Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUPHENAZINE 10 MG TABLET

Facility

$967.74

Service Code	NDC 50268036915
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$609.68
Max. Negotiated Rate	$870.97
Rate for Payer: Aetna Commercial	$822.58
Rate for Payer: Aetna New Business (MI Preferred)	$629.03
Rate for Payer: Cash Price	$774.19
Rate for Payer: Cofinity Commercial	$677.42
Rate for Payer: Cofinity Commercial	$832.26
Rate for Payer: Cofinity Medicare Advantage	$677.42
Rate for Payer: Encore Health Key Benefits Commercial	$774.19
Rate for Payer: Healthscope Commercial	$870.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.58
Rate for Payer: PHP Commercial	$822.58
Rate for Payer: Priority Health Cigna Priority Health	$629.03
Rate for Payer: Priority Health SBD	$609.68

FLUPHENAZINE 10 MG TABLET

Facility

$967.74

Service Code	NDC 50268036915
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$387.10
Max. Negotiated Rate	$870.97
Rate for Payer: Aetna Commercial	$822.58
Rate for Payer: Aetna Medicare	$483.87
Rate for Payer: Aetna New Business (MI Preferred)	$629.03
Rate for Payer: BCBS Complete	$387.10
Rate for Payer: Cash Price	$774.19
Rate for Payer: Cofinity Commercial	$677.42
Rate for Payer: Cofinity Commercial	$832.26
Rate for Payer: Cofinity Medicare Advantage	$677.42
Rate for Payer: Encore Health Key Benefits Commercial	$774.19
Rate for Payer: Healthscope Commercial	$870.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.58
Rate for Payer: PHP Commercial	$822.58
Rate for Payer: Priority Health Cigna Priority Health	$629.03
Rate for Payer: Priority Health SBD	$609.68

FLUPHENAZINE 1 MG TABLET

Facility

$3.35

Service Code	NDC 51079048501
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$1.68
Rate for Payer: Aetna New Business (MI Preferred)	$2.18
Rate for Payer: BCBS Complete	$1.34
Rate for Payer: Cash Price	$2.68
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Medicare Advantage	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.68
Rate for Payer: Healthscope Commercial	$3.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.85
Rate for Payer: PHP Commercial	$2.85
Rate for Payer: Priority Health Cigna Priority Health	$2.18
Rate for Payer: Priority Health SBD	$2.11

FLUPHENAZINE 1 MG TABLET

Facility

$669.12

Service Code	NDC 00527178801
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$267.65
Max. Negotiated Rate	$602.21
Rate for Payer: Aetna Commercial	$568.75
Rate for Payer: Aetna Medicare	$334.56
Rate for Payer: Aetna New Business (MI Preferred)	$434.93
Rate for Payer: BCBS Complete	$267.65
Rate for Payer: Cash Price	$535.30
Rate for Payer: Cofinity Commercial	$468.38
Rate for Payer: Cofinity Commercial	$575.44
Rate for Payer: Cofinity Medicare Advantage	$468.38
Rate for Payer: Encore Health Key Benefits Commercial	$535.30
Rate for Payer: Healthscope Commercial	$602.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$568.75
Rate for Payer: PHP Commercial	$568.75
Rate for Payer: Priority Health Cigna Priority Health	$434.93
Rate for Payer: Priority Health SBD	$421.55

FLUPHENAZINE 1 MG TABLET

Facility

$3.35

Service Code	NDC 51079048501
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.18
Rate for Payer: Cash Price	$2.68
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Medicare Advantage	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.68
Rate for Payer: Healthscope Commercial	$3.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.85
Rate for Payer: PHP Commercial	$2.85
Rate for Payer: Priority Health Cigna Priority Health	$2.18
Rate for Payer: Priority Health SBD	$2.11

FLUPHENAZINE 1 MG TABLET

Facility

$669.12

Service Code	NDC 00527178801
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$421.55
Max. Negotiated Rate	$602.21
Rate for Payer: Aetna Commercial	$568.75
Rate for Payer: Aetna New Business (MI Preferred)	$434.93
Rate for Payer: Cash Price	$535.30
Rate for Payer: Cofinity Commercial	$468.38
Rate for Payer: Cofinity Commercial	$575.44
Rate for Payer: Cofinity Medicare Advantage	$468.38
Rate for Payer: Encore Health Key Benefits Commercial	$535.30
Rate for Payer: Healthscope Commercial	$602.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$568.75
Rate for Payer: PHP Commercial	$568.75
Rate for Payer: Priority Health Cigna Priority Health	$434.93
Rate for Payer: Priority Health SBD	$421.55

FLUPHENAZINE 2.5 MG TABLET

Facility

$12.39

Service Code	NDC 50268036711
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna New Business (MI Preferred)	$8.05
Rate for Payer: Cash Price	$9.91
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$8.67
Rate for Payer: Encore Health Key Benefits Commercial	$9.91
Rate for Payer: Healthscope Commercial	$11.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.53
Rate for Payer: PHP Commercial	$10.53
Rate for Payer: Priority Health Cigna Priority Health	$8.05
Rate for Payer: Priority Health SBD	$7.81

FLUPHENAZINE 2.5 MG TABLET

Facility

$12.39

Service Code	NDC 50268036711
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna Medicare	$6.20
Rate for Payer: Aetna New Business (MI Preferred)	$8.05
Rate for Payer: BCBS Complete	$4.96
Rate for Payer: Cash Price	$9.91
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$8.67
Rate for Payer: Encore Health Key Benefits Commercial	$9.91
Rate for Payer: Healthscope Commercial	$11.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.53
Rate for Payer: PHP Commercial	$10.53
Rate for Payer: Priority Health Cigna Priority Health	$8.05
Rate for Payer: Priority Health SBD	$7.81

FLUPHENAZINE 2.5 MG TABLET

Facility

$619.38

Service Code	NDC 50268036715
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$247.75
Max. Negotiated Rate	$557.44
Rate for Payer: Aetna Commercial	$526.47
Rate for Payer: Aetna Medicare	$309.69
Rate for Payer: Aetna New Business (MI Preferred)	$402.60
Rate for Payer: BCBS Complete	$247.75
Rate for Payer: Cash Price	$495.50
Rate for Payer: Cofinity Commercial	$433.57
Rate for Payer: Cofinity Commercial	$532.67
Rate for Payer: Cofinity Medicare Advantage	$433.57
Rate for Payer: Encore Health Key Benefits Commercial	$495.50
Rate for Payer: Healthscope Commercial	$557.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.47
Rate for Payer: PHP Commercial	$526.47
Rate for Payer: Priority Health Cigna Priority Health	$402.60
Rate for Payer: Priority Health SBD	$390.21

FLUPHENAZINE 2.5 MG TABLET

Facility

$619.38

Service Code	NDC 50268036715
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$390.21
Max. Negotiated Rate	$557.44
Rate for Payer: Aetna Commercial	$526.47
Rate for Payer: Aetna New Business (MI Preferred)	$402.60
Rate for Payer: Cash Price	$495.50
Rate for Payer: Cofinity Commercial	$433.57
Rate for Payer: Cofinity Commercial	$532.67
Rate for Payer: Cofinity Medicare Advantage	$433.57
Rate for Payer: Encore Health Key Benefits Commercial	$495.50
Rate for Payer: Healthscope Commercial	$557.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.47
Rate for Payer: PHP Commercial	$526.47
Rate for Payer: Priority Health Cigna Priority Health	$402.60
Rate for Payer: Priority Health SBD	$390.21

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 Commercial	$756.28
Rate for Payer: Cofinity Commercial	$929.14
Rate for Payer: Cofinity Medicare Advantage	$756.28
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: PHP Commercial	$918.34
Rate for Payer: Priority Health Cigna Priority Health	$702.26
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	$432.16
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 Commercial	$756.28
Rate for Payer: Cofinity Commercial	$929.14
Rate for Payer: Cofinity Medicare Advantage	$756.28
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: PHP Commercial	$918.34
Rate for Payer: Priority Health Cigna Priority Health	$702.26
Rate for Payer: Priority Health SBD	$680.65

FLUPHENAZINE 5 MG TABLET

Facility

$3,686.68

Service Code	NDC 68084084601
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$1,474.67
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 Commercial	$2,580.68
Rate for Payer: Cofinity Commercial	$3,170.54
Rate for Payer: Cofinity Medicare Advantage	$2,580.68
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: PHP Commercial	$3,133.68
Rate for Payer: Priority Health Cigna Priority Health	$2,396.34
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	$14.75
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 Commercial	$25.81
Rate for Payer: Cofinity Commercial	$31.71
Rate for Payer: Cofinity Medicare Advantage	$25.81
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: PHP Commercial	$31.34
Rate for Payer: Priority Health Cigna Priority Health	$23.97
Rate for Payer: Priority Health SBD	$23.23

FLUPHENAZINE 5 MG TABLET

Facility

$1,253.56

Service Code	NDC 00904715961
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$501.42
Max. Negotiated Rate	$1,128.20
Rate for Payer: Aetna Commercial	$1,065.53
Rate for Payer: Aetna Medicare	$626.78
Rate for Payer: Aetna New Business (MI Preferred)	$814.81
Rate for Payer: BCBS Complete	$501.42
Rate for Payer: Cash Price	$1,002.85
Rate for Payer: Cofinity Commercial	$1,078.06
Rate for Payer: Cofinity Commercial	$877.49
Rate for Payer: Cofinity Medicare Advantage	$877.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,002.85
Rate for Payer: Healthscope Commercial	$1,128.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,065.53
Rate for Payer: PHP Commercial	$1,065.53
Rate for Payer: Priority Health Cigna Priority Health	$814.81
Rate for Payer: Priority Health SBD	$789.74

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 Commercial	$25.81
Rate for Payer: Cofinity Commercial	$31.71
Rate for Payer: Cofinity Medicare Advantage	$25.81
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: PHP Commercial	$31.34
Rate for Payer: Priority Health Cigna Priority Health	$23.97
Rate for Payer: Priority Health SBD	$23.23

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 Commercial	$2,580.68
Rate for Payer: Cofinity Commercial	$3,170.54
Rate for Payer: Cofinity Medicare Advantage	$2,580.68
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: PHP Commercial	$3,133.68
Rate for Payer: Priority Health Cigna Priority Health	$2,396.34
Rate for Payer: Priority Health SBD	$2,322.61

FLUPHENAZINE 5 MG TABLET

Facility

$1,253.56

Service Code	NDC 00904715961
Hospital Charge Code	3221
Hospital Revenue Code	637
Min. Negotiated Rate	$789.74
Max. Negotiated Rate	$1,128.20
Rate for Payer: Aetna Commercial	$1,065.53
Rate for Payer: Aetna New Business (MI Preferred)	$814.81
Rate for Payer: Cash Price	$1,002.85
Rate for Payer: Cofinity Commercial	$1,078.06
Rate for Payer: Cofinity Commercial	$877.49
Rate for Payer: Cofinity Medicare Advantage	$877.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,002.85
Rate for Payer: Healthscope Commercial	$1,128.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,065.53
Rate for Payer: PHP Commercial	$1,065.53
Rate for Payer: Priority Health Cigna Priority Health	$814.81
Rate for Payer: Priority Health SBD	$789.74

FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION

Facility

$199.98

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

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	$133.04
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	$133.04
Rate for Payer: BCBS Complete	$79.99
Rate for Payer: Cash Price	$266.08
Rate for Payer: Cash Price	$159.98
Rate for Payer: Cofinity Commercial	$286.04
Rate for Payer: Cofinity Commercial	$139.99
Rate for Payer: Cofinity Commercial	$171.98
Rate for Payer: Cofinity Commercial	$232.82
Rate for Payer: Cofinity Medicare Advantage	$139.99
Rate for Payer: Cofinity Medicare Advantage	$232.82
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	$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: PHP Commercial	$282.71
Rate for Payer: PHP Commercial	$169.98
Rate for Payer: Priority Health Cigna Priority Health	$129.99
Rate for Payer: Priority Health Cigna Priority Health	$216.19
Rate for Payer: Priority Health SBD	$125.99
Rate for Payer: Priority Health SBD	$209.54

FLURBIPROFEN 0.03 % EYE DROPS

Facility

$117.15

Service Code	NDC 69292072225
Hospital Charge Code	10080
Hospital Revenue Code	637
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$105.44
Rate for Payer: Aetna Commercial	$99.58
Rate for Payer: Aetna Medicare	$58.58
Rate for Payer: Aetna New Business (MI Preferred)	$76.15
Rate for Payer: BCBS Complete	$46.86
Rate for Payer: Cash Price	$93.72
Rate for Payer: Cofinity Commercial	$100.75
Rate for Payer: Cofinity Commercial	$82.00
Rate for Payer: Cofinity Medicare Advantage	$82.00
Rate for Payer: Encore Health Key Benefits Commercial	$93.72
Rate for Payer: Healthscope Commercial	$105.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.58
Rate for Payer: PHP Commercial	$99.58
Rate for Payer: Priority Health Cigna Priority Health	$76.15
Rate for Payer: Priority Health SBD	$73.80

FLURBIPROFEN 0.03 % EYE DROPS

Facility

$117.15

Service Code	NDC 69292072225
Hospital Charge Code	10080
Hospital Revenue Code	637
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$105.44
Rate for Payer: Aetna Commercial	$99.58
Rate for Payer: Aetna New Business (MI Preferred)	$76.15
Rate for Payer: Cash Price	$93.72
Rate for Payer: Cofinity Commercial	$100.75
Rate for Payer: Cofinity Commercial	$82.00
Rate for Payer: Cofinity Medicare Advantage	$82.00
Rate for Payer: Encore Health Key Benefits Commercial	$93.72
Rate for Payer: Healthscope Commercial	$105.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.58
Rate for Payer: PHP Commercial	$99.58
Rate for Payer: Priority Health Cigna Priority Health	$76.15
Rate for Payer: Priority Health SBD	$73.80

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$794.31

Service Code	NDC 66993007996
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$500.42
Max. Negotiated Rate	$714.88
Rate for Payer: Aetna Commercial	$675.16
Rate for Payer: Aetna New Business (MI Preferred)	$516.30
Rate for Payer: Cash Price	$635.45
Rate for Payer: Cofinity Commercial	$556.02
Rate for Payer: Cofinity Commercial	$683.11
Rate for Payer: Cofinity Medicare Advantage	$556.02
Rate for Payer: Encore Health Key Benefits Commercial	$635.45
Rate for Payer: Healthscope Commercial	$714.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.16
Rate for Payer: PHP Commercial	$675.16
Rate for Payer: Priority Health Cigna Priority Health	$516.30
Rate for Payer: Priority Health SBD	$500.42

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$794.31

Service Code	NDC 66993007996
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$317.72
Max. Negotiated Rate	$714.88
Rate for Payer: Aetna Commercial	$675.16
Rate for Payer: Aetna Medicare	$397.15
Rate for Payer: Aetna New Business (MI Preferred)	$516.30
Rate for Payer: BCBS Complete	$317.72
Rate for Payer: Cash Price	$635.45
Rate for Payer: Cofinity Commercial	$556.02
Rate for Payer: Cofinity Commercial	$683.11
Rate for Payer: Cofinity Medicare Advantage	$556.02
Rate for Payer: Encore Health Key Benefits Commercial	$635.45
Rate for Payer: Healthscope Commercial	$714.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.16
Rate for Payer: PHP Commercial	$675.16
Rate for Payer: Priority Health Cigna Priority Health	$516.30
Rate for Payer: Priority Health SBD	$500.42

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	$418.18
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 Commercial	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Cofinity Medicare Advantage	$731.81
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: PHP Commercial	$888.62
Rate for Payer: Priority Health Cigna Priority Health	$679.54
Rate for Payer: Priority Health SBD	$658.63

Know your out-of-pocket cost for care.

All Charges