Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUPHENAZINE 5 MG TABLET

Facility

$3,686.68

Service Code	NDC 68084084601
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 Advantage	$2,580.68
Rate for Payer: Cofinity Commercial	$3,170.54
Rate for Payer: Encore Health Key Benefits Commercial	$2,949.34
Rate for Payer: Healthscope Commercial	$3,318.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,133.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,765.01
Rate for Payer: PHP Commercial	$3,133.68
Rate for Payer: Priority Health SBD	$2,322.61

FLUPHENAZINE 5 MG TABLET

Facility

$36.87

Service Code	NDC 68084084611
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 Advantage	$25.81
Rate for Payer: Cofinity Commercial	$31.71
Rate for Payer: Encore Health Key Benefits Commercial	$29.50
Rate for Payer: Healthscope Commercial	$33.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.65
Rate for Payer: PHP Commercial	$31.34
Rate for Payer: Priority Health SBD	$23.23

FLUPHENAZINE 5 MG TABLET

Facility

$1,187.33

Service Code	NDC 00904715961
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$748.02
Max. Negotiated Rate	$1,068.60
Rate for Payer: Aetna Commercial	$1,009.23
Rate for Payer: Aetna New Business (MI Preferred)	$771.76
Rate for Payer: Cash Price	$949.86
Rate for Payer: Cofinity Advantage	$831.13
Rate for Payer: Cofinity Commercial	$1,021.10
Rate for Payer: Encore Health Key Benefits Commercial	$949.86
Rate for Payer: Healthscope Commercial	$1,068.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,009.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$890.50
Rate for Payer: PHP Commercial	$1,009.23
Rate for Payer: Priority Health SBD	$748.02

FLUPHENAZINE 5 MG TABLET

Facility

$36.87

Service Code	NDC 68084084611
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$33.18
Rate for Payer: Aetna Commercial	$31.34
Rate for Payer: Aetna Medicare	$18.43
Rate for Payer: Aetna New Business (MI Preferred)	$23.97
Rate for Payer: BCBS Complete	$14.75
Rate for Payer: Cash Price	$29.50
Rate for Payer: Cofinity Advantage	$25.81
Rate for Payer: Cofinity Commercial	$31.71
Rate for Payer: Encore Health Key Benefits Commercial	$29.50
Rate for Payer: Healthscope Commercial	$33.18
Rate for Payer: MI Amish Medical Board Commercial	$29.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.65
Rate for Payer: PHP Commercial	$31.34
Rate for Payer: Priority Health SBD	$23.23
Rate for Payer: UHC All Payor (Choice/PPO)	$23.97
Rate for Payer: UHC Core	$19.21
Rate for Payer: UHC Exchange	$14.49

FLUPHENAZINE 5 MG TABLET

Facility

$1,187.33

Service Code	NDC 00904715961
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$466.62
Max. Negotiated Rate	$1,068.60
Rate for Payer: Aetna Commercial	$1,009.23
Rate for Payer: Aetna Medicare	$593.66
Rate for Payer: Aetna New Business (MI Preferred)	$771.76
Rate for Payer: BCBS Complete	$474.93
Rate for Payer: Cash Price	$949.86
Rate for Payer: Cofinity Advantage	$831.13
Rate for Payer: Cofinity Commercial	$1,021.10
Rate for Payer: Encore Health Key Benefits Commercial	$949.86
Rate for Payer: Healthscope Commercial	$1,068.60
Rate for Payer: MI Amish Medical Board Commercial	$949.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,009.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$890.50
Rate for Payer: PHP Commercial	$1,009.23
Rate for Payer: Priority Health SBD	$748.02
Rate for Payer: UHC All Payor (Choice/PPO)	$771.76
Rate for Payer: UHC Core	$618.60
Rate for Payer: UHC Exchange	$466.62

FLUPHENAZINE 5 MG TABLET

Facility

$1,080.40

Service Code	NDC 00527179001
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 Advantage	$756.28
Rate for Payer: Cofinity Commercial	$929.14
Rate for Payer: Encore Health Key Benefits Commercial	$864.32
Rate for Payer: Healthscope Commercial	$972.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$918.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$810.30
Rate for Payer: PHP Commercial	$918.34
Rate for Payer: Priority Health SBD	$680.65

FLUPHENAZINE 5 MG TABLET

Facility

$1,080.40

Service Code	NDC 00527179001
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$424.60
Max. Negotiated Rate	$972.36
Rate for Payer: Aetna Commercial	$918.34
Rate for Payer: Aetna Medicare	$540.20
Rate for Payer: Aetna New Business (MI Preferred)	$702.26
Rate for Payer: BCBS Complete	$432.16
Rate for Payer: Cash Price	$864.32
Rate for Payer: Cofinity Advantage	$756.28
Rate for Payer: Cofinity Commercial	$929.14
Rate for Payer: Encore Health Key Benefits Commercial	$864.32
Rate for Payer: Healthscope Commercial	$972.36
Rate for Payer: MI Amish Medical Board Commercial	$864.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$918.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$810.30
Rate for Payer: PHP Commercial	$918.34
Rate for Payer: Priority Health SBD	$680.65
Rate for Payer: UHC All Payor (Choice/PPO)	$702.26
Rate for Payer: UHC Core	$562.89
Rate for Payer: UHC Exchange	$424.60

FLUPHENAZINE 5 MG TABLET

Facility

$3,686.68

Service Code	NDC 68084084601
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$1,448.87
Max. Negotiated Rate	$3,318.01
Rate for Payer: Aetna Commercial	$3,133.68
Rate for Payer: Aetna Medicare	$1,843.34
Rate for Payer: Aetna New Business (MI Preferred)	$2,396.34
Rate for Payer: BCBS Complete	$1,474.67
Rate for Payer: Cash Price	$2,949.34
Rate for Payer: Cofinity Advantage	$2,580.68
Rate for Payer: Cofinity Commercial	$3,170.54
Rate for Payer: Encore Health Key Benefits Commercial	$2,949.34
Rate for Payer: Healthscope Commercial	$3,318.01
Rate for Payer: MI Amish Medical Board Commercial	$2,949.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,133.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,765.01
Rate for Payer: PHP Commercial	$3,133.68
Rate for Payer: Priority Health SBD	$2,322.61
Rate for Payer: UHC All Payor (Choice/PPO)	$2,396.34
Rate for Payer: UHC Core	$1,920.76
Rate for Payer: UHC Exchange	$1,448.87

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION

Facility

$332.60

Service Code	HCPCS J2680
Hospital Charge Code	3215
Hospital Revenue Code	636
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$299.34
Rate for Payer: Aetna Commercial	$282.71
Rate for Payer: Aetna Commercial	$169.98
Rate for Payer: Aetna Medicare	$99.99
Rate for Payer: Aetna Medicare	$166.30
Rate for Payer: Aetna New Business (MI Preferred)	$216.19
Rate for Payer: Aetna New Business (MI Preferred)	$129.99
Rate for Payer: BCBS Complete	$79.99
Rate for Payer: BCBS Complete	$133.04
Rate for Payer: BCBS Trust/PPO	$15.54
Rate for Payer: BCBS Trust/PPO	$15.54
Rate for Payer: BCN Commercial	$15.54
Rate for Payer: BCN Commercial	$15.54
Rate for Payer: Cash Price	$266.08
Rate for Payer: Cash Price	$159.98
Rate for Payer: Cash Price	$266.08
Rate for Payer: Cash Price	$159.98
Rate for Payer: Cofinity Advantage	$232.82
Rate for Payer: Cofinity Advantage	$139.99
Rate for Payer: Cofinity Commercial	$286.04
Rate for Payer: Cofinity Commercial	$171.98
Rate for Payer: Encore Health Key Benefits Commercial	$159.98
Rate for Payer: Encore Health Key Benefits Commercial	$266.08
Rate for Payer: Healthscope Commercial	$179.98
Rate for Payer: Healthscope Commercial	$299.34
Rate for Payer: MI Amish Medical Board Commercial	$159.98
Rate for Payer: MI Amish Medical Board Commercial	$266.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$282.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.99
Rate for Payer: PHP Commercial	$282.71
Rate for Payer: PHP Commercial	$169.98
Rate for Payer: Priority Health SBD	$209.54
Rate for Payer: Priority Health SBD	$125.99
Rate for Payer: UHC All Payor (Choice/PPO)	$10.23
Rate for Payer: UHC All Payor (Choice/PPO)	$10.23
Rate for Payer: UHC Core	$10.23
Rate for Payer: UHC Core	$10.23
Rate for Payer: UHC Exchange	$10.23
Rate for Payer: UHC Exchange	$10.23

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION

Facility

$332.60

Service Code	HCPCS J2680
Hospital Charge Code	3215
Hospital Revenue Code	636
Min. Negotiated Rate	$209.54
Max. Negotiated Rate	$299.34
Rate for Payer: Aetna Commercial	$282.71
Rate for Payer: Aetna Commercial	$169.98
Rate for Payer: Aetna New Business (MI Preferred)	$216.19
Rate for Payer: Aetna New Business (MI Preferred)	$129.99
Rate for Payer: Cash Price	$159.98
Rate for Payer: Cash Price	$266.08
Rate for Payer: Cofinity Advantage	$232.82
Rate for Payer: Cofinity Advantage	$139.99
Rate for Payer: Cofinity Commercial	$171.98
Rate for Payer: Cofinity Commercial	$286.04
Rate for Payer: Encore Health Key Benefits Commercial	$266.08
Rate for Payer: Encore Health Key Benefits Commercial	$159.98
Rate for Payer: Healthscope Commercial	$299.34
Rate for Payer: Healthscope Commercial	$179.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$282.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.45
Rate for Payer: PHP Commercial	$169.98
Rate for Payer: PHP Commercial	$282.71
Rate for Payer: Priority Health SBD	$209.54
Rate for Payer: Priority Health SBD	$125.99

FLURBIPROFEN 0.03 % EYE DROPS

Facility

$117.43

Service Code	NDC 69292072225
Hospital Charge Code	10080
Hospital Revenue Code	637
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$105.69
Rate for Payer: Aetna Commercial	$99.82
Rate for Payer: Aetna Medicare	$58.72
Rate for Payer: Aetna New Business (MI Preferred)	$76.33
Rate for Payer: BCBS Complete	$46.97
Rate for Payer: Cash Price	$93.94
Rate for Payer: Cofinity Advantage	$82.20
Rate for Payer: Cofinity Commercial	$100.99
Rate for Payer: Encore Health Key Benefits Commercial	$93.94
Rate for Payer: Healthscope Commercial	$105.69
Rate for Payer: MI Amish Medical Board Commercial	$93.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.07
Rate for Payer: PHP Commercial	$99.82
Rate for Payer: Priority Health SBD	$73.98
Rate for Payer: UHC All Payor (Choice/PPO)	$76.33
Rate for Payer: UHC Core	$61.18
Rate for Payer: UHC Exchange	$46.15

FLURBIPROFEN 0.03 % EYE DROPS

Facility

$117.43

Service Code	NDC 69292072225
Hospital Charge Code	10080
Hospital Revenue Code	637
Min. Negotiated Rate	$73.98
Max. Negotiated Rate	$105.69
Rate for Payer: Aetna Commercial	$99.82
Rate for Payer: Aetna New Business (MI Preferred)	$76.33
Rate for Payer: Cash Price	$93.94
Rate for Payer: Cofinity Advantage	$82.20
Rate for Payer: Cofinity Commercial	$100.99
Rate for Payer: Encore Health Key Benefits Commercial	$93.94
Rate for Payer: Healthscope Commercial	$105.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.07
Rate for Payer: PHP Commercial	$99.82
Rate for Payer: Priority Health SBD	$73.98

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$410.86
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna Medicare	$522.72
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: BCBS Complete	$418.18
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Advantage	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: MI Amish Medical Board Commercial	$836.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$784.08
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health SBD	$658.63
Rate for Payer: UHC All Payor (Choice/PPO)	$679.54
Rate for Payer: UHC Core	$544.67
Rate for Payer: UHC Exchange	$410.86

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$814.47

Service Code	NDC 66993007996
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$513.12
Max. Negotiated Rate	$733.02
Rate for Payer: Aetna Commercial	$692.30
Rate for Payer: Aetna New Business (MI Preferred)	$529.41
Rate for Payer: Cash Price	$651.58
Rate for Payer: Cofinity Advantage	$570.13
Rate for Payer: Cofinity Commercial	$700.44
Rate for Payer: Encore Health Key Benefits Commercial	$651.58
Rate for Payer: Healthscope Commercial	$733.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$692.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$610.85
Rate for Payer: PHP Commercial	$692.30
Rate for Payer: Priority Health SBD	$513.12

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$814.47

Service Code	NDC 66993007996
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$320.09
Max. Negotiated Rate	$733.02
Rate for Payer: Aetna Commercial	$692.30
Rate for Payer: Aetna Medicare	$407.24
Rate for Payer: Aetna New Business (MI Preferred)	$529.41
Rate for Payer: BCBS Complete	$325.79
Rate for Payer: Cash Price	$651.58
Rate for Payer: Cofinity Advantage	$570.13
Rate for Payer: Cofinity Commercial	$700.44
Rate for Payer: Encore Health Key Benefits Commercial	$651.58
Rate for Payer: Healthscope Commercial	$733.02
Rate for Payer: MI Amish Medical Board Commercial	$651.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$692.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$610.85
Rate for Payer: PHP Commercial	$692.30
Rate for Payer: Priority Health SBD	$513.12
Rate for Payer: UHC All Payor (Choice/PPO)	$529.41
Rate for Payer: UHC Core	$424.34
Rate for Payer: UHC Exchange	$320.09

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$658.63
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Advantage	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$784.08
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health SBD	$658.63

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$488.58
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna Medicare	$621.60
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: BCBS Complete	$497.28
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Advantage	$870.24
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Encore Health Key Benefits Commercial	$994.56
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: MI Amish Medical Board Commercial	$994.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,056.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$932.40
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health SBD	$783.22
Rate for Payer: UHC All Payor (Choice/PPO)	$808.08
Rate for Payer: UHC Core	$647.71
Rate for Payer: UHC Exchange	$488.58

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$783.22
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Advantage	$870.24
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Encore Health Key Benefits Commercial	$994.56
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,056.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$932.40
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$978.58

Service Code	NDC 66993008096
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$880.72
Rate for Payer: Aetna Commercial	$831.79
Rate for Payer: Aetna Medicare	$489.29
Rate for Payer: Aetna New Business (MI Preferred)	$636.08
Rate for Payer: BCBS Complete	$391.43
Rate for Payer: Cash Price	$782.86
Rate for Payer: Cofinity Advantage	$685.01
Rate for Payer: Cofinity Commercial	$841.58
Rate for Payer: Encore Health Key Benefits Commercial	$782.86
Rate for Payer: Healthscope Commercial	$880.72
Rate for Payer: MI Amish Medical Board Commercial	$782.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$733.93
Rate for Payer: PHP Commercial	$831.79
Rate for Payer: Priority Health SBD	$616.51
Rate for Payer: UHC All Payor (Choice/PPO)	$636.08
Rate for Payer: UHC Core	$509.84
Rate for Payer: UHC Exchange	$384.58

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$978.58

Service Code	NDC 66993008096
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$616.51
Max. Negotiated Rate	$880.72
Rate for Payer: Aetna Commercial	$831.79
Rate for Payer: Aetna New Business (MI Preferred)	$636.08
Rate for Payer: Cash Price	$782.86
Rate for Payer: Cofinity Advantage	$685.01
Rate for Payer: Cofinity Commercial	$841.58
Rate for Payer: Encore Health Key Benefits Commercial	$782.86
Rate for Payer: Healthscope Commercial	$880.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$733.93
Rate for Payer: PHP Commercial	$831.79
Rate for Payer: Priority Health SBD	$616.51

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$658.63
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Advantage	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$784.08
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health SBD	$658.63

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$814.47

Service Code	NDC 66993007996
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$513.12
Max. Negotiated Rate	$733.02
Rate for Payer: Aetna Commercial	$692.30
Rate for Payer: Aetna New Business (MI Preferred)	$529.41
Rate for Payer: Cash Price	$651.58
Rate for Payer: Cofinity Advantage	$570.13
Rate for Payer: Cofinity Commercial	$700.44
Rate for Payer: Encore Health Key Benefits Commercial	$651.58
Rate for Payer: Healthscope Commercial	$733.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$692.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$610.85
Rate for Payer: PHP Commercial	$692.30
Rate for Payer: Priority Health SBD	$513.12

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$410.86
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna Medicare	$522.72
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: BCBS Complete	$418.18
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Advantage	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: MI Amish Medical Board Commercial	$836.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$784.08
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health SBD	$658.63
Rate for Payer: UHC All Payor (Choice/PPO)	$679.54
Rate for Payer: UHC Core	$544.67
Rate for Payer: UHC Exchange	$410.86

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$814.47

Service Code	NDC 66993007996
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$320.09
Max. Negotiated Rate	$733.02
Rate for Payer: Aetna Commercial	$692.30
Rate for Payer: Aetna Medicare	$407.24
Rate for Payer: Aetna New Business (MI Preferred)	$529.41
Rate for Payer: BCBS Complete	$325.79
Rate for Payer: Cash Price	$651.58
Rate for Payer: Cofinity Advantage	$570.13
Rate for Payer: Cofinity Commercial	$700.44
Rate for Payer: Encore Health Key Benefits Commercial	$651.58
Rate for Payer: Healthscope Commercial	$733.02
Rate for Payer: MI Amish Medical Board Commercial	$651.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$692.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$610.85
Rate for Payer: PHP Commercial	$692.30
Rate for Payer: Priority Health SBD	$513.12
Rate for Payer: UHC All Payor (Choice/PPO)	$529.41
Rate for Payer: UHC Core	$424.34
Rate for Payer: UHC Exchange	$320.09

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$978.58

Service Code	NDC 66993008096
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$880.72
Rate for Payer: Aetna Commercial	$831.79
Rate for Payer: Aetna Medicare	$489.29
Rate for Payer: Aetna New Business (MI Preferred)	$636.08
Rate for Payer: BCBS Complete	$391.43
Rate for Payer: Cash Price	$782.86
Rate for Payer: Cofinity Advantage	$685.01
Rate for Payer: Cofinity Commercial	$841.58
Rate for Payer: Encore Health Key Benefits Commercial	$782.86
Rate for Payer: Healthscope Commercial	$880.72
Rate for Payer: MI Amish Medical Board Commercial	$782.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$733.93
Rate for Payer: PHP Commercial	$831.79
Rate for Payer: Priority Health SBD	$616.51
Rate for Payer: UHC All Payor (Choice/PPO)	$636.08
Rate for Payer: UHC Core	$509.84
Rate for Payer: UHC Exchange	$384.58

Know your out-of-pocket cost for care.

All Charges