Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

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

$287.28

Service Code	NDC 50268033915
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$180.99
Max. Negotiated Rate	$258.55
Rate for Payer: Aetna Commercial	$244.19
Rate for Payer: Aetna New Business (MI Preferred)	$186.73
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: 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

FLUCONAZOLE 200 MG TABLET

Facility

$991.23

Service Code	NDC 55111014601
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$624.47
Max. Negotiated Rate	$892.11
Rate for Payer: Aetna Commercial	$842.55
Rate for Payer: Aetna New Business (MI Preferred)	$644.30
Rate for Payer: Cash Price	$792.98
Rate for Payer: Cofinity Advantage	$693.86
Rate for Payer: Cofinity Commercial	$852.46
Rate for Payer: Encore Health Key Benefits Commercial	$792.98
Rate for Payer: Healthscope Commercial	$892.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$842.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$743.42
Rate for Payer: PHP Commercial	$842.55
Rate for Payer: Priority Health SBD	$624.47

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

Facility

$63.80

Service Code	HCPCS J1450
Hospital Charge Code	10050
Hospital Revenue Code	636
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Commercial	$84.06
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Aetna New Business (MI Preferred)	$64.28
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cash Price	$79.11
Rate for Payer: Cofinity Advantage	$44.66
Rate for Payer: Cofinity Advantage	$69.22
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Commercial	$85.05
Rate for Payer: Encore Health Key Benefits Commercial	$79.11
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$89.00
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.17
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: PHP Commercial	$84.06
Rate for Payer: Priority Health SBD	$40.19
Rate for Payer: Priority Health SBD	$62.30

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$98.89

Service Code	HCPCS J1450
Hospital Charge Code	10050
Hospital Revenue Code	636
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$84.06
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$49.45
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Aetna New Business (MI Preferred)	$64.28
Rate for Payer: BCBS Complete	$39.56
Rate for Payer: BCBS Complete	$25.52
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: Cash Price	$51.04
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cash Price	$79.11
Rate for Payer: Cash Price	$79.11
Rate for Payer: Cofinity Advantage	$44.66
Rate for Payer: Cofinity Advantage	$69.22
Rate for Payer: Cofinity Commercial	$85.05
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Encore Health Key Benefits Commercial	$79.11
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Healthscope Commercial	$89.00
Rate for Payer: MI Amish Medical Board Commercial	$79.11
Rate for Payer: MI Amish Medical Board Commercial	$51.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.17
Rate for Payer: PHP Commercial	$84.06
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health SBD	$40.19
Rate for Payer: Priority Health SBD	$62.30
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 Exchange	$7.39
Rate for Payer: UHC Exchange	$7.39

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION

Facility

$361.73

Service Code	HCPCS J9185
Hospital Charge Code	41294
Hospital Revenue Code	636
Min. Negotiated Rate	$134.33
Max. Negotiated Rate	$325.56
Rate for Payer: Aetna Commercial	$307.47
Rate for Payer: Aetna Commercial	$1,074.57
Rate for Payer: Aetna Medicare	$632.10
Rate for Payer: Aetna Medicare	$180.87
Rate for Payer: Aetna New Business (MI Preferred)	$235.12
Rate for Payer: Aetna New Business (MI Preferred)	$821.73
Rate for Payer: BCBS Complete	$505.68
Rate for Payer: BCBS Complete	$144.69
Rate for Payer: BCBS Trust/PPO	$204.23
Rate for Payer: BCBS Trust/PPO	$204.23
Rate for Payer: BCN Commercial	$204.23
Rate for Payer: BCN Commercial	$204.23
Rate for Payer: Cash Price	$289.38
Rate for Payer: Cash Price	$1,011.36
Rate for Payer: Cash Price	$289.38
Rate for Payer: Cash Price	$1,011.36
Rate for Payer: Cofinity Advantage	$253.21
Rate for Payer: Cofinity Advantage	$884.94
Rate for Payer: Cofinity Commercial	$311.09
Rate for Payer: Cofinity Commercial	$1,087.21
Rate for Payer: Encore Health Key Benefits Commercial	$1,011.36
Rate for Payer: Encore Health Key Benefits Commercial	$289.38
Rate for Payer: Healthscope Commercial	$1,137.78
Rate for Payer: Healthscope Commercial	$325.56
Rate for Payer: MI Amish Medical Board Commercial	$1,011.36
Rate for Payer: MI Amish Medical Board Commercial	$289.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,074.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$948.15
Rate for Payer: PHP Commercial	$307.47
Rate for Payer: PHP Commercial	$1,074.57
Rate for Payer: Priority Health SBD	$227.89
Rate for Payer: Priority Health SBD	$796.45
Rate for Payer: UHC All Payor (Choice/PPO)	$134.33
Rate for Payer: UHC All Payor (Choice/PPO)	$134.33
Rate for Payer: UHC Core	$134.33
Rate for Payer: UHC Core	$134.33
Rate for Payer: UHC Exchange	$134.33
Rate for Payer: UHC Exchange	$134.33

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION

Facility

$361.73

Service Code	HCPCS J9185
Hospital Charge Code	41294
Hospital Revenue Code	636
Min. Negotiated Rate	$227.89
Max. Negotiated Rate	$325.56
Rate for Payer: Aetna Commercial	$307.47
Rate for Payer: Aetna Commercial	$1,074.57
Rate for Payer: Aetna New Business (MI Preferred)	$235.12
Rate for Payer: Aetna New Business (MI Preferred)	$821.73
Rate for Payer: Cash Price	$1,011.36
Rate for Payer: Cash Price	$289.38
Rate for Payer: Cofinity Advantage	$253.21
Rate for Payer: Cofinity Advantage	$884.94
Rate for Payer: Cofinity Commercial	$1,087.21
Rate for Payer: Cofinity Commercial	$311.09
Rate for Payer: Encore Health Key Benefits Commercial	$289.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,011.36
Rate for Payer: Healthscope Commercial	$325.56
Rate for Payer: Healthscope Commercial	$1,137.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,074.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$948.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.30
Rate for Payer: PHP Commercial	$1,074.57
Rate for Payer: PHP Commercial	$307.47
Rate for Payer: Priority Health SBD	$227.89
Rate for Payer: Priority Health SBD	$796.45

FLUDROCORTISONE 0.1 MG TABLET

Facility

$263.04

Service Code	NDC 00115703301
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$165.72
Max. Negotiated Rate	$236.74
Rate for Payer: Aetna Commercial	$223.58
Rate for Payer: Aetna New Business (MI Preferred)	$170.98
Rate for Payer: Cash Price	$210.43
Rate for Payer: Cofinity Advantage	$184.13
Rate for Payer: Cofinity Commercial	$226.21
Rate for Payer: Encore Health Key Benefits Commercial	$210.43
Rate for Payer: Healthscope Commercial	$236.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.28
Rate for Payer: PHP Commercial	$223.58
Rate for Payer: Priority Health SBD	$165.72

FLUDROCORTISONE 0.1 MG TABLET

Facility

$3.96

Service Code	NDC 68084028811
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: Aetna New Business (MI Preferred)	$2.57
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Advantage	$2.77
Rate for Payer: Cofinity Commercial	$3.41
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: PHP Commercial	$3.37
Rate for Payer: Priority Health SBD	$2.49

FLUDROCORTISONE 0.1 MG TABLET

Facility

$263.04

Service Code	NDC 00115703301
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$103.37
Max. Negotiated Rate	$236.74
Rate for Payer: Aetna Commercial	$223.58
Rate for Payer: Aetna Medicare	$131.52
Rate for Payer: Aetna New Business (MI Preferred)	$170.98
Rate for Payer: BCBS Complete	$105.22
Rate for Payer: Cash Price	$210.43
Rate for Payer: Cofinity Advantage	$184.13
Rate for Payer: Cofinity Commercial	$226.21
Rate for Payer: Encore Health Key Benefits Commercial	$210.43
Rate for Payer: Healthscope Commercial	$236.74
Rate for Payer: MI Amish Medical Board Commercial	$210.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.28
Rate for Payer: PHP Commercial	$223.58
Rate for Payer: Priority Health SBD	$165.72
Rate for Payer: UHC All Payor (Choice/PPO)	$170.98
Rate for Payer: UHC Core	$137.04
Rate for Payer: UHC Exchange	$103.37

FLUDROCORTISONE 0.1 MG TABLET

Facility

$395.52

Service Code	NDC 68084028801
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$355.97
Rate for Payer: Aetna Commercial	$336.19
Rate for Payer: Aetna Medicare	$197.76
Rate for Payer: Aetna New Business (MI Preferred)	$257.09
Rate for Payer: BCBS Complete	$158.21
Rate for Payer: Cash Price	$316.42
Rate for Payer: Cofinity Advantage	$276.86
Rate for Payer: Cofinity Commercial	$340.15
Rate for Payer: Encore Health Key Benefits Commercial	$316.42
Rate for Payer: Healthscope Commercial	$355.97
Rate for Payer: MI Amish Medical Board Commercial	$316.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$296.64
Rate for Payer: PHP Commercial	$336.19
Rate for Payer: Priority Health SBD	$249.18
Rate for Payer: UHC All Payor (Choice/PPO)	$257.09
Rate for Payer: UHC Core	$206.07
Rate for Payer: UHC Exchange	$155.44

FLUDROCORTISONE 0.1 MG TABLET

Facility

$3.96

Service Code	NDC 68084028811
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: Aetna Medicare	$1.98
Rate for Payer: Aetna New Business (MI Preferred)	$2.57
Rate for Payer: BCBS Complete	$1.58
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Advantage	$2.77
Rate for Payer: Cofinity Commercial	$3.41
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.56
Rate for Payer: MI Amish Medical Board Commercial	$3.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: PHP Commercial	$3.37
Rate for Payer: Priority Health SBD	$2.49
Rate for Payer: UHC All Payor (Choice/PPO)	$2.57
Rate for Payer: UHC Core	$2.06
Rate for Payer: UHC Exchange	$1.56

FLUDROCORTISONE 0.1 MG TABLET

Facility

$395.52

Service Code	NDC 68084028801
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$249.18
Max. Negotiated Rate	$355.97
Rate for Payer: Aetna Commercial	$336.19
Rate for Payer: Aetna New Business (MI Preferred)	$257.09
Rate for Payer: Cash Price	$316.42
Rate for Payer: Cofinity Advantage	$276.86
Rate for Payer: Cofinity Commercial	$340.15
Rate for Payer: Encore Health Key Benefits Commercial	$316.42
Rate for Payer: Healthscope Commercial	$355.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$296.64
Rate for Payer: PHP Commercial	$336.19
Rate for Payer: Priority Health SBD	$249.18

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.50

Service Code	NDC 00143968401
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare	$9.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.03
Rate for Payer: BCBS Complete	$7.40
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cofinity Advantage	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Encore Health Key Benefits Commercial	$14.80
Rate for Payer: Healthscope Commercial	$16.65
Rate for Payer: MI Amish Medical Board Commercial	$14.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.88
Rate for Payer: PHP Commercial	$15.72
Rate for Payer: Priority Health SBD	$11.65
Rate for Payer: UHC All Payor (Choice/PPO)	$12.03
Rate for Payer: UHC Core	$9.64
Rate for Payer: UHC Exchange	$7.27

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$83.44

Service Code	NDC 36000014901
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$52.57
Max. Negotiated Rate	$75.10
Rate for Payer: Aetna Commercial	$70.92
Rate for Payer: Aetna New Business (MI Preferred)	$54.24
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cofinity Advantage	$58.41
Rate for Payer: Cofinity Commercial	$71.76
Rate for Payer: Encore Health Key Benefits Commercial	$66.75
Rate for Payer: Healthscope Commercial	$75.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.58
Rate for Payer: PHP Commercial	$70.92
Rate for Payer: Priority Health SBD	$52.57

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$83.44

Service Code	NDC 36000014910
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$52.57
Max. Negotiated Rate	$75.10
Rate for Payer: Aetna Commercial	$70.92
Rate for Payer: Aetna New Business (MI Preferred)	$54.24
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cofinity Advantage	$58.41
Rate for Payer: Cofinity Commercial	$71.76
Rate for Payer: Encore Health Key Benefits Commercial	$66.75
Rate for Payer: Healthscope Commercial	$75.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.58
Rate for Payer: PHP Commercial	$70.92
Rate for Payer: Priority Health SBD	$52.57

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$83.44

Service Code	NDC 36000014901
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$75.10
Rate for Payer: Aetna Commercial	$70.92
Rate for Payer: Aetna Medicare	$41.72
Rate for Payer: Aetna New Business (MI Preferred)	$54.24
Rate for Payer: BCBS Complete	$33.38
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cofinity Advantage	$58.41
Rate for Payer: Cofinity Commercial	$71.76
Rate for Payer: Encore Health Key Benefits Commercial	$66.75
Rate for Payer: Healthscope Commercial	$75.10
Rate for Payer: MI Amish Medical Board Commercial	$66.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.58
Rate for Payer: PHP Commercial	$70.92
Rate for Payer: Priority Health SBD	$52.57
Rate for Payer: UHC All Payor (Choice/PPO)	$54.24
Rate for Payer: UHC Core	$43.47
Rate for Payer: UHC Exchange	$32.79

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.50

Service Code	NDC 00143968410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna New Business (MI Preferred)	$12.03
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cofinity Advantage	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Encore Health Key Benefits Commercial	$14.80
Rate for Payer: Healthscope Commercial	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.88
Rate for Payer: PHP Commercial	$15.72
Rate for Payer: Priority Health SBD	$11.65

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$30.67

Service Code	NDC 63323042405
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$27.60
Rate for Payer: Aetna Commercial	$26.07
Rate for Payer: Aetna Medicare	$15.34
Rate for Payer: Aetna New Business (MI Preferred)	$19.94
Rate for Payer: BCBS Complete	$12.27
Rate for Payer: Cash Price	$24.54
Rate for Payer: Cofinity Advantage	$21.47
Rate for Payer: Cofinity Commercial	$26.38
Rate for Payer: Encore Health Key Benefits Commercial	$24.54
Rate for Payer: Healthscope Commercial	$27.60
Rate for Payer: MI Amish Medical Board Commercial	$24.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.00
Rate for Payer: PHP Commercial	$26.07
Rate for Payer: Priority Health SBD	$19.32
Rate for Payer: UHC All Payor (Choice/PPO)	$19.94
Rate for Payer: UHC Core	$15.98
Rate for Payer: UHC Exchange	$12.05

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.50

Service Code	NDC 00143968401
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna New Business (MI Preferred)	$12.03
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cofinity Advantage	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Encore Health Key Benefits Commercial	$14.80
Rate for Payer: Healthscope Commercial	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.88
Rate for Payer: PHP Commercial	$15.72
Rate for Payer: Priority Health SBD	$11.65

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$30.67

Service Code	NDC 63323042405
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$19.32
Max. Negotiated Rate	$27.60
Rate for Payer: Aetna Commercial	$26.07
Rate for Payer: Aetna New Business (MI Preferred)	$19.94
Rate for Payer: Cash Price	$24.54
Rate for Payer: Cofinity Advantage	$21.47
Rate for Payer: Cofinity Commercial	$26.38
Rate for Payer: Encore Health Key Benefits Commercial	$24.54
Rate for Payer: Healthscope Commercial	$27.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.00
Rate for Payer: PHP Commercial	$26.07
Rate for Payer: Priority Health SBD	$19.32

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.50

Service Code	NDC 00143968410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare	$9.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.03
Rate for Payer: BCBS Complete	$7.40
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cofinity Advantage	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Encore Health Key Benefits Commercial	$14.80
Rate for Payer: Healthscope Commercial	$16.65
Rate for Payer: MI Amish Medical Board Commercial	$14.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.88
Rate for Payer: PHP Commercial	$15.72
Rate for Payer: Priority Health SBD	$11.65
Rate for Payer: UHC All Payor (Choice/PPO)	$12.03
Rate for Payer: UHC Core	$9.64
Rate for Payer: UHC Exchange	$7.27

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.50

Service Code	NDC 00143978410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna New Business (MI Preferred)	$12.03
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cofinity Advantage	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Encore Health Key Benefits Commercial	$14.80
Rate for Payer: Healthscope Commercial	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.88
Rate for Payer: PHP Commercial	$15.72
Rate for Payer: Priority Health SBD	$11.65

Know your out-of-pocket cost for care.

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