Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$36.67

Service Code	NDC 36000014910
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.17
Rate for Payer: Aetna New Business (MI Preferred)	$23.84
Rate for Payer: Cash Price	$29.34
Rate for Payer: Cofinity Commercial	$25.67
Rate for Payer: Cofinity Commercial	$31.54
Rate for Payer: Cofinity Medicare Advantage	$25.67
Rate for Payer: Encore Health Key Benefits Commercial	$29.34
Rate for Payer: Healthscope Commercial	$33.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.17
Rate for Payer: PHP Commercial	$31.17
Rate for Payer: Priority Health Cigna Priority Health	$23.84
Rate for Payer: Priority Health SBD	$23.10

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 00143978410
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

$36.67

Service Code	NDC 36000014910
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.17
Rate for Payer: Aetna Medicare	$18.34
Rate for Payer: Aetna New Business (MI Preferred)	$23.84
Rate for Payer: BCBS Complete	$14.67
Rate for Payer: Cash Price	$29.34
Rate for Payer: Cofinity Commercial	$25.67
Rate for Payer: Cofinity Commercial	$31.54
Rate for Payer: Cofinity Medicare Advantage	$25.67
Rate for Payer: Encore Health Key Benefits Commercial	$29.34
Rate for Payer: Healthscope Commercial	$33.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.17
Rate for Payer: PHP Commercial	$31.17
Rate for Payer: Priority Health Cigna Priority Health	$23.84
Rate for Payer: Priority Health SBD	$23.10

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$36.67

Service Code	NDC 36000014901
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.17
Rate for Payer: Aetna Medicare	$18.34
Rate for Payer: Aetna New Business (MI Preferred)	$23.84
Rate for Payer: BCBS Complete	$14.67
Rate for Payer: Cash Price	$29.34
Rate for Payer: Cofinity Commercial	$25.67
Rate for Payer: Cofinity Commercial	$31.54
Rate for Payer: Cofinity Medicare Advantage	$25.67
Rate for Payer: Encore Health Key Benefits Commercial	$29.34
Rate for Payer: Healthscope Commercial	$33.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.17
Rate for Payer: PHP Commercial	$31.17
Rate for Payer: Priority Health Cigna Priority Health	$23.84
Rate for Payer: Priority Health SBD	$23.10

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 IV (CODE)

Facility

$30.67

Service Code	NDC 63323042405
Hospital Charge Code	163712
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 IV (CODE)

Facility

$30.67

Service Code	NDC 63323042405
Hospital Charge Code	163712
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

FLUOCINONIDE 0.05 % TOPICAL CREAM

Facility

$39.96

Service Code	NDC 51672138601
Hospital Charge Code	3187
Hospital Revenue Code	637
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna Commercial	$33.97
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: Cash Price	$31.97
Rate for Payer: Cofinity Commercial	$27.97
Rate for Payer: Cofinity Commercial	$34.37
Rate for Payer: Cofinity Medicare Advantage	$27.97
Rate for Payer: Encore Health Key Benefits Commercial	$31.97
Rate for Payer: Healthscope Commercial	$35.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.97
Rate for Payer: PHP Commercial	$33.97
Rate for Payer: Priority Health Cigna Priority Health	$25.97
Rate for Payer: Priority Health SBD	$25.17

FLUOCINONIDE 0.05 % TOPICAL CREAM

Facility

$39.96

Service Code	NDC 51672138601
Hospital Charge Code	3187
Hospital Revenue Code	637
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna Commercial	$33.97
Rate for Payer: Aetna Medicare	$19.98
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: BCBS Complete	$15.98
Rate for Payer: Cash Price	$31.97
Rate for Payer: Cofinity Commercial	$27.97
Rate for Payer: Cofinity Commercial	$34.37
Rate for Payer: Cofinity Medicare Advantage	$27.97
Rate for Payer: Encore Health Key Benefits Commercial	$31.97
Rate for Payer: Healthscope Commercial	$35.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.97
Rate for Payer: PHP Commercial	$33.97
Rate for Payer: Priority Health Cigna Priority Health	$25.97
Rate for Payer: Priority Health SBD	$25.17

FLUORESCEIN 0.6 MG EYE STRIPS

Facility

$571.05

Service Code	NDC 17478040303
Hospital Charge Code	27662
Hospital Revenue Code	250
Min. Negotiated Rate	$359.76
Max. Negotiated Rate	$513.95
Rate for Payer: Aetna Commercial	$485.39
Rate for Payer: Aetna New Business (MI Preferred)	$371.18
Rate for Payer: Cash Price	$456.84
Rate for Payer: Cofinity Commercial	$399.74
Rate for Payer: Cofinity Commercial	$491.10
Rate for Payer: Cofinity Medicare Advantage	$399.74
Rate for Payer: Encore Health Key Benefits Commercial	$456.84
Rate for Payer: Healthscope Commercial	$513.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$485.39
Rate for Payer: PHP Commercial	$485.39
Rate for Payer: Priority Health Cigna Priority Health	$371.18
Rate for Payer: Priority Health SBD	$359.76

FLUORESCEIN 0.6 MG EYE STRIPS

Facility

$571.05

Service Code	NDC 17478040303
Hospital Charge Code	27662
Hospital Revenue Code	250
Min. Negotiated Rate	$228.42
Max. Negotiated Rate	$513.95
Rate for Payer: Aetna Commercial	$485.39
Rate for Payer: Aetna Medicare	$285.52
Rate for Payer: Aetna New Business (MI Preferred)	$371.18
Rate for Payer: BCBS Complete	$228.42
Rate for Payer: Cash Price	$456.84
Rate for Payer: Cofinity Commercial	$399.74
Rate for Payer: Cofinity Commercial	$491.10
Rate for Payer: Cofinity Medicare Advantage	$399.74
Rate for Payer: Encore Health Key Benefits Commercial	$456.84
Rate for Payer: Healthscope Commercial	$513.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$485.39
Rate for Payer: PHP Commercial	$485.39
Rate for Payer: Priority Health Cigna Priority Health	$371.18
Rate for Payer: Priority Health SBD	$359.76

FLUORESCEIN 1 MG EYE STRIPS

Facility

$458.25

Service Code	NDC 17238090011
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$183.30
Max. Negotiated Rate	$412.43
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna Medicare	$229.12
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: BCBS Complete	$183.30
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$320.77
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Cofinity Medicare Advantage	$320.77
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: Priority Health SBD	$288.70

FLUORESCEIN 1 MG EYE STRIPS

Facility

$2.33

Service Code	NDC 17478040401
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna Medicare	$1.17
Rate for Payer: Aetna New Business (MI Preferred)	$1.51
Rate for Payer: BCBS Complete	$0.93
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cofinity Commercial	$1.63
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Medicare Advantage	$1.63
Rate for Payer: Encore Health Key Benefits Commercial	$1.86
Rate for Payer: Healthscope Commercial	$2.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.98
Rate for Payer: PHP Commercial	$1.98
Rate for Payer: Priority Health Cigna Priority Health	$1.51
Rate for Payer: Priority Health SBD	$1.47

FLUORESCEIN 1 MG EYE STRIPS

Facility

$458.25

Service Code	NDC 17238090011
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$288.70
Max. Negotiated Rate	$412.43
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$320.77
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Cofinity Medicare Advantage	$320.77
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: Priority Health SBD	$288.70

FLUORESCEIN 1 MG EYE STRIPS

Facility

$2.33

Service Code	NDC 17478040401
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna New Business (MI Preferred)	$1.51
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cofinity Commercial	$1.63
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Medicare Advantage	$1.63
Rate for Payer: Encore Health Key Benefits Commercial	$1.86
Rate for Payer: Healthscope Commercial	$2.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.98
Rate for Payer: PHP Commercial	$1.98
Rate for Payer: Priority Health Cigna Priority Health	$1.51
Rate for Payer: Priority Health SBD	$1.47

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$237.71

Service Code	NDC 81298866001
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$95.08
Max. Negotiated Rate	$213.94
Rate for Payer: Aetna Commercial	$202.05
Rate for Payer: Aetna Medicare	$118.86
Rate for Payer: Aetna New Business (MI Preferred)	$154.51
Rate for Payer: BCBS Complete	$95.08
Rate for Payer: Cash Price	$190.17
Rate for Payer: Cofinity Commercial	$166.40
Rate for Payer: Cofinity Commercial	$204.43
Rate for Payer: Cofinity Medicare Advantage	$166.40
Rate for Payer: Encore Health Key Benefits Commercial	$190.17
Rate for Payer: Healthscope Commercial	$213.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.05
Rate for Payer: PHP Commercial	$202.05
Rate for Payer: Priority Health Cigna Priority Health	$154.51
Rate for Payer: Priority Health SBD	$149.76

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$199.57

Service Code	NDC 00065009265
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$79.83
Max. Negotiated Rate	$179.61
Rate for Payer: Aetna Commercial	$169.63
Rate for Payer: Aetna Medicare	$99.78
Rate for Payer: Aetna New Business (MI Preferred)	$129.72
Rate for Payer: BCBS Complete	$79.83
Rate for Payer: Cash Price	$159.66
Rate for Payer: Cofinity Commercial	$139.70
Rate for Payer: Cofinity Commercial	$171.63
Rate for Payer: Cofinity Medicare Advantage	$139.70
Rate for Payer: Encore Health Key Benefits Commercial	$159.66
Rate for Payer: Healthscope Commercial	$179.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.63
Rate for Payer: PHP Commercial	$169.63
Rate for Payer: Priority Health Cigna Priority Health	$129.72
Rate for Payer: Priority Health SBD	$125.73

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$237.71

Service Code	NDC 81298866003
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$95.08
Max. Negotiated Rate	$213.94
Rate for Payer: Aetna Commercial	$202.05
Rate for Payer: Aetna Medicare	$118.86
Rate for Payer: Aetna New Business (MI Preferred)	$154.51
Rate for Payer: BCBS Complete	$95.08
Rate for Payer: Cash Price	$190.17
Rate for Payer: Cofinity Commercial	$166.40
Rate for Payer: Cofinity Commercial	$204.43
Rate for Payer: Cofinity Medicare Advantage	$166.40
Rate for Payer: Encore Health Key Benefits Commercial	$190.17
Rate for Payer: Healthscope Commercial	$213.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.05
Rate for Payer: PHP Commercial	$202.05
Rate for Payer: Priority Health Cigna Priority Health	$154.51
Rate for Payer: Priority Health SBD	$149.76

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$199.57

Service Code	NDC 00065009265
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$125.73
Max. Negotiated Rate	$179.61
Rate for Payer: Aetna Commercial	$169.63
Rate for Payer: Aetna New Business (MI Preferred)	$129.72
Rate for Payer: Cash Price	$159.66
Rate for Payer: Cofinity Commercial	$139.70
Rate for Payer: Cofinity Commercial	$171.63
Rate for Payer: Cofinity Medicare Advantage	$139.70
Rate for Payer: Encore Health Key Benefits Commercial	$159.66
Rate for Payer: Healthscope Commercial	$179.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.63
Rate for Payer: PHP Commercial	$169.63
Rate for Payer: Priority Health Cigna Priority Health	$129.72
Rate for Payer: Priority Health SBD	$125.73

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$237.71

Service Code	NDC 81298866001
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$149.76
Max. Negotiated Rate	$213.94
Rate for Payer: Aetna Commercial	$202.05
Rate for Payer: Aetna New Business (MI Preferred)	$154.51
Rate for Payer: Cash Price	$190.17
Rate for Payer: Cofinity Commercial	$166.40
Rate for Payer: Cofinity Commercial	$204.43
Rate for Payer: Cofinity Medicare Advantage	$166.40
Rate for Payer: Encore Health Key Benefits Commercial	$190.17
Rate for Payer: Healthscope Commercial	$213.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.05
Rate for Payer: PHP Commercial	$202.05
Rate for Payer: Priority Health Cigna Priority Health	$154.51
Rate for Payer: Priority Health SBD	$149.76

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION

Facility

$237.71

Service Code	NDC 81298866003
Hospital Charge Code	10059
Hospital Revenue Code	250
Min. Negotiated Rate	$149.76
Max. Negotiated Rate	$213.94
Rate for Payer: Aetna Commercial	$202.05
Rate for Payer: Aetna New Business (MI Preferred)	$154.51
Rate for Payer: Cash Price	$190.17
Rate for Payer: Cofinity Commercial	$166.40
Rate for Payer: Cofinity Commercial	$204.43
Rate for Payer: Cofinity Medicare Advantage	$166.40
Rate for Payer: Encore Health Key Benefits Commercial	$190.17
Rate for Payer: Healthscope Commercial	$213.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.05
Rate for Payer: PHP Commercial	$202.05
Rate for Payer: Priority Health Cigna Priority Health	$154.51
Rate for Payer: Priority Health SBD	$149.76

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION

Facility

$548.21

Service Code	NDC 11980021105
Hospital Charge Code	3208
Hospital Revenue Code	637
Min. Negotiated Rate	$219.28
Max. Negotiated Rate	$493.39
Rate for Payer: Aetna Commercial	$465.98
Rate for Payer: Aetna Medicare	$274.11
Rate for Payer: Aetna New Business (MI Preferred)	$356.34
Rate for Payer: BCBS Complete	$219.28
Rate for Payer: Cash Price	$438.57
Rate for Payer: Cofinity Commercial	$383.75
Rate for Payer: Cofinity Commercial	$471.46
Rate for Payer: Cofinity Medicare Advantage	$383.75
Rate for Payer: Encore Health Key Benefits Commercial	$438.57
Rate for Payer: Healthscope Commercial	$493.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$465.98
Rate for Payer: PHP Commercial	$465.98
Rate for Payer: Priority Health Cigna Priority Health	$356.34
Rate for Payer: Priority Health SBD	$345.37

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION

Facility

$252.00

Service Code	NDC 60758088005
Hospital Charge Code	3208
Hospital Revenue Code	637
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna New Business (MI Preferred)	$163.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cofinity Commercial	$176.40
Rate for Payer: Cofinity Commercial	$216.72
Rate for Payer: Cofinity Medicare Advantage	$176.40
Rate for Payer: Encore Health Key Benefits Commercial	$201.60
Rate for Payer: Healthscope Commercial	$226.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.20
Rate for Payer: PHP Commercial	$214.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health SBD	$158.76

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION

Facility

$548.21

Service Code	NDC 11980021105
Hospital Charge Code	3208
Hospital Revenue Code	637
Min. Negotiated Rate	$345.37
Max. Negotiated Rate	$493.39
Rate for Payer: Aetna Commercial	$465.98
Rate for Payer: Aetna New Business (MI Preferred)	$356.34
Rate for Payer: Cash Price	$438.57
Rate for Payer: Cofinity Commercial	$383.75
Rate for Payer: Cofinity Commercial	$471.46
Rate for Payer: Cofinity Medicare Advantage	$383.75
Rate for Payer: Encore Health Key Benefits Commercial	$438.57
Rate for Payer: Healthscope Commercial	$493.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$465.98
Rate for Payer: PHP Commercial	$465.98
Rate for Payer: Priority Health Cigna Priority Health	$356.34
Rate for Payer: Priority Health SBD	$345.37

Know your out-of-pocket cost for care.

All Charges