Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 200 MG TABLET

Facility

$6.17

Service Code	NDC 50268033911
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$5.55
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna New Business (MI Preferred)	$4.01
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

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

$8.14

Service Code	NDC 68084073511
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$3.26
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 Commercial	$5.70
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Cofinity Medicare Advantage	$5.70
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: PHP Commercial	$6.92
Rate for Payer: Priority Health Cigna Priority Health	$5.29
Rate for Payer: Priority Health SBD	$5.13

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

$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 Commercial	$569.18
Rate for Payer: Cofinity Commercial	$699.28
Rate for Payer: Cofinity Medicare Advantage	$569.18
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: PHP Commercial	$691.15
Rate for Payer: Priority Health Cigna Priority Health	$528.53
Rate for Payer: Priority Health SBD	$512.27

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

FLUCONAZOLE 200 MG TABLET

Facility

$308.16

Service Code	NDC 50268033915
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$123.26
Max. Negotiated Rate	$277.34
Rate for Payer: Aetna Commercial	$261.94
Rate for Payer: Aetna Medicare	$154.08
Rate for Payer: Aetna New Business (MI Preferred)	$200.30
Rate for Payer: BCBS Complete	$123.26
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

$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 Commercial	$693.86
Rate for Payer: Cofinity Commercial	$852.46
Rate for Payer: Cofinity Medicare Advantage	$693.86
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: PHP Commercial	$842.55
Rate for Payer: Priority Health Cigna Priority Health	$644.30
Rate for Payer: Priority Health SBD	$624.47

FLUCONAZOLE 200 MG TABLET

Facility

$813.12

Service Code	NDC 68084073501
Hospital Charge Code	10045
Hospital Revenue Code	637
Min. Negotiated Rate	$325.25
Max. Negotiated Rate	$731.81
Rate for Payer: Aetna Commercial	$691.15
Rate for Payer: Aetna Medicare	$406.56
Rate for Payer: Aetna New Business (MI Preferred)	$528.53
Rate for Payer: BCBS Complete	$325.25
Rate for Payer: Cash Price	$650.50
Rate for Payer: Cofinity Commercial	$569.18
Rate for Payer: Cofinity Commercial	$699.28
Rate for Payer: Cofinity Medicare Advantage	$569.18
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: PHP Commercial	$691.15
Rate for Payer: Priority Health Cigna Priority Health	$528.53
Rate for Payer: Priority Health SBD	$512.27

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	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Commercial	$86.77
Rate for Payer: Aetna Medicare	$51.04
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$66.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: BCBS Complete	$40.83
Rate for Payer: Cash Price	$81.66
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$71.46
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Commercial	$87.79
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Cofinity Medicare Advantage	$71.46
Rate for Payer: Encore Health Key Benefits Commercial	$81.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$91.87
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: PHP Commercial	$86.77
Rate for Payer: Priority Health Cigna Priority Health	$66.35
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19
Rate for Payer: Priority Health SBD	$64.31

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	$86.77
Rate for Payer: Aetna New Business (MI Preferred)	$66.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$81.66
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$71.46
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Commercial	$87.79
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Cofinity Medicare Advantage	$71.46
Rate for Payer: Encore Health Key Benefits Commercial	$81.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$91.87
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$86.77
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health Cigna Priority Health	$66.35
Rate for Payer: Priority Health SBD	$40.19
Rate for Payer: Priority Health SBD	$64.31

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION

Facility

$394.01

Service Code	HCPCS J9185
Hospital Charge Code	41294
Hospital Revenue Code	636
Min. Negotiated Rate	$36.56
Max. Negotiated Rate	$354.61
Rate for Payer: Aetna Commercial	$334.91
Rate for Payer: Aetna Commercial	$606.91
Rate for Payer: Aetna Medicare	$70.93
Rate for Payer: Aetna Medicare	$70.93
Rate for Payer: Aetna New Business (MI Preferred)	$256.11
Rate for Payer: Aetna New Business (MI Preferred)	$464.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$85.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$85.25
Rate for Payer: Amish Plain Church Group Commercial	$85.25
Rate for Payer: Amish Plain Church Group Commercial	$85.25
Rate for Payer: BCBS Complete	$38.38
Rate for Payer: BCBS Complete	$38.38
Rate for Payer: BCBS MAPPO	$68.20
Rate for Payer: BCBS MAPPO	$68.20
Rate for Payer: BCN Medicare Advantage	$68.20
Rate for Payer: BCN Medicare Advantage	$68.20
Rate for Payer: Cash Price	$571.21
Rate for Payer: Cash Price	$571.21
Rate for Payer: Cash Price	$315.21
Rate for Payer: Cash Price	$315.21
Rate for Payer: Cofinity Commercial	$499.81
Rate for Payer: Cofinity Commercial	$614.05
Rate for Payer: Cofinity Commercial	$338.85
Rate for Payer: Cofinity Commercial	$275.81
Rate for Payer: Cofinity Medicare Advantage	$275.81
Rate for Payer: Cofinity Medicare Advantage	$499.81
Rate for Payer: Encore Health Key Benefits Commercial	$571.21
Rate for Payer: Encore Health Key Benefits Commercial	$315.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$68.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$68.20
Rate for Payer: Healthscope Commercial	$354.61
Rate for Payer: Healthscope Commercial	$642.61
Rate for Payer: Mclaren Medicaid	$36.56
Rate for Payer: Mclaren Medicaid	$36.56
Rate for Payer: Mclaren Medicare	$68.20
Rate for Payer: Mclaren Medicare	$68.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$71.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$71.61
Rate for Payer: Meridian Medicaid	$38.38
Rate for Payer: Meridian Medicaid	$38.38
Rate for Payer: MI Amish Medical Board Commercial	$78.43
Rate for Payer: MI Amish Medical Board Commercial	$78.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$334.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$606.91
Rate for Payer: PACE Medicare	$64.79
Rate for Payer: PACE Medicare	$64.79
Rate for Payer: PACE SWMI	$68.20
Rate for Payer: PACE SWMI	$68.20
Rate for Payer: PHP Commercial	$606.91
Rate for Payer: PHP Commercial	$334.91
Rate for Payer: PHP Medicare Advantage	$68.20
Rate for Payer: PHP Medicare Advantage	$68.20
Rate for Payer: Priority Health Choice Medicaid	$36.56
Rate for Payer: Priority Health Choice Medicaid	$36.56
Rate for Payer: Priority Health Cigna Priority Health	$464.11
Rate for Payer: Priority Health Cigna Priority Health	$256.11
Rate for Payer: Priority Health Medicare	$68.20
Rate for Payer: Priority Health Medicare	$68.20
Rate for Payer: Priority Health SBD	$449.83
Rate for Payer: Priority Health SBD	$248.23
Rate for Payer: Railroad Medicare Medicare	$68.20
Rate for Payer: Railroad Medicare Medicare	$68.20
Rate for Payer: UHC All Payor (Choice/PPO)	$191.98
Rate for Payer: UHC All Payor (Choice/PPO)	$191.98
Rate for Payer: UHC Dual Complete DSNP	$68.20
Rate for Payer: UHC Dual Complete DSNP	$68.20
Rate for Payer: UHC Medicare Advantage	$68.20
Rate for Payer: UHC Medicare Advantage	$68.20
Rate for Payer: UHCCP Medicaid	$38.40
Rate for Payer: UHCCP Medicaid	$38.40
Rate for Payer: VA VA	$68.20
Rate for Payer: VA VA	$68.20

FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION

Facility

$394.01

Service Code	HCPCS J9185
Hospital Charge Code	41294
Hospital Revenue Code	636
Min. Negotiated Rate	$248.23
Max. Negotiated Rate	$354.61
Rate for Payer: Aetna Commercial	$334.91
Rate for Payer: Aetna Commercial	$606.91
Rate for Payer: Aetna New Business (MI Preferred)	$256.11
Rate for Payer: Aetna New Business (MI Preferred)	$464.11
Rate for Payer: Cash Price	$315.21
Rate for Payer: Cash Price	$571.21
Rate for Payer: Cofinity Commercial	$275.81
Rate for Payer: Cofinity Commercial	$499.81
Rate for Payer: Cofinity Commercial	$614.05
Rate for Payer: Cofinity Commercial	$338.85
Rate for Payer: Cofinity Medicare Advantage	$499.81
Rate for Payer: Cofinity Medicare Advantage	$275.81
Rate for Payer: Encore Health Key Benefits Commercial	$315.21
Rate for Payer: Encore Health Key Benefits Commercial	$571.21
Rate for Payer: Healthscope Commercial	$354.61
Rate for Payer: Healthscope Commercial	$642.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$334.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$606.91
Rate for Payer: PHP Commercial	$334.91
Rate for Payer: PHP Commercial	$606.91
Rate for Payer: Priority Health Cigna Priority Health	$464.11
Rate for Payer: Priority Health Cigna Priority Health	$256.11
Rate for Payer: Priority Health SBD	$449.83
Rate for Payer: Priority Health SBD	$248.23

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 Commercial	$184.13
Rate for Payer: Cofinity Commercial	$226.21
Rate for Payer: Cofinity Medicare Advantage	$184.13
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: PHP Commercial	$223.58
Rate for Payer: Priority Health Cigna Priority Health	$170.98
Rate for Payer: Priority Health SBD	$165.72

FLUDROCORTISONE 0.1 MG TABLET

Facility

$3.77

Service Code	NDC 68084028811
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.39
Rate for Payer: Aetna Commercial	$3.20
Rate for Payer: Aetna Medicare	$1.89
Rate for Payer: Aetna New Business (MI Preferred)	$2.45
Rate for Payer: BCBS Complete	$1.51
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cofinity Commercial	$2.64
Rate for Payer: Cofinity Commercial	$3.24
Rate for Payer: Cofinity Medicare Advantage	$2.64
Rate for Payer: Encore Health Key Benefits Commercial	$3.02
Rate for Payer: Healthscope Commercial	$3.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.20
Rate for Payer: PHP Commercial	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.45
Rate for Payer: Priority Health SBD	$2.38

FLUDROCORTISONE 0.1 MG TABLET

Facility

$263.04

Service Code	NDC 00115703301
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$105.22
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 Commercial	$184.13
Rate for Payer: Cofinity Commercial	$226.21
Rate for Payer: Cofinity Medicare Advantage	$184.13
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: PHP Commercial	$223.58
Rate for Payer: Priority Health Cigna Priority Health	$170.98
Rate for Payer: Priority Health SBD	$165.72

FLUDROCORTISONE 0.1 MG TABLET

Facility

$376.80

Service Code	NDC 68084028801
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$150.72
Max. Negotiated Rate	$339.12
Rate for Payer: Aetna Commercial	$320.28
Rate for Payer: Aetna Medicare	$188.40
Rate for Payer: Aetna New Business (MI Preferred)	$244.92
Rate for Payer: BCBS Complete	$150.72
Rate for Payer: Cash Price	$301.44
Rate for Payer: Cofinity Commercial	$263.76
Rate for Payer: Cofinity Commercial	$324.05
Rate for Payer: Cofinity Medicare Advantage	$263.76
Rate for Payer: Encore Health Key Benefits Commercial	$301.44
Rate for Payer: Healthscope Commercial	$339.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$320.28
Rate for Payer: PHP Commercial	$320.28
Rate for Payer: Priority Health Cigna Priority Health	$244.92
Rate for Payer: Priority Health SBD	$237.38

FLUDROCORTISONE 0.1 MG TABLET

Facility

$3.77

Service Code	NDC 68084028811
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.39
Rate for Payer: Aetna Commercial	$3.20
Rate for Payer: Aetna New Business (MI Preferred)	$2.45
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cofinity Commercial	$2.64
Rate for Payer: Cofinity Commercial	$3.24
Rate for Payer: Cofinity Medicare Advantage	$2.64
Rate for Payer: Encore Health Key Benefits Commercial	$3.02
Rate for Payer: Healthscope Commercial	$3.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.20
Rate for Payer: PHP Commercial	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.45
Rate for Payer: Priority Health SBD	$2.38

FLUDROCORTISONE 0.1 MG TABLET

Facility

$376.80

Service Code	NDC 68084028801
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$237.38
Max. Negotiated Rate	$339.12
Rate for Payer: Aetna Commercial	$320.28
Rate for Payer: Aetna New Business (MI Preferred)	$244.92
Rate for Payer: Cash Price	$301.44
Rate for Payer: Cofinity Commercial	$263.76
Rate for Payer: Cofinity Commercial	$324.05
Rate for Payer: Cofinity Medicare Advantage	$263.76
Rate for Payer: Encore Health Key Benefits Commercial	$301.44
Rate for Payer: Healthscope Commercial	$339.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$320.28
Rate for Payer: PHP Commercial	$320.28
Rate for Payer: Priority Health Cigna Priority Health	$244.92
Rate for Payer: Priority Health SBD	$237.38

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	$7.40
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 Commercial	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Cofinity Medicare Advantage	$12.95
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: PHP Commercial	$15.72
Rate for Payer: Priority Health Cigna Priority Health	$12.03
Rate for Payer: Priority Health SBD	$11.65

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 Commercial	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Cofinity Medicare Advantage	$12.95
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: PHP Commercial	$15.72
Rate for Payer: Priority Health Cigna Priority Health	$12.03
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	$12.27
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 Commercial	$21.47
Rate for Payer: Cofinity Commercial	$26.38
Rate for Payer: Cofinity Medicare Advantage	$21.47
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: PHP Commercial	$26.07
Rate for Payer: Priority Health Cigna Priority Health	$19.94
Rate for Payer: Priority Health SBD	$19.32

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 Commercial	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Cofinity Medicare Advantage	$12.95
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: PHP Commercial	$15.72
Rate for Payer: Priority Health Cigna Priority Health	$12.03
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 Commercial	$21.47
Rate for Payer: Cofinity Commercial	$26.38
Rate for Payer: Cofinity Medicare Advantage	$21.47
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: PHP Commercial	$26.07
Rate for Payer: Priority Health Cigna Priority Health	$19.94
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	$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 Commercial	$12.95
Rate for Payer: Cofinity Commercial	$15.91
Rate for Payer: Cofinity Medicare Advantage	$12.95
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: PHP Commercial	$15.72
Rate for Payer: Priority Health Cigna Priority Health	$12.03
Rate for Payer: Priority Health SBD	$11.65

Know your out-of-pocket cost for care.

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