|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$2,416.23
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$2,301.18 |
| Max. Negotiated Rate |
$2,416.23 |
| Rate for Payer: BCBS Complete |
$2,416.23
|
| Rate for Payer: Mclaren Medicaid |
$2,301.18
|
| Rate for Payer: Meridian Medicaid |
$2,416.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,301.18
|
| Rate for Payer: UHC Medicaid |
$2,301.18
|
| Rate for Payer: UHCCP Medicaid |
$2,301.18
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.40
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Mclaren Medicaid |
$1.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.52
|
| Rate for Payer: Meridian Medicaid |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PACE Senior Care Partners |
$2.28
|
| Rate for Payer: PACE SWMI |
$2.40
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: UHC Exchange |
$2.40
|
| Rate for Payer: UHC Medicaid |
$1.69
|
| Rate for Payer: UHC Medicare Advantage |
$2.40
|
| Rate for Payer: UHCCP Medicaid |
$1.69
|
| Rate for Payer: VA VA |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$61.34
|
|
|
Service Code
|
NDC 65862014930
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna Commercial |
$52.14
|
| Rate for Payer: Aetna Medicare |
$15.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.17
|
| Rate for Payer: BCBS Complete |
$11.35
|
| Rate for Payer: BCBS MAPPO |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$50.43
|
| Rate for Payer: BCN Commercial |
$50.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.34
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cofinity Commercial |
$52.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$55.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.01
|
| Rate for Payer: Mclaren Medicaid |
$10.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.10
|
| Rate for Payer: Meridian Medicaid |
$11.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.14
|
| Rate for Payer: Nomi Health Commercial |
$50.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.01
|
| Rate for Payer: PACE Senior Care Partners |
$14.57
|
| Rate for Payer: PACE SWMI |
$15.34
|
| Rate for Payer: PHP Commercial |
$52.14
|
| Rate for Payer: PHP Medicare Advantage |
$15.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.37
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.98
|
| Rate for Payer: UHC Core |
$51.22
|
| Rate for Payer: UHC Exchange |
$15.34
|
| Rate for Payer: UHC Medicaid |
$10.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.34
|
| Rate for Payer: UHCCP Medicaid |
$10.81
|
| Rate for Payer: VA VA |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.01
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.07 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: BCBS Trust/PPO |
$212.49
|
| Rate for Payer: BCN Commercial |
$212.49
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$61.34
|
|
|
Service Code
|
NDC 65862014930
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna Commercial |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$50.66
|
| Rate for Payer: BCN Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cofinity Commercial |
$52.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.07
|
| Rate for Payer: Healthscope Commercial |
$55.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.14
|
| Rate for Payer: Nomi Health Commercial |
$50.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.01
|
| Rate for Payer: PHP Commercial |
$52.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.98
|
| Rate for Payer: UHC Core |
$51.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.01
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.51 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$165.55
|
| Rate for Payer: BCN Commercial |
$165.55
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$66.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.40
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$211.51
|
| Rate for Payer: BCN Commercial |
$211.51
|
| Rate for Payer: BCN Medicare Advantage |
$64.32
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.32
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Mclaren Medicaid |
$45.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.54
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PACE Senior Care Partners |
$61.10
|
| Rate for Payer: PACE SWMI |
$64.32
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Medicare Advantage |
$64.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Medicare |
$64.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.07
|
| Rate for Payer: Railroad Medicare Medicare |
$64.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: UHC Exchange |
$64.32
|
| Rate for Payer: UHC Medicaid |
$45.36
|
| Rate for Payer: UHC Medicare Advantage |
$64.32
|
| Rate for Payer: UHCCP Medicaid |
$45.36
|
| Rate for Payer: VA VA |
$64.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: BCBS Trust/PPO |
$44.25
|
| Rate for Payer: BCN Commercial |
$44.25
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$44.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.19
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$52.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.64
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: BCBS MAPPO |
$50.11
|
| Rate for Payer: BCBS Trust/PPO |
$164.79
|
| Rate for Payer: BCN Commercial |
$164.79
|
| Rate for Payer: BCN Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Mclaren Medicaid |
$35.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.62
|
| Rate for Payer: Meridian Medicaid |
$37.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PACE Senior Care Partners |
$47.61
|
| Rate for Payer: PACE SWMI |
$50.11
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: PHP Medicare Advantage |
$50.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Medicare |
$50.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.51
|
| Rate for Payer: Railroad Medicare Medicare |
$50.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: UHC Exchange |
$50.11
|
| Rate for Payer: UHC Medicaid |
$35.34
|
| Rate for Payer: UHC Medicare Advantage |
$50.11
|
| Rate for Payer: UHCCP Medicaid |
$35.34
|
| Rate for Payer: VA VA |
$50.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.74
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$44.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.19
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PACE Senior Care Partners |
$12.73
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Medicare |
$13.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.29
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$44.74
|
| Rate for Payer: UHC Exchange |
$13.39
|
| Rate for Payer: UHC Medicaid |
$9.45
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: VA VA |
$13.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.19
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$256.32
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.10
|
| Rate for Payer: BCBS Complete |
$47.44
|
| Rate for Payer: BCBS MAPPO |
$64.08
|
| Rate for Payer: BCBS Trust/PPO |
$210.72
|
| Rate for Payer: BCN Commercial |
$210.72
|
| Rate for Payer: BCN Medicare Advantage |
$64.08
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Mclaren Medicaid |
$45.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.28
|
| Rate for Payer: Meridian Medicaid |
$47.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Nomi Health Commercial |
$210.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PACE Senior Care Partners |
$60.88
|
| Rate for Payer: PACE SWMI |
$64.08
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: PHP Medicare Advantage |
$64.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.00
|
| Rate for Payer: Priority Health Medicare |
$64.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.40
|
| Rate for Payer: Railroad Medicare Medicare |
$64.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.56
|
| Rate for Payer: UHC Core |
$214.03
|
| Rate for Payer: UHC Exchange |
$64.08
|
| Rate for Payer: UHC Medicaid |
$45.19
|
| Rate for Payer: UHC Medicare Advantage |
$64.08
|
| Rate for Payer: UHCCP Medicaid |
$45.19
|
| Rate for Payer: VA VA |
$64.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.04 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: BCBS Trust/PPO |
$127.02
|
| Rate for Payer: BCN Commercial |
$127.02
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.04
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.73
|
| Rate for Payer: Nomi Health Commercial |
$126.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.35
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.34
|
| Rate for Payer: UHC Core |
$128.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.35
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: BCBS Trust/PPO |
$211.69
|
| Rate for Payer: BCN Commercial |
$211.69
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Nomi Health Commercial |
$210.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.56
|
| Rate for Payer: UHC Core |
$214.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$212.64
|
|
|
Service Code
|
NDC 50268032015
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$191.38 |
| Rate for Payer: Aetna Commercial |
$180.74
|
| Rate for Payer: BCBS Trust/PPO |
$175.62
|
| Rate for Payer: BCN Commercial |
$175.62
|
| Rate for Payer: Cash Price |
$170.11
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.11
|
| Rate for Payer: Healthscope Commercial |
$191.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.74
|
| Rate for Payer: Nomi Health Commercial |
$174.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.48
|
| Rate for Payer: PHP Commercial |
$180.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$185.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.12
|
| Rate for Payer: UHC Core |
$177.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.48
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50268032011
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: Meridian Medicaid |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$212.64
|
|
|
Service Code
|
NDC 50268032015
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$191.38 |
| Rate for Payer: Aetna Commercial |
$180.74
|
| Rate for Payer: Aetna Medicare |
$55.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.45
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$53.16
|
| Rate for Payer: BCBS Trust/PPO |
$174.81
|
| Rate for Payer: BCN Commercial |
$174.81
|
| Rate for Payer: BCN Medicare Advantage |
$53.16
|
| Rate for Payer: Cash Price |
$170.11
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.16
|
| Rate for Payer: Healthscope Commercial |
$191.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.48
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.82
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.74
|
| Rate for Payer: Nomi Health Commercial |
$174.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.48
|
| Rate for Payer: PACE Senior Care Partners |
$50.50
|
| Rate for Payer: PACE SWMI |
$53.16
|
| Rate for Payer: PHP Commercial |
$180.74
|
| Rate for Payer: PHP Medicare Advantage |
$53.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$185.00
|
| Rate for Payer: Priority Health Medicare |
$53.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.00
|
| Rate for Payer: Railroad Medicare Medicare |
$53.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.12
|
| Rate for Payer: UHC Core |
$177.55
|
| Rate for Payer: UHC Exchange |
$53.16
|
| Rate for Payer: UHC Medicaid |
$37.49
|
| Rate for Payer: UHC Medicare Advantage |
$53.16
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
| Rate for Payer: VA VA |
$53.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.48
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50268032011
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: Aetna Medicare |
$39.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.06
|
| Rate for Payer: BCBS Complete |
$28.47
|
| Rate for Payer: BCBS MAPPO |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$126.44
|
| Rate for Payer: BCN Commercial |
$126.44
|
| Rate for Payer: BCN Medicare Advantage |
$38.45
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.45
|
| Rate for Payer: Healthscope Commercial |
$138.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.35
|
| Rate for Payer: Mclaren Medicaid |
$27.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.37
|
| Rate for Payer: Meridian Medicaid |
$28.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.73
|
| Rate for Payer: Nomi Health Commercial |
$126.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.35
|
| Rate for Payer: PACE Senior Care Partners |
$36.53
|
| Rate for Payer: PACE SWMI |
$38.45
|
| Rate for Payer: PHP Commercial |
$130.73
|
| Rate for Payer: PHP Medicare Advantage |
$38.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.81
|
| Rate for Payer: Priority Health Medicare |
$38.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.04
|
| Rate for Payer: Railroad Medicare Medicare |
$38.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.34
|
| Rate for Payer: UHC Core |
$128.42
|
| Rate for Payer: UHC Exchange |
$38.45
|
| Rate for Payer: UHC Medicaid |
$27.11
|
| Rate for Payer: UHC Medicare Advantage |
$38.45
|
| Rate for Payer: UHCCP Medicaid |
$27.11
|
| Rate for Payer: VA VA |
$38.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.35
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$97.76
|
|
|
Service Code
|
NDC 55111014430
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$87.98 |
| Rate for Payer: Aetna Commercial |
$83.10
|
| Rate for Payer: BCBS Trust/PPO |
$80.74
|
| Rate for Payer: BCN Commercial |
$80.74
|
| Rate for Payer: Cash Price |
$78.21
|
| Rate for Payer: Cofinity Commercial |
$84.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.21
|
| Rate for Payer: Healthscope Commercial |
$87.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.10
|
| Rate for Payer: Nomi Health Commercial |
$80.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.32
|
| Rate for Payer: PHP Commercial |
$83.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.03
|
| Rate for Payer: UHC Core |
$81.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.32
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$284.64
|
|
|
Service Code
|
NDC 50268033715
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.11 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$235.08
|
| Rate for Payer: Cash Price |
$227.71
|
| Rate for Payer: Cofinity Commercial |
$244.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.71
|
| Rate for Payer: Healthscope Commercial |
$256.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.94
|
| Rate for Payer: Nomi Health Commercial |
$233.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.48
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.48
|
| Rate for Payer: UHC Core |
$237.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
NDC 00904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.24 |
| Max. Negotiated Rate |
$233.06 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: BCBS Trust/PPO |
$213.88
|
| Rate for Payer: BCN Commercial |
$213.88
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.22
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.88
|
| Rate for Payer: UHC Core |
$216.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.22
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$105.68 |
| Rate for Payer: Aetna Commercial |
$99.81
|
| Rate for Payer: BCBS Trust/PPO |
$96.98
|
| Rate for Payer: BCN Commercial |
$96.98
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Commercial |
$100.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$105.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.81
|
| Rate for Payer: Nomi Health Commercial |
$96.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.06
|
| Rate for Payer: PHP Commercial |
$99.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.33
|
| Rate for Payer: UHC Core |
$98.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.06
|
|
