Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION

Facility

$124.88

Service Code	HCPCS J9190
Hospital Charge Code	82204
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$112.39
Rate for Payer: Aetna Commercial	$106.15
Rate for Payer: Aetna Commercial	$225.83
Rate for Payer: Aetna Commercial	$245.01
Rate for Payer: Aetna New Business (MI Preferred)	$172.69
Rate for Payer: Aetna New Business (MI Preferred)	$81.17
Rate for Payer: Aetna New Business (MI Preferred)	$187.36
Rate for Payer: BCBS Complete	$49.95
Rate for Payer: BCBS Complete	$106.27
Rate for Payer: BCBS Complete	$115.30
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: Cash Price	$230.60
Rate for Payer: Cash Price	$212.54
Rate for Payer: Cash Price	$212.54
Rate for Payer: Cash Price	$230.60
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cofinity Commercial	$87.42
Rate for Payer: Cofinity Commercial	$185.98
Rate for Payer: Cofinity Commercial	$228.48
Rate for Payer: Cofinity Commercial	$107.40
Rate for Payer: Cofinity Commercial	$247.90
Rate for Payer: Cofinity Commercial	$201.78
Rate for Payer: Healthscope Commercial	$239.11
Rate for Payer: Healthscope Commercial	$259.42
Rate for Payer: Healthscope Commercial	$112.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$245.01
Rate for Payer: PHP Commercial	$245.01
Rate for Payer: PHP Commercial	$225.83
Rate for Payer: PHP Commercial	$106.15
Rate for Payer: Priority Health Cigna Priority Health	$185.98
Rate for Payer: Priority Health Cigna Priority Health	$87.42
Rate for Payer: Priority Health Cigna Priority Health	$201.78
Rate for Payer: Priority Health SBD	$167.38
Rate for Payer: Priority Health SBD	$181.60
Rate for Payer: Priority Health SBD	$78.67

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION

Facility

$269.58

Service Code	HCPCS J9190
Hospital Charge Code	82180
Hospital Revenue Code	636
Min. Negotiated Rate	$169.84
Max. Negotiated Rate	$242.62
Rate for Payer: Aetna Commercial	$229.14
Rate for Payer: Aetna Commercial	$240.46
Rate for Payer: Aetna New Business (MI Preferred)	$183.88
Rate for Payer: Aetna New Business (MI Preferred)	$175.23
Rate for Payer: Cash Price	$226.32
Rate for Payer: Cash Price	$215.66
Rate for Payer: Cofinity Commercial	$231.84
Rate for Payer: Cofinity Commercial	$198.03
Rate for Payer: Cofinity Commercial	$243.29
Rate for Payer: Cofinity Commercial	$188.71
Rate for Payer: Healthscope Commercial	$254.61
Rate for Payer: Healthscope Commercial	$242.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$240.46
Rate for Payer: PHP Commercial	$229.14
Rate for Payer: PHP Commercial	$240.46
Rate for Payer: Priority Health Cigna Priority Health	$198.03
Rate for Payer: Priority Health Cigna Priority Health	$188.71
Rate for Payer: Priority Health SBD	$169.84
Rate for Payer: Priority Health SBD	$178.23

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION

Facility

$269.58

Service Code	HCPCS J9190
Hospital Charge Code	82180
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$242.62
Rate for Payer: Aetna Commercial	$229.14
Rate for Payer: Aetna New Business (MI Preferred)	$175.23
Rate for Payer: BCBS Complete	$107.83
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: Cash Price	$215.66
Rate for Payer: Cash Price	$215.66
Rate for Payer: Cofinity Commercial	$188.71
Rate for Payer: Cofinity Commercial	$231.84
Rate for Payer: Healthscope Commercial	$242.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.14
Rate for Payer: PHP Commercial	$229.14
Rate for Payer: Priority Health Cigna Priority Health	$188.71
Rate for Payer: Priority Health SBD	$169.84

FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION

Facility

$130.18

Service Code	HCPCS J9190
Hospital Charge Code	82200
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$117.16
Rate for Payer: Aetna Commercial	$110.65
Rate for Payer: Aetna New Business (MI Preferred)	$84.62
Rate for Payer: BCBS Complete	$52.07
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: Cash Price	$104.14
Rate for Payer: Cash Price	$104.14
Rate for Payer: Cofinity Commercial	$111.95
Rate for Payer: Cofinity Commercial	$91.13
Rate for Payer: Healthscope Commercial	$117.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$110.65
Rate for Payer: PHP Commercial	$110.65
Rate for Payer: Priority Health Cigna Priority Health	$91.13
Rate for Payer: Priority Health SBD	$82.01

FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION

Facility

$130.18

Service Code	HCPCS J9190
Hospital Charge Code	82200
Hospital Revenue Code	636
Min. Negotiated Rate	$82.01
Max. Negotiated Rate	$117.16
Rate for Payer: Aetna Commercial	$110.65
Rate for Payer: Aetna New Business (MI Preferred)	$84.62
Rate for Payer: Cash Price	$104.14
Rate for Payer: Cofinity Commercial	$111.95
Rate for Payer: Cofinity Commercial	$91.13
Rate for Payer: Healthscope Commercial	$117.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$110.65
Rate for Payer: PHP Commercial	$110.65
Rate for Payer: Priority Health Cigna Priority Health	$91.13
Rate for Payer: Priority Health SBD	$82.01

FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION

Facility

$3,556.30

Service Code	HCPCS J9190
Hospital Charge Code	98249
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$3,200.67
Rate for Payer: Aetna Commercial	$3,022.86
Rate for Payer: Aetna Commercial	$845.16
Rate for Payer: Aetna Commercial	$1,311.80
Rate for Payer: Aetna Commercial	$2,862.12
Rate for Payer: Aetna New Business (MI Preferred)	$646.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,188.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,003.14
Rate for Payer: Aetna New Business (MI Preferred)	$2,311.60
Rate for Payer: BCBS Complete	$1,346.88
Rate for Payer: BCBS Complete	$617.32
Rate for Payer: BCBS Complete	$1,422.52
Rate for Payer: BCBS Complete	$397.72
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: BCBS Trust/PPO	$9.50
Rate for Payer: Cash Price	$1,234.64
Rate for Payer: Cash Price	$2,693.76
Rate for Payer: Cash Price	$1,234.64
Rate for Payer: Cash Price	$795.44
Rate for Payer: Cash Price	$2,693.76
Rate for Payer: Cash Price	$2,845.04
Rate for Payer: Cash Price	$2,845.04
Rate for Payer: Cash Price	$795.44
Rate for Payer: Cofinity Commercial	$1,080.31
Rate for Payer: Cofinity Commercial	$696.01
Rate for Payer: Cofinity Commercial	$855.10
Rate for Payer: Cofinity Commercial	$1,327.24
Rate for Payer: Cofinity Commercial	$2,357.04
Rate for Payer: Cofinity Commercial	$2,895.79
Rate for Payer: Cofinity Commercial	$2,489.41
Rate for Payer: Cofinity Commercial	$3,058.42
Rate for Payer: Healthscope Commercial	$1,388.97
Rate for Payer: Healthscope Commercial	$3,030.48
Rate for Payer: Healthscope Commercial	$3,200.67
Rate for Payer: Healthscope Commercial	$894.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,311.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,022.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$845.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,862.12
Rate for Payer: PHP Commercial	$2,862.12
Rate for Payer: PHP Commercial	$3,022.86
Rate for Payer: PHP Commercial	$845.16
Rate for Payer: PHP Commercial	$1,311.80
Rate for Payer: Priority Health Cigna Priority Health	$1,080.31
Rate for Payer: Priority Health Cigna Priority Health	$2,357.04
Rate for Payer: Priority Health Cigna Priority Health	$2,489.41
Rate for Payer: Priority Health Cigna Priority Health	$696.01
Rate for Payer: Priority Health SBD	$2,240.47
Rate for Payer: Priority Health SBD	$2,121.34
Rate for Payer: Priority Health SBD	$972.28
Rate for Payer: Priority Health SBD	$626.41

FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION

Facility

$994.30

Service Code	HCPCS J9190
Hospital Charge Code	98249
Hospital Revenue Code	636
Min. Negotiated Rate	$626.41
Max. Negotiated Rate	$894.87
Rate for Payer: Aetna Commercial	$845.16
Rate for Payer: Aetna Commercial	$1,311.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,003.14
Rate for Payer: Aetna New Business (MI Preferred)	$646.30
Rate for Payer: Cash Price	$795.44
Rate for Payer: Cash Price	$1,234.64
Rate for Payer: Cofinity Commercial	$1,327.24
Rate for Payer: Cofinity Commercial	$696.01
Rate for Payer: Cofinity Commercial	$855.10
Rate for Payer: Cofinity Commercial	$1,080.31
Rate for Payer: Healthscope Commercial	$894.87
Rate for Payer: Healthscope Commercial	$1,388.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$845.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,311.80
Rate for Payer: PHP Commercial	$1,311.80
Rate for Payer: PHP Commercial	$845.16
Rate for Payer: Priority Health Cigna Priority Health	$1,080.31
Rate for Payer: Priority Health Cigna Priority Health	$696.01
Rate for Payer: Priority Health SBD	$626.41
Rate for Payer: Priority Health SBD	$972.28

FLUOXETINE 10 MG CAPSULE

Facility

$19.04

Service Code	NDC 0904-5784-61
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$16.18
Rate for Payer: Aetna New Business (MI Preferred)	$12.38
Rate for Payer: Cash Price	$15.23
Rate for Payer: Cofinity Commercial	$13.33
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Healthscope Commercial	$17.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.18
Rate for Payer: PHP Commercial	$16.18
Rate for Payer: Priority Health Cigna Priority Health	$13.33
Rate for Payer: Priority Health SBD	$12.00

FLUOXETINE 20 MG CAPSULE

Facility

$20.68

Service Code	NDC 0904-5785-61
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$18.61
Rate for Payer: Aetna Commercial	$17.58
Rate for Payer: Aetna New Business (MI Preferred)	$13.44
Rate for Payer: Cash Price	$16.54
Rate for Payer: Cofinity Commercial	$14.48
Rate for Payer: Cofinity Commercial	$17.78
Rate for Payer: Healthscope Commercial	$18.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.58
Rate for Payer: PHP Commercial	$17.58
Rate for Payer: Priority Health Cigna Priority Health	$14.48
Rate for Payer: Priority Health SBD	$13.03

FLUOXETINE 20 MG CAPSULE

Facility

$2.85

Service Code	NDC 68084-605-11
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.42
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$2.00
Rate for Payer: Priority Health SBD	$1.80

FLUOXETINE 20 MG CAPSULE

Facility

$115.15

Service Code	NDC 23155-029-01
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Commercial	$80.60
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.88
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health Cigna Priority Health	$80.60
Rate for Payer: Priority Health SBD	$72.54

FLUOXETINE 20 MG CAPSULE

Facility

$129.25

Service Code	NDC 50111-648-01
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$116.32
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.48
Rate for Payer: Healthscope Commercial	$116.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$90.48
Rate for Payer: Priority Health SBD	$81.43

FLUOXETINE 20 MG CAPSULE

Facility

$284.35

Service Code	NDC 68084-605-01
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$179.14
Max. Negotiated Rate	$255.92
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Commercial	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Healthscope Commercial	$255.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$241.70
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health Cigna Priority Health	$199.04
Rate for Payer: Priority Health SBD	$179.14

FLUOXETINE 20 MG CAPSULE

Facility

$56.40

Service Code	NDC 65862-193-01
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$35.53
Max. Negotiated Rate	$50.76
Rate for Payer: Aetna Commercial	$47.94
Rate for Payer: Aetna New Business (MI Preferred)	$36.66
Rate for Payer: Cash Price	$45.12
Rate for Payer: Cofinity Commercial	$39.48
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Healthscope Commercial	$50.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.94
Rate for Payer: PHP Commercial	$47.94
Rate for Payer: Priority Health Cigna Priority Health	$39.48
Rate for Payer: Priority Health SBD	$35.53

FLUPHENAZINE 10 MG TABLET

Facility

$969.22

Service Code	NDC 50268-369-15
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$610.61
Max. Negotiated Rate	$872.30
Rate for Payer: Aetna Commercial	$823.84
Rate for Payer: Aetna New Business (MI Preferred)	$629.99
Rate for Payer: Cash Price	$775.38
Rate for Payer: Cofinity Commercial	$678.45
Rate for Payer: Cofinity Commercial	$833.53
Rate for Payer: Healthscope Commercial	$872.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$823.84
Rate for Payer: PHP Commercial	$823.84
Rate for Payer: Priority Health Cigna Priority Health	$678.45
Rate for Payer: Priority Health SBD	$610.61

FLUPHENAZINE 10 MG TABLET

Facility

$19.39

Service Code	NDC 50268-369-11
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$17.45
Rate for Payer: Aetna Commercial	$16.48
Rate for Payer: Aetna New Business (MI Preferred)	$12.60
Rate for Payer: Cash Price	$15.51
Rate for Payer: Cofinity Commercial	$13.57
Rate for Payer: Cofinity Commercial	$16.68
Rate for Payer: Healthscope Commercial	$17.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.48
Rate for Payer: PHP Commercial	$16.48
Rate for Payer: Priority Health Cigna Priority Health	$13.57
Rate for Payer: Priority Health SBD	$12.22

FLUPHENAZINE 1 MG TABLET

Facility

$3.35

Service Code	NDC 51079-485-01
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.18
Rate for Payer: Cash Price	$2.68
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Healthscope Commercial	$3.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.85
Rate for Payer: PHP Commercial	$2.85
Rate for Payer: Priority Health Cigna Priority Health	$2.34
Rate for Payer: Priority Health SBD	$2.11

FLUPHENAZINE 1 MG TABLET

Facility

$669.12

Service Code	NDC 0527-1788-01
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$421.55
Max. Negotiated Rate	$602.21
Rate for Payer: Aetna Commercial	$568.75
Rate for Payer: Aetna New Business (MI Preferred)	$434.93
Rate for Payer: Cash Price	$535.30
Rate for Payer: Cofinity Commercial	$468.38
Rate for Payer: Cofinity Commercial	$575.44
Rate for Payer: Healthscope Commercial	$602.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$568.75
Rate for Payer: PHP Commercial	$568.75
Rate for Payer: Priority Health Cigna Priority Health	$468.38
Rate for Payer: Priority Health SBD	$421.55

FLUPHENAZINE 2.5 MG TABLET

Facility

$621.97

Service Code	NDC 50268-367-15
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$391.84
Max. Negotiated Rate	$559.77
Rate for Payer: Aetna Commercial	$528.67
Rate for Payer: Aetna New Business (MI Preferred)	$404.28
Rate for Payer: Cash Price	$497.58
Rate for Payer: Cofinity Commercial	$435.38
Rate for Payer: Cofinity Commercial	$534.89
Rate for Payer: Healthscope Commercial	$559.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$528.67
Rate for Payer: PHP Commercial	$528.67
Rate for Payer: Priority Health Cigna Priority Health	$435.38
Rate for Payer: Priority Health SBD	$391.84

FLUPHENAZINE 2.5 MG TABLET

Facility

$12.44

Service Code	NDC 50268-367-11
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna Commercial	$10.57
Rate for Payer: Aetna New Business (MI Preferred)	$8.09
Rate for Payer: Cash Price	$9.95
Rate for Payer: Cofinity Commercial	$10.70
Rate for Payer: Cofinity Commercial	$8.71
Rate for Payer: Healthscope Commercial	$11.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.57
Rate for Payer: PHP Commercial	$10.57
Rate for Payer: Priority Health Cigna Priority Health	$8.71
Rate for Payer: Priority Health SBD	$7.84

FLUPHENAZINE 5 MG TABLET

Facility

$1,209.53

Service Code	NDC 0904-7159-61
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$1,088.58
Rate for Payer: Aetna Commercial	$1,028.10
Rate for Payer: Aetna New Business (MI Preferred)	$786.19
Rate for Payer: Cash Price	$967.62
Rate for Payer: Cofinity Commercial	$1,040.20
Rate for Payer: Cofinity Commercial	$846.67
Rate for Payer: Healthscope Commercial	$1,088.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,028.10
Rate for Payer: PHP Commercial	$1,028.10
Rate for Payer: Priority Health Cigna Priority Health	$846.67
Rate for Payer: Priority Health SBD	$762.00

FLUPHENAZINE 5 MG TABLET

Facility

$1,080.40

Service Code	NDC 0527-1790-01
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$680.65
Max. Negotiated Rate	$972.36
Rate for Payer: Aetna Commercial	$918.34
Rate for Payer: Aetna New Business (MI Preferred)	$702.26
Rate for Payer: Cash Price	$864.32
Rate for Payer: Cofinity Commercial	$756.28
Rate for Payer: Cofinity Commercial	$929.14
Rate for Payer: Healthscope Commercial	$972.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$918.34
Rate for Payer: PHP Commercial	$918.34
Rate for Payer: Priority Health Cigna Priority Health	$756.28
Rate for Payer: Priority Health SBD	$680.65

FLUPHENAZINE 5 MG TABLET

Facility

$36.87

Service Code	NDC 68084-846-11
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$23.23
Max. Negotiated Rate	$33.18
Rate for Payer: Aetna Commercial	$31.34
Rate for Payer: Aetna New Business (MI Preferred)	$23.97
Rate for Payer: Cash Price	$29.50
Rate for Payer: Cofinity Commercial	$31.71
Rate for Payer: Cofinity Commercial	$25.81
Rate for Payer: Healthscope Commercial	$33.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.34
Rate for Payer: PHP Commercial	$31.34
Rate for Payer: Priority Health Cigna Priority Health	$25.81
Rate for Payer: Priority Health SBD	$23.23

FLUPHENAZINE 5 MG TABLET

Facility

$3,686.68

Service Code	NDC 68084-846-01
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$2,322.61
Max. Negotiated Rate	$3,318.01
Rate for Payer: Aetna Commercial	$3,133.68
Rate for Payer: Aetna New Business (MI Preferred)	$2,396.34
Rate for Payer: Cash Price	$2,949.34
Rate for Payer: Cofinity Commercial	$2,580.68
Rate for Payer: Cofinity Commercial	$3,170.54
Rate for Payer: Healthscope Commercial	$3,318.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,133.68
Rate for Payer: PHP Commercial	$3,133.68
Rate for Payer: Priority Health Cigna Priority Health	$2,580.68
Rate for Payer: Priority Health SBD	$2,322.61

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION

Facility

$276.87

Service Code	HCPCS J2680
Hospital Charge Code	3215
Hospital Revenue Code	636
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$249.18
Rate for Payer: Aetna Commercial	$235.34
Rate for Payer: Aetna Commercial	$276.26
Rate for Payer: Aetna New Business (MI Preferred)	$211.26
Rate for Payer: Aetna New Business (MI Preferred)	$179.97
Rate for Payer: Cash Price	$221.50
Rate for Payer: Cash Price	$260.01
Rate for Payer: Cofinity Commercial	$193.81
Rate for Payer: Cofinity Commercial	$238.11
Rate for Payer: Cofinity Commercial	$227.51
Rate for Payer: Cofinity Commercial	$279.51
Rate for Payer: Healthscope Commercial	$292.51
Rate for Payer: Healthscope Commercial	$249.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$235.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$276.26
Rate for Payer: PHP Commercial	$235.34
Rate for Payer: PHP Commercial	$276.26
Rate for Payer: Priority Health Cigna Priority Health	$227.51
Rate for Payer: Priority Health Cigna Priority Health	$193.81
Rate for Payer: Priority Health SBD	$174.43
Rate for Payer: Priority Health SBD	$204.76

Know your out-of-pocket cost for care.

All Charges