Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FINASTERIDE 5 MG TABLET

Facility

$4.31

Service Code	NDC 50268031411
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$3.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.80
Rate for Payer: Cash Price	$3.45
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Commercial	$3.71
Rate for Payer: Cofinity Medicare Advantage	$3.02
Rate for Payer: Encore Health Key Benefits Commercial	$3.45
Rate for Payer: Healthscope Commercial	$3.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.66
Rate for Payer: PHP Commercial	$3.66
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: Priority Health SBD	$2.72

FINASTERIDE 5 MG TABLET

Facility

$53.58

Service Code	NDC 16729009010
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$33.76
Max. Negotiated Rate	$48.22
Rate for Payer: Aetna Commercial	$45.54
Rate for Payer: Aetna New Business (MI Preferred)	$34.83
Rate for Payer: Cash Price	$42.86
Rate for Payer: Cofinity Commercial	$37.51
Rate for Payer: Cofinity Commercial	$46.08
Rate for Payer: Cofinity Medicare Advantage	$37.51
Rate for Payer: Encore Health Key Benefits Commercial	$42.86
Rate for Payer: Healthscope Commercial	$48.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.54
Rate for Payer: PHP Commercial	$45.54
Rate for Payer: Priority Health Cigna Priority Health	$34.83
Rate for Payer: Priority Health SBD	$33.76

FINASTERIDE 5 MG TABLET

Facility

$148.05

Service Code	NDC 16729009001
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Cofinity Medicare Advantage	$103.64
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$96.23
Rate for Payer: Priority Health SBD	$93.27

FINASTERIDE 5 MG TABLET

Facility

$195.70

Service Code	NDC 00904683006
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$78.28
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna Medicare	$97.85
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Cofinity Medicare Advantage	$136.99
Rate for Payer: Encore Health Key Benefits Commercial	$156.56
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$127.20
Rate for Payer: Priority Health SBD	$123.29

FINASTERIDE 5 MG TABLET

Facility

$195.70

Service Code	NDC 00904683006
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Cofinity Medicare Advantage	$136.99
Rate for Payer: Encore Health Key Benefits Commercial	$156.56
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$127.20
Rate for Payer: Priority Health SBD	$123.29

FINASTERIDE 5 MG TABLET

Facility

$4.31

Service Code	NDC 50268031411
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$3.66
Rate for Payer: Aetna Medicare	$2.15
Rate for Payer: Aetna New Business (MI Preferred)	$2.80
Rate for Payer: BCBS Complete	$1.72
Rate for Payer: Cash Price	$3.45
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Commercial	$3.71
Rate for Payer: Cofinity Medicare Advantage	$3.02
Rate for Payer: Encore Health Key Benefits Commercial	$3.45
Rate for Payer: Healthscope Commercial	$3.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.66
Rate for Payer: PHP Commercial	$3.66
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: Priority Health SBD	$2.72

FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION

Facility

$1,931.58

Service Code	CPT 10005
Hospital Revenue Code	361
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$386.33
Rate for Payer: VA VA	$686.20

FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED

Facility

$7,528.73

Service Code	CPT 46200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

FLECAINIDE 50 MG TABLET

Facility

$253.92

Service Code	NDC 00054001020
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$159.97
Max. Negotiated Rate	$228.53
Rate for Payer: Aetna Commercial	$215.83
Rate for Payer: Aetna New Business (MI Preferred)	$165.05
Rate for Payer: Cash Price	$203.14
Rate for Payer: Cofinity Commercial	$177.74
Rate for Payer: Cofinity Commercial	$218.37
Rate for Payer: Cofinity Medicare Advantage	$177.74
Rate for Payer: Encore Health Key Benefits Commercial	$203.14
Rate for Payer: Healthscope Commercial	$228.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.83
Rate for Payer: PHP Commercial	$215.83
Rate for Payer: Priority Health Cigna Priority Health	$165.05
Rate for Payer: Priority Health SBD	$159.97

FLECAINIDE 50 MG TABLET

Facility

$258.50

Service Code	NDC 53746064101
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

FLECAINIDE 50 MG TABLET

Facility

$258.50

Service Code	NDC 53746064101
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna Medicare	$129.25
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: BCBS Complete	$103.40
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

FLECAINIDE 50 MG TABLET

Facility

$253.92

Service Code	NDC 00054001020
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$101.57
Max. Negotiated Rate	$228.53
Rate for Payer: Aetna Commercial	$215.83
Rate for Payer: Aetna Medicare	$126.96
Rate for Payer: Aetna New Business (MI Preferred)	$165.05
Rate for Payer: BCBS Complete	$101.57
Rate for Payer: Cash Price	$203.14
Rate for Payer: Cofinity Commercial	$177.74
Rate for Payer: Cofinity Commercial	$218.37
Rate for Payer: Cofinity Medicare Advantage	$177.74
Rate for Payer: Encore Health Key Benefits Commercial	$203.14
Rate for Payer: Healthscope Commercial	$228.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.83
Rate for Payer: PHP Commercial	$215.83
Rate for Payer: Priority Health Cigna Priority Health	$165.05
Rate for Payer: Priority Health SBD	$159.97

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 Commercial	$107.66
Rate for Payer: Cofinity Commercial	$132.27
Rate for Payer: Cofinity Medicare Advantage	$107.66
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: PHP Commercial	$130.73
Rate for Payer: Priority Health Cigna Priority Health	$99.97
Rate for Payer: Priority Health SBD	$96.89

FLECAINIDE 50 MG TABLET

Facility

$153.80

Service Code	NDC 00054001021
Hospital Charge Code	10043
Hospital Revenue Code	637
Min. Negotiated Rate	$61.52
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 Commercial	$107.66
Rate for Payer: Cofinity Commercial	$132.27
Rate for Payer: Cofinity Medicare Advantage	$107.66
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: PHP Commercial	$130.73
Rate for Payer: Priority Health Cigna Priority Health	$99.97
Rate for Payer: Priority Health SBD	$96.89

FLUCONAZOLE 100 MG TABLET

Facility

$554.40

Service Code	NDC 00904650061
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$349.27
Max. Negotiated Rate	$498.96
Rate for Payer: Aetna Commercial	$471.24
Rate for Payer: Aetna New Business (MI Preferred)	$360.36
Rate for Payer: Cash Price	$443.52
Rate for Payer: Cofinity Commercial	$388.08
Rate for Payer: Cofinity Commercial	$476.78
Rate for Payer: Cofinity Medicare Advantage	$388.08
Rate for Payer: Encore Health Key Benefits Commercial	$443.52
Rate for Payer: Healthscope Commercial	$498.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$471.24
Rate for Payer: PHP Commercial	$471.24
Rate for Payer: Priority Health Cigna Priority Health	$360.36
Rate for Payer: Priority Health SBD	$349.27

FLUCONAZOLE 100 MG TABLET

Facility

$554.40

Service Code	NDC 00904650061
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$221.76
Max. Negotiated Rate	$498.96
Rate for Payer: Aetna Commercial	$471.24
Rate for Payer: Aetna Medicare	$277.20
Rate for Payer: Aetna New Business (MI Preferred)	$360.36
Rate for Payer: BCBS Complete	$221.76
Rate for Payer: Cash Price	$443.52
Rate for Payer: Cofinity Commercial	$388.08
Rate for Payer: Cofinity Commercial	$476.78
Rate for Payer: Cofinity Medicare Advantage	$388.08
Rate for Payer: Encore Health Key Benefits Commercial	$443.52
Rate for Payer: Healthscope Commercial	$498.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$471.24
Rate for Payer: PHP Commercial	$471.24
Rate for Payer: Priority Health Cigna Priority Health	$360.36
Rate for Payer: Priority Health SBD	$349.27

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 Commercial	$100.98
Rate for Payer: Cofinity Commercial	$82.19
Rate for Payer: Cofinity Medicare Advantage	$82.19
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: PHP Commercial	$99.81
Rate for Payer: Priority Health Cigna Priority Health	$76.32
Rate for Payer: Priority Health SBD	$73.97

FLUCONAZOLE 100 MG TABLET

Facility

$117.42

Service Code	NDC 68462010230
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$46.97
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 Commercial	$100.98
Rate for Payer: Cofinity Commercial	$82.19
Rate for Payer: Cofinity Medicare Advantage	$82.19
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: PHP Commercial	$99.81
Rate for Payer: Priority Health Cigna Priority Health	$76.32
Rate for Payer: Priority Health SBD	$73.97

FLUCONAZOLE 150 MG TABLET

Facility

$60.20

Service Code	NDC 57237000511
Hospital Charge Code	13577
Hospital Revenue Code	637
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$54.18
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: Aetna Medicare	$30.10
Rate for Payer: Aetna New Business (MI Preferred)	$39.13
Rate for Payer: BCBS Complete	$24.08
Rate for Payer: Cash Price	$48.16
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Cofinity Commercial	$51.77
Rate for Payer: Cofinity Medicare Advantage	$42.14
Rate for Payer: Encore Health Key Benefits Commercial	$48.16
Rate for Payer: Healthscope Commercial	$54.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.17
Rate for Payer: PHP Commercial	$51.17
Rate for Payer: Priority Health Cigna Priority Health	$39.13
Rate for Payer: Priority Health SBD	$37.93

FLUCONAZOLE 150 MG TABLET

Facility

$60.20

Service Code	NDC 57237000511
Hospital Charge Code	13577
Hospital Revenue Code	637
Min. Negotiated Rate	$37.93
Max. Negotiated Rate	$54.18
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: Aetna New Business (MI Preferred)	$39.13
Rate for Payer: Cash Price	$48.16
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Cofinity Commercial	$51.77
Rate for Payer: Cofinity Medicare Advantage	$42.14
Rate for Payer: Encore Health Key Benefits Commercial	$48.16
Rate for Payer: Healthscope Commercial	$54.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.17
Rate for Payer: PHP Commercial	$51.17
Rate for Payer: Priority Health Cigna Priority Health	$39.13
Rate for Payer: Priority Health SBD	$37.93

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	$42.11
Max. Negotiated Rate	$94.74
Rate for Payer: Aetna Commercial	$89.48
Rate for Payer: Aetna Commercial	$75.92
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare	$44.66
Rate for Payer: Aetna Medicare	$52.63
Rate for Payer: Aetna Medicare	$29.51
Rate for Payer: Aetna New Business (MI Preferred)	$58.06
Rate for Payer: Aetna New Business (MI Preferred)	$68.43
Rate for Payer: Aetna New Business (MI Preferred)	$38.36
Rate for Payer: BCBS Complete	$23.61
Rate for Payer: BCBS Complete	$42.11
Rate for Payer: BCBS Complete	$35.73
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cash Price	$84.22
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Cofinity Commercial	$90.53
Rate for Payer: Cofinity Commercial	$73.69
Rate for Payer: Cofinity Commercial	$50.76
Rate for Payer: Cofinity Commercial	$41.31
Rate for Payer: Cofinity Commercial	$62.52
Rate for Payer: Cofinity Medicare Advantage	$41.31
Rate for Payer: Cofinity Medicare Advantage	$73.69
Rate for Payer: Cofinity Medicare Advantage	$62.52
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	$53.12
Rate for Payer: Healthscope Commercial	$94.74
Rate for Payer: Healthscope Commercial	$80.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.48
Rate for Payer: PHP Commercial	$50.17
Rate for Payer: PHP Commercial	$89.48
Rate for Payer: PHP Commercial	$75.92
Rate for Payer: Priority Health Cigna Priority Health	$68.43
Rate for Payer: Priority Health Cigna Priority Health	$58.06
Rate for Payer: Priority Health Cigna Priority Health	$38.36
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

$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)	$38.36
Rate for Payer: Aetna New Business (MI Preferred)	$68.43
Rate for Payer: Aetna New Business (MI Preferred)	$58.06
Rate for Payer: Cash Price	$84.22
Rate for Payer: Cash Price	$71.46
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cofinity Commercial	$73.69
Rate for Payer: Cofinity Commercial	$90.53
Rate for Payer: Cofinity Commercial	$41.31
Rate for Payer: Cofinity Commercial	$50.76
Rate for Payer: Cofinity Commercial	$62.52
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Cofinity Medicare Advantage	$73.69
Rate for Payer: Cofinity Medicare Advantage	$62.52
Rate for Payer: Cofinity Medicare Advantage	$41.31
Rate for Payer: Encore Health Key Benefits Commercial	$84.22
Rate for Payer: Encore Health Key Benefits Commercial	$47.22
Rate for Payer: Encore Health Key Benefits Commercial	$71.46
Rate for Payer: Healthscope Commercial	$94.74
Rate for Payer: Healthscope Commercial	$53.12
Rate for Payer: Healthscope Commercial	$80.39
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: PHP Commercial	$50.17
Rate for Payer: PHP Commercial	$75.92
Rate for Payer: PHP Commercial	$89.48
Rate for Payer: Priority Health Cigna Priority Health	$58.06
Rate for Payer: Priority Health Cigna Priority Health	$38.36
Rate for Payer: Priority Health Cigna Priority Health	$68.43
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 TABLET

Facility

$308.16

Service Code	NDC 50268033915
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$194.14
Max. Negotiated Rate	$277.34
Rate for Payer: Aetna Commercial	$261.94
Rate for Payer: Aetna New Business (MI Preferred)	$200.30
Rate for Payer: Cash Price	$246.53
Rate for Payer: Cofinity Commercial	$215.71
Rate for Payer: Cofinity Commercial	$265.02
Rate for Payer: Cofinity Medicare Advantage	$215.71
Rate for Payer: Encore Health Key Benefits Commercial	$246.53
Rate for Payer: Healthscope Commercial	$277.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.94
Rate for Payer: PHP Commercial	$261.94
Rate for Payer: Priority Health Cigna Priority Health	$200.30
Rate for Payer: Priority Health SBD	$194.14

FLUCONAZOLE 200 MG TABLET

Facility

$280.08

Service Code	NDC 00904650106
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$112.03
Max. Negotiated Rate	$252.07
Rate for Payer: Aetna Commercial	$238.07
Rate for Payer: Aetna Medicare	$140.04
Rate for Payer: Aetna New Business (MI Preferred)	$182.05
Rate for Payer: BCBS Complete	$112.03
Rate for Payer: Cash Price	$224.06
Rate for Payer: Cofinity Commercial	$196.06
Rate for Payer: Cofinity Commercial	$240.87
Rate for Payer: Cofinity Medicare Advantage	$196.06
Rate for Payer: Encore Health Key Benefits Commercial	$224.06
Rate for Payer: Healthscope Commercial	$252.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.07
Rate for Payer: PHP Commercial	$238.07
Rate for Payer: Priority Health Cigna Priority Health	$182.05
Rate for Payer: Priority Health SBD	$176.45

FLUCONAZOLE 200 MG TABLET

Facility

$6.17

Service Code	NDC 50268033911
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.55
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna Medicare	$3.08
Rate for Payer: Aetna New Business (MI Preferred)	$4.01
Rate for Payer: BCBS Complete	$2.47
Rate for Payer: Cash Price	$4.94
Rate for Payer: Cofinity Commercial	$4.32
Rate for Payer: Cofinity Commercial	$5.31
Rate for Payer: Cofinity Medicare Advantage	$4.32
Rate for Payer: Encore Health Key Benefits Commercial	$4.94
Rate for Payer: Healthscope Commercial	$5.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.24
Rate for Payer: PHP Commercial	$5.24
Rate for Payer: Priority Health Cigna Priority Health	$4.01
Rate for Payer: Priority Health SBD	$3.89

Know your out-of-pocket cost for care.

All Charges