5.80
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.54
|
|
|
FLUPHENAZINE HCL 10 MG PO TABS [3219]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 51672423601
|
| Hospital Charge Code |
51672423601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.10
|
| Rate for Payer: Aetna Government |
$1.10
|
| Rate for Payer: Brighton Health Commercial |
$1.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.49
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.42
|
|
|
FLUPHENAZINE HCL 1 MG PO TABS [3218]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
NDC 00904715761
|
| Hospital Charge Code |
00904715761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.57
|
| Rate for Payer: Aetna Government |
$3.57
|
| Rate for Payer: Brighton Health Commercial |
$5.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.86
|
| Rate for Payer: Group Health Inc Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Medicare |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.64
|
|
|
FLUPHENAZINE HCL 1 MG PO TABS [3218]
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 69238167801
|
| Hospital Charge Code |
69238167801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.20
|
| Rate for Payer: Aetna Government |
$2.20
|
| Rate for Payer: Brighton Health Commercial |
$3.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.99
|
| Rate for Payer: Group Health Inc Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Medicare |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.85
|
|
|
FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN [3216]
|
Facility
|
OP
|
$23.05
|
|
|
Service Code
|
HCPCS J2679
|
| Hospital Charge Code |
63323028110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.52
|
| Rate for Payer: Aetna Government |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$17.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.67
|
| Rate for Payer: Group Health Inc Commercial |
$11.52
|
| Rate for Payer: Group Health Inc Medicare |
$8.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.98
|
|
|
FLUPHENAZINE HCL 2.5 MG/ML INJ
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
41645381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$103.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Government |
$64.50
|
| Rate for Payer: Brighton Health Commercial |
$96.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.72
|
| Rate for Payer: Group Health Inc Commercial |
$64.50
|
| Rate for Payer: Group Health Inc Medicare |
$45.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.85
|
|
|
FLUPHENAZINE HCL 2.5 MG/ML INJ
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
41655381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$103.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Government |
$64.50
|
| Rate for Payer: Brighton Health Commercial |
$96.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.72
|
| Rate for Payer: Group Health Inc Commercial |
$64.50
|
| Rate for Payer: Group Health Inc Medicare |
$45.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.85
|
|
|
FLUPHENAZINE HCL 2.5 MG PO TABS [3220]
|
Facility
|
OP
|
$6.80
|
|
|
Service Code
|
NDC 00527178901
|
| Hospital Charge Code |
00527178901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna Government |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$5.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Group Health Inc Commercial |
$3.40
|
| Rate for Payer: Group Health Inc Medicare |
$2.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.42
|
|
|
FLUPHENAZINE HCL 2.5 MG PO TABS [3220]
|
Facility
|
OP
|
$8.89
|
|
|
Service Code
|
NDC 00904715861
|
| Hospital Charge Code |
00904715861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.44
|
| Rate for Payer: Aetna Government |
$4.44
|
| Rate for Payer: Brighton Health Commercial |
$6.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.04
|
| Rate for Payer: Group Health Inc Commercial |
$4.44
|
| Rate for Payer: Group Health Inc Medicare |
$3.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
|
|
FLUPHENAZINE HCL 2.5 MG PO TABS [3220]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 51672423401
|
| Hospital Charge Code |
51672423401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.64
|
| Rate for Payer: Aetna Government |
$0.64
|
| Rate for Payer: Brighton Health Commercial |
$0.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
FLUPHENAZINE HCL 5 MG/ML PO CONC [3217]
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 00121065304
|
| Hospital Charge Code |
00121065304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.57
|
| Rate for Payer: Aetna Government |
$1.57
|
| Rate for Payer: Brighton Health Commercial |
$2.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.57
|
| Rate for Payer: Group Health Inc Medicare |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.04
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS [3221]
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
00904715961
|
|
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: 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 [3221]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
NDC 51672423501
|
| Hospital Charge Code |
51672423501
|
|
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: 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
|
|
|
FLUPHENAZINE HCL 5 MG PO TABS [3221]
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
00527179001
|
|
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: 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 [3221]
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 24979013801
|
| Hospital Charge Code |
24979013801
|
|
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: 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
|
|
|
FL UPPR GI TRACT
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Hospital Charge Code |
41102506
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL UPPR GI TRACT
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Hospital Charge Code |
41102506
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FLURBIPROFEN 0.03% OPHTHALMIC SOLN
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41640299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
FLURBIPROFEN 0.03% OPHTHALMIC SOLN
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41650299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
FL UROGRAPHY NFS DRIP&/BLS W/NF
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74415 TC
|
| Hospital Charge Code |
41102148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL UROGRAPHY NFS DRIP&/BLS W/NF
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74415 TC
|
| Hospital Charge Code |
41102148
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL UROGRAPHY NFS DRIP&/BOLUS
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74410 TC
|
| Hospital Charge Code |
41102140
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL UROGRAPHY NFS DRIP&/BOLUS
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74410 TC
|
| Hospital Charge Code |
41102140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
