Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLECAINIDE 50 MG TABLET

Facility

$4.26

Service Code	NDC 50268032011
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Advantage	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.19
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health SBD	$2.68

FLECAINIDE 50 MG TABLET

Facility

$256.32

Service Code	NDC 00054001020
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$161.48
Max. Negotiated Rate	$230.69
Rate for Payer: Aetna Commercial	$217.87
Rate for Payer: Aetna New Business (MI Preferred)	$166.61
Rate for Payer: Cash Price	$205.06
Rate for Payer: Cofinity Advantage	$179.42
Rate for Payer: Cofinity Commercial	$220.44
Rate for Payer: Encore Health Key Benefits Commercial	$205.06
Rate for Payer: Healthscope Commercial	$230.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$192.24
Rate for Payer: PHP Commercial	$217.87
Rate for Payer: Priority Health SBD	$161.48

FLECAINIDE 50 MG TABLET

Facility

$307.85

Service Code	NDC 53746064101
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$120.99
Max. Negotiated Rate	$277.06
Rate for Payer: Aetna Commercial	$261.67
Rate for Payer: Aetna Medicare	$153.93
Rate for Payer: Aetna New Business (MI Preferred)	$200.10
Rate for Payer: BCBS Complete	$123.14
Rate for Payer: Cash Price	$246.28
Rate for Payer: Cofinity Advantage	$215.50
Rate for Payer: Cofinity Commercial	$264.75
Rate for Payer: Encore Health Key Benefits Commercial	$246.28
Rate for Payer: Healthscope Commercial	$277.06
Rate for Payer: MI Amish Medical Board Commercial	$246.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$230.89
Rate for Payer: PHP Commercial	$261.67
Rate for Payer: Priority Health SBD	$193.95
Rate for Payer: UHC All Payor (Choice/PPO)	$200.10
Rate for Payer: UHC Core	$160.39
Rate for Payer: UHC Exchange	$120.99

FLECAINIDE 50 MG TABLET

Facility

$4.26

Service Code	NDC 50268032011
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare	$2.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Advantage	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: MI Amish Medical Board Commercial	$3.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.19
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health SBD	$2.68
Rate for Payer: UHC All Payor (Choice/PPO)	$2.77
Rate for Payer: UHC Core	$2.22
Rate for Payer: UHC Exchange	$1.67

FLECAINIDE 50 MG TABLET

Facility

$153.80

Service Code	NDC 00054001021
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$60.44
Max. Negotiated Rate	$138.42
Rate for Payer: Aetna Commercial	$130.73
Rate for Payer: Aetna Medicare	$76.90
Rate for Payer: Aetna New Business (MI Preferred)	$99.97
Rate for Payer: BCBS Complete	$61.52
Rate for Payer: Cash Price	$123.04
Rate for Payer: Cofinity Advantage	$107.66
Rate for Payer: Cofinity Commercial	$132.27
Rate for Payer: Encore Health Key Benefits Commercial	$123.04
Rate for Payer: Healthscope Commercial	$138.42
Rate for Payer: MI Amish Medical Board Commercial	$123.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.35
Rate for Payer: PHP Commercial	$130.73
Rate for Payer: Priority Health SBD	$96.89
Rate for Payer: UHC All Payor (Choice/PPO)	$99.97
Rate for Payer: UHC Core	$80.13
Rate for Payer: UHC Exchange	$60.44

FLECAINIDE 50 MG TABLET

Facility

$256.32

Service Code	NDC 00054001020
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$100.73
Max. Negotiated Rate	$230.69
Rate for Payer: Aetna Commercial	$217.87
Rate for Payer: Aetna Medicare	$128.16
Rate for Payer: Aetna New Business (MI Preferred)	$166.61
Rate for Payer: BCBS Complete	$102.53
Rate for Payer: Cash Price	$205.06
Rate for Payer: Cofinity Advantage	$179.42
Rate for Payer: Cofinity Commercial	$220.44
Rate for Payer: Encore Health Key Benefits Commercial	$205.06
Rate for Payer: Healthscope Commercial	$230.69
Rate for Payer: MI Amish Medical Board Commercial	$205.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$192.24
Rate for Payer: PHP Commercial	$217.87
Rate for Payer: Priority Health SBD	$161.48
Rate for Payer: UHC All Payor (Choice/PPO)	$166.61
Rate for Payer: UHC Core	$133.54
Rate for Payer: UHC Exchange	$100.73

FLECAINIDE 50 MG TABLET

Facility

$212.64

Service Code	NDC 50268032015
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$133.96
Max. Negotiated Rate	$191.38
Rate for Payer: Aetna Commercial	$180.74
Rate for Payer: Aetna New Business (MI Preferred)	$138.22
Rate for Payer: Cash Price	$170.11
Rate for Payer: Cofinity Advantage	$148.85
Rate for Payer: Cofinity Commercial	$182.87
Rate for Payer: Encore Health Key Benefits Commercial	$170.11
Rate for Payer: Healthscope Commercial	$191.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.48
Rate for Payer: PHP Commercial	$180.74
Rate for Payer: Priority Health SBD	$133.96

FLECAINIDE 50 MG TABLET

Facility

$307.85

Service Code	NDC 53746064101
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$277.06
Rate for Payer: Aetna Commercial	$261.67
Rate for Payer: Aetna New Business (MI Preferred)	$200.10
Rate for Payer: Cash Price	$246.28
Rate for Payer: Cofinity Advantage	$215.50
Rate for Payer: Cofinity Commercial	$264.75
Rate for Payer: Encore Health Key Benefits Commercial	$246.28
Rate for Payer: Healthscope Commercial	$277.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$230.89
Rate for Payer: PHP Commercial	$261.67
Rate for Payer: Priority Health SBD	$193.95

FLECAINIDE 50 MG TABLET

Facility

$153.80

Service Code	NDC 00054001021
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$96.89
Max. Negotiated Rate	$138.42
Rate for Payer: Aetna Commercial	$130.73
Rate for Payer: Aetna New Business (MI Preferred)	$99.97
Rate for Payer: Cash Price	$123.04
Rate for Payer: Cofinity Advantage	$107.66
Rate for Payer: Cofinity Commercial	$132.27
Rate for Payer: Encore Health Key Benefits Commercial	$123.04
Rate for Payer: Healthscope Commercial	$138.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.35
Rate for Payer: PHP Commercial	$130.73
Rate for Payer: Priority Health SBD	$96.89

FLECAINIDE 50 MG TABLET

Facility

$212.64

Service Code	NDC 50268032015
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$83.57
Max. Negotiated Rate	$191.38
Rate for Payer: Aetna Commercial	$180.74
Rate for Payer: Aetna Medicare	$106.32
Rate for Payer: Aetna New Business (MI Preferred)	$138.22
Rate for Payer: BCBS Complete	$85.06
Rate for Payer: Cash Price	$170.11
Rate for Payer: Cofinity Advantage	$148.85
Rate for Payer: Cofinity Commercial	$182.87
Rate for Payer: Encore Health Key Benefits Commercial	$170.11
Rate for Payer: Healthscope Commercial	$191.38
Rate for Payer: MI Amish Medical Board Commercial	$170.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.48
Rate for Payer: PHP Commercial	$180.74
Rate for Payer: Priority Health SBD	$133.96
Rate for Payer: UHC All Payor (Choice/PPO)	$138.22
Rate for Payer: UHC Core	$110.79
Rate for Payer: UHC Exchange	$83.57

FLUCONAZOLE 100 MG TABLET

Facility

$117.42

Service Code	NDC 68462010230
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$105.68
Rate for Payer: Aetna Commercial	$99.81
Rate for Payer: Aetna Medicare	$58.71
Rate for Payer: Aetna New Business (MI Preferred)	$76.32
Rate for Payer: BCBS Complete	$46.97
Rate for Payer: Cash Price	$93.94
Rate for Payer: Cofinity Advantage	$82.19
Rate for Payer: Cofinity Commercial	$100.98
Rate for Payer: Encore Health Key Benefits Commercial	$93.94
Rate for Payer: Healthscope Commercial	$105.68
Rate for Payer: MI Amish Medical Board Commercial	$93.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.06
Rate for Payer: PHP Commercial	$99.81
Rate for Payer: Priority Health SBD	$73.97
Rate for Payer: UHC All Payor (Choice/PPO)	$76.32
Rate for Payer: UHC Core	$61.18
Rate for Payer: UHC Exchange	$46.15

FLUCONAZOLE 100 MG TABLET

Facility

$582.24

Service Code	NDC 00904650061
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$228.82
Max. Negotiated Rate	$524.02
Rate for Payer: Aetna Commercial	$494.90
Rate for Payer: Aetna Medicare	$291.12
Rate for Payer: Aetna New Business (MI Preferred)	$378.46
Rate for Payer: BCBS Complete	$232.90
Rate for Payer: Cash Price	$465.79
Rate for Payer: Cofinity Advantage	$407.57
Rate for Payer: Cofinity Commercial	$500.73
Rate for Payer: Encore Health Key Benefits Commercial	$465.79
Rate for Payer: Healthscope Commercial	$524.02
Rate for Payer: MI Amish Medical Board Commercial	$465.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$494.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$436.68
Rate for Payer: PHP Commercial	$494.90
Rate for Payer: Priority Health SBD	$366.81
Rate for Payer: UHC All Payor (Choice/PPO)	$378.46
Rate for Payer: UHC Core	$303.35
Rate for Payer: UHC Exchange	$228.82

FLUCONAZOLE 100 MG TABLET

Facility

$117.42

Service Code	NDC 68462010230
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$73.97
Max. Negotiated Rate	$105.68
Rate for Payer: Aetna Commercial	$99.81
Rate for Payer: Aetna New Business (MI Preferred)	$76.32
Rate for Payer: Cash Price	$93.94
Rate for Payer: Cofinity Advantage	$82.19
Rate for Payer: Cofinity Commercial	$100.98
Rate for Payer: Encore Health Key Benefits Commercial	$93.94
Rate for Payer: Healthscope Commercial	$105.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.06
Rate for Payer: PHP Commercial	$99.81
Rate for Payer: Priority Health SBD	$73.97

FLUCONAZOLE 100 MG TABLET

Facility

$582.24

Service Code	NDC 00904650061
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$366.81
Max. Negotiated Rate	$524.02
Rate for Payer: Aetna Commercial	$494.90
Rate for Payer: Aetna New Business (MI Preferred)	$378.46
Rate for Payer: Cash Price	$465.79
Rate for Payer: Cofinity Advantage	$407.57
Rate for Payer: Cofinity Commercial	$500.73
Rate for Payer: Encore Health Key Benefits Commercial	$465.79
Rate for Payer: Healthscope Commercial	$524.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$494.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$436.68
Rate for Payer: PHP Commercial	$494.90
Rate for Payer: Priority Health SBD	$366.81

FLUCONAZOLE 150 MG TABLET

Facility

$40.44

Service Code	NDC 57237000511
Hospital Charge Code	13577
Hospital Revenue Code	637
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$34.37
Rate for Payer: Aetna New Business (MI Preferred)	$26.29
Rate for Payer: Cash Price	$32.35
Rate for Payer: Cofinity Advantage	$28.31
Rate for Payer: Cofinity Commercial	$34.78
Rate for Payer: Encore Health Key Benefits Commercial	$32.35
Rate for Payer: Healthscope Commercial	$36.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.33
Rate for Payer: PHP Commercial	$34.37
Rate for Payer: Priority Health SBD	$25.48

FLUCONAZOLE 150 MG TABLET

Facility

$40.44

Service Code	NDC 57237000511
Hospital Charge Code	13577
Hospital Revenue Code	637
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$34.37
Rate for Payer: Aetna Medicare	$20.22
Rate for Payer: Aetna New Business (MI Preferred)	$26.29
Rate for Payer: BCBS Complete	$16.18
Rate for Payer: Cash Price	$32.35
Rate for Payer: Cofinity Advantage	$28.31
Rate for Payer: Cofinity Commercial	$34.78
Rate for Payer: Encore Health Key Benefits Commercial	$32.35
Rate for Payer: Healthscope Commercial	$36.40
Rate for Payer: MI Amish Medical Board Commercial	$32.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.33
Rate for Payer: PHP Commercial	$34.37
Rate for Payer: Priority Health SBD	$25.48
Rate for Payer: UHC All Payor (Choice/PPO)	$26.29
Rate for Payer: UHC Core	$21.07
Rate for Payer: UHC Exchange	$15.89

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK

Facility

$59.02

Service Code	HCPCS J1450
Hospital Charge Code	10049
Hospital Revenue Code	636
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$53.12
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Commercial	$89.48
Rate for Payer: Aetna Commercial	$75.92
Rate for Payer: Aetna New Business (MI Preferred)	$58.06
Rate for Payer: Aetna New Business (MI Preferred)	$38.36
Rate for Payer: Aetna New Business (MI Preferred)	$68.43
Rate for Payer: Cash Price	$84.22
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cofinity Advantage	$62.52
Rate for Payer: Cofinity Advantage	$73.69
Rate for Payer: Cofinity Advantage	$41.31
Rate for Payer: Cofinity Commercial	$50.76
Rate for Payer: Cofinity Commercial	$90.53
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Encore Health Key Benefits Commercial	$71.46
Rate for Payer: Encore Health Key Benefits Commercial	$84.22
Rate for Payer: Encore Health Key Benefits Commercial	$47.22
Rate for Payer: Healthscope Commercial	$80.39
Rate for Payer: Healthscope Commercial	$94.74
Rate for Payer: Healthscope Commercial	$53.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.27
Rate for Payer: PHP Commercial	$89.48
Rate for Payer: PHP Commercial	$75.92
Rate for Payer: PHP Commercial	$50.17
Rate for Payer: Priority Health SBD	$56.27
Rate for Payer: Priority Health SBD	$37.18
Rate for Payer: Priority Health SBD	$66.32

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK

Facility

$105.27

Service Code	HCPCS J1450
Hospital Charge Code	10049
Hospital Revenue Code	636
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$94.74
Rate for Payer: Aetna Commercial	$89.48
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Commercial	$75.92
Rate for Payer: Aetna Medicare	$52.63
Rate for Payer: Aetna Medicare	$29.51
Rate for Payer: Aetna Medicare	$44.66
Rate for Payer: Aetna New Business (MI Preferred)	$68.43
Rate for Payer: Aetna New Business (MI Preferred)	$38.36
Rate for Payer: Aetna New Business (MI Preferred)	$58.06
Rate for Payer: BCBS Complete	$35.73
Rate for Payer: BCBS Complete	$42.11
Rate for Payer: BCBS Complete	$23.61
Rate for Payer: BCBS Trust/PPO	$11.23
Rate for Payer: BCBS Trust/PPO	$11.23
Rate for Payer: BCBS Trust/PPO	$11.23
Rate for Payer: BCN Commercial	$11.23
Rate for Payer: BCN Commercial	$11.23
Rate for Payer: BCN Commercial	$11.23
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cash Price	$84.22
Rate for Payer: Cash Price	$84.22
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cofinity Advantage	$41.31
Rate for Payer: Cofinity Advantage	$73.69
Rate for Payer: Cofinity Advantage	$62.52
Rate for Payer: Cofinity Commercial	$90.53
Rate for Payer: Cofinity Commercial	$50.76
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Encore Health Key Benefits Commercial	$47.22
Rate for Payer: Encore Health Key Benefits Commercial	$71.46
Rate for Payer: Encore Health Key Benefits Commercial	$84.22
Rate for Payer: Healthscope Commercial	$80.39
Rate for Payer: Healthscope Commercial	$53.12
Rate for Payer: Healthscope Commercial	$94.74
Rate for Payer: MI Amish Medical Board Commercial	$84.22
Rate for Payer: MI Amish Medical Board Commercial	$71.46
Rate for Payer: MI Amish Medical Board Commercial	$47.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.99
Rate for Payer: PHP Commercial	$89.48
Rate for Payer: PHP Commercial	$50.17
Rate for Payer: PHP Commercial	$75.92
Rate for Payer: Priority Health SBD	$66.32
Rate for Payer: Priority Health SBD	$56.27
Rate for Payer: Priority Health SBD	$37.18
Rate for Payer: UHC All Payor (Choice/PPO)	$7.39
Rate for Payer: UHC All Payor (Choice/PPO)	$7.39
Rate for Payer: UHC All Payor (Choice/PPO)	$7.39
Rate for Payer: UHC Core	$7.39
Rate for Payer: UHC Core	$7.39
Rate for Payer: UHC Core	$7.39
Rate for Payer: UHC Exchange	$7.39
Rate for Payer: UHC Exchange	$7.39
Rate for Payer: UHC Exchange	$7.39

FLUCONAZOLE 200 MG TABLET

Facility

$8.14

Service Code	NDC 68084073511
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$6.92
Rate for Payer: Aetna New Business (MI Preferred)	$5.29
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cofinity Advantage	$5.70
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Encore Health Key Benefits Commercial	$6.51
Rate for Payer: Healthscope Commercial	$7.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.11
Rate for Payer: PHP Commercial	$6.92
Rate for Payer: Priority Health SBD	$5.13

FLUCONAZOLE 200 MG TABLET

Facility

$261.12

Service Code	NDC 00904650106
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$164.51
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Advantage	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.84
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health SBD	$164.51

FLUCONAZOLE 200 MG TABLET

Facility

$813.12

Service Code	NDC 68084073501
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$512.27
Max. Negotiated Rate	$731.81
Rate for Payer: Aetna Commercial	$691.15
Rate for Payer: Aetna New Business (MI Preferred)	$528.53
Rate for Payer: Cash Price	$650.50
Rate for Payer: Cofinity Advantage	$569.18
Rate for Payer: Cofinity Commercial	$699.28
Rate for Payer: Encore Health Key Benefits Commercial	$650.50
Rate for Payer: Healthscope Commercial	$731.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$691.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$609.84
Rate for Payer: PHP Commercial	$691.15
Rate for Payer: Priority Health SBD	$512.27

FLUCONAZOLE 200 MG TABLET

Facility

$261.12

Service Code	NDC 00904650106
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$102.62
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna Medicare	$130.56
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: BCBS Complete	$104.45
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Advantage	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: MI Amish Medical Board Commercial	$208.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.84
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health SBD	$164.51
Rate for Payer: UHC All Payor (Choice/PPO)	$169.73
Rate for Payer: UHC Core	$136.04
Rate for Payer: UHC Exchange	$102.62

FLUCONAZOLE 200 MG TABLET

Facility

$287.28

Service Code	NDC 50268033915
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$112.90
Max. Negotiated Rate	$258.55
Rate for Payer: Aetna Commercial	$244.19
Rate for Payer: Aetna Medicare	$143.64
Rate for Payer: Aetna New Business (MI Preferred)	$186.73
Rate for Payer: BCBS Complete	$114.91
Rate for Payer: Cash Price	$229.82
Rate for Payer: Cofinity Advantage	$201.10
Rate for Payer: Cofinity Commercial	$247.06
Rate for Payer: Encore Health Key Benefits Commercial	$229.82
Rate for Payer: Healthscope Commercial	$258.55
Rate for Payer: MI Amish Medical Board Commercial	$229.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.46
Rate for Payer: PHP Commercial	$244.19
Rate for Payer: Priority Health SBD	$180.99
Rate for Payer: UHC All Payor (Choice/PPO)	$186.73
Rate for Payer: UHC Core	$149.67
Rate for Payer: UHC Exchange	$112.90

FLUCONAZOLE 200 MG TABLET

Facility

$8.14

Service Code	NDC 68084073511
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$6.92
Rate for Payer: Aetna Medicare	$4.07
Rate for Payer: Aetna New Business (MI Preferred)	$5.29
Rate for Payer: BCBS Complete	$3.26
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cofinity Advantage	$5.70
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Encore Health Key Benefits Commercial	$6.51
Rate for Payer: Healthscope Commercial	$7.33
Rate for Payer: MI Amish Medical Board Commercial	$6.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.11
Rate for Payer: PHP Commercial	$6.92
Rate for Payer: Priority Health SBD	$5.13
Rate for Payer: UHC All Payor (Choice/PPO)	$5.29
Rate for Payer: UHC Core	$4.24
Rate for Payer: UHC Exchange	$3.20

FLUCONAZOLE 200 MG TABLET

Facility

$5.75

Service Code	NDC 50268033911
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.17
Rate for Payer: Aetna Commercial	$4.89
Rate for Payer: Aetna New Business (MI Preferred)	$3.74
Rate for Payer: Cash Price	$4.60
Rate for Payer: Cofinity Advantage	$4.03
Rate for Payer: Cofinity Commercial	$4.95
Rate for Payer: Encore Health Key Benefits Commercial	$4.60
Rate for Payer: Healthscope Commercial	$5.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.31
Rate for Payer: PHP Commercial	$4.89
Rate for Payer: Priority Health SBD	$3.62

Know your out-of-pocket cost for care.

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