|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$284.64
|
|
|
Service Code
|
NDC 50268033715
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna Medicare |
$74.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.95
|
| Rate for Payer: BCBS Complete |
$52.69
|
| Rate for Payer: BCBS MAPPO |
$71.16
|
| Rate for Payer: BCBS Trust/PPO |
$234.00
|
| Rate for Payer: BCN Commercial |
$234.00
|
| Rate for Payer: BCN Medicare Advantage |
$71.16
|
| 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: Health Alliance Plan Medicare Advantage |
$71.16
|
| Rate for Payer: Healthscope Commercial |
$256.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: Mclaren Medicaid |
$50.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.72
|
| Rate for Payer: Meridian Medicaid |
$52.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.28
|
| 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: PACE Senior Care Partners |
$67.60
|
| Rate for Payer: PACE SWMI |
$71.16
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: PHP Medicare Advantage |
$71.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.64
|
| Rate for Payer: Priority Health Medicare |
$71.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.11
|
| Rate for Payer: Railroad Medicare Medicare |
$71.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.48
|
| Rate for Payer: UHC Core |
$237.67
|
| Rate for Payer: UHC Exchange |
$71.16
|
| Rate for Payer: UHC Medicaid |
$50.18
|
| Rate for Payer: UHC Medicare Advantage |
$71.16
|
| Rate for Payer: UHCCP Medicaid |
$50.18
|
| Rate for Payer: VA VA |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$640.32
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$445.66 |
| Max. Negotiated Rate |
$576.29 |
| Rate for Payer: Aetna Commercial |
$544.27
|
| Rate for Payer: BCBS Trust/PPO |
$528.84
|
| Rate for Payer: BCN Commercial |
$528.84
|
| Rate for Payer: Cash Price |
$512.26
|
| Rate for Payer: Cofinity Commercial |
$550.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.26
|
| Rate for Payer: Healthscope Commercial |
$576.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.27
|
| Rate for Payer: Nomi Health Commercial |
$525.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.24
|
| Rate for Payer: PHP Commercial |
$544.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$557.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.48
|
| Rate for Payer: UHC Core |
$534.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.24
|
|
|
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
|
OP
|
$5.70
|
|
|
Service Code
|
NDC 50268033711
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Mclaren Medicaid |
$1.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$1.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.28
|
| Rate for Payer: PACE Senior Care Partners |
$1.35
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.96
|
| Rate for Payer: Priority Health Medicare |
$1.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$4.76
|
| Rate for Payer: UHC Exchange |
$1.43
|
| Rate for Payer: UHC Medicaid |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$1.00
|
| Rate for Payer: VA VA |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
NDC 00904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$233.06 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna Medicare |
$67.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.92
|
| Rate for Payer: BCBS Complete |
$47.93
|
| Rate for Payer: BCBS MAPPO |
$64.74
|
| Rate for Payer: BCBS Trust/PPO |
$212.89
|
| Rate for Payer: BCN Commercial |
$212.89
|
| Rate for Payer: BCN Medicare Advantage |
$64.74
|
| 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: Health Alliance Plan Medicare Advantage |
$64.74
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.22
|
| Rate for Payer: Mclaren Medicaid |
$45.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.98
|
| Rate for Payer: Meridian Medicaid |
$47.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.21
|
| 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: PACE Senior Care Partners |
$61.50
|
| Rate for Payer: PACE SWMI |
$64.74
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: PHP Medicare Advantage |
$64.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.30
|
| Rate for Payer: Priority Health Medicare |
$65.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.24
|
| Rate for Payer: Railroad Medicare Medicare |
$64.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.88
|
| Rate for Payer: UHC Core |
$216.23
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHC Medicaid |
$45.65
|
| Rate for Payer: UHC Medicare Advantage |
$64.74
|
| Rate for Payer: UHCCP Medicaid |
$45.65
|
| Rate for Payer: VA VA |
$64.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.22
|
|
|
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
|
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
|
OP
|
$97.76
|
|
|
Service Code
|
NDC 55111014430
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$87.98 |
| Rate for Payer: Aetna Commercial |
$83.10
|
| Rate for Payer: Aetna Medicare |
$25.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.10
|
| Rate for Payer: BCBS MAPPO |
$24.44
|
| Rate for Payer: BCBS Trust/PPO |
$80.37
|
| Rate for Payer: BCN Commercial |
$80.37
|
| Rate for Payer: BCN Medicare Advantage |
$24.44
|
| 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: Health Alliance Plan Medicare Advantage |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$87.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.32
|
| Rate for Payer: Mclaren Medicaid |
$17.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.66
|
| Rate for Payer: Meridian Medicaid |
$18.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.88
|
| 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: PACE Senior Care Partners |
$23.22
|
| Rate for Payer: PACE SWMI |
$24.44
|
| Rate for Payer: PHP Commercial |
$83.10
|
| Rate for Payer: PHP Medicare Advantage |
$24.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.05
|
| Rate for Payer: Priority Health Medicare |
$24.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.04
|
| Rate for Payer: Railroad Medicare Medicare |
$24.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.03
|
| Rate for Payer: UHC Core |
$81.63
|
| Rate for Payer: UHC Exchange |
$24.44
|
| Rate for Payer: UHC Medicaid |
$17.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.44
|
| Rate for Payer: UHCCP Medicaid |
$17.24
|
| Rate for Payer: VA VA |
$24.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.32
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$89.32
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: BCBS Trust/PPO |
$73.77
|
| Rate for Payer: BCN Commercial |
$73.77
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.60
|
| Rate for Payer: UHC Core |
$74.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$89.32
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.91
|
| Rate for Payer: BCBS Complete |
$16.53
|
| Rate for Payer: BCBS MAPPO |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$73.43
|
| Rate for Payer: BCN Commercial |
$73.43
|
| Rate for Payer: BCN Medicare Advantage |
$22.33
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.33
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.45
|
| Rate for Payer: Meridian Medicaid |
$16.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PACE Senior Care Partners |
$21.21
|
| Rate for Payer: PACE SWMI |
$22.33
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Medicare Advantage |
$22.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.71
|
| Rate for Payer: Priority Health Medicare |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.17
|
| Rate for Payer: Railroad Medicare Medicare |
$22.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.60
|
| Rate for Payer: UHC Core |
$74.58
|
| Rate for Payer: UHC Exchange |
$22.33
|
| Rate for Payer: UHC Medicaid |
$15.75
|
| Rate for Payer: UHC Medicare Advantage |
$22.33
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$359.52
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.23 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: BCBS Trust/PPO |
$296.93
|
| Rate for Payer: BCN Commercial |
$296.93
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Nomi Health Commercial |
$294.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.38
|
| Rate for Payer: UHC Core |
$300.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$359.52
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.38 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna Medicare |
$93.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.35
|
| Rate for Payer: BCBS Complete |
$66.55
|
| Rate for Payer: BCBS MAPPO |
$89.88
|
| Rate for Payer: BCBS Trust/PPO |
$295.56
|
| Rate for Payer: BCN Commercial |
$295.56
|
| Rate for Payer: BCN Medicare Advantage |
$89.88
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.88
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: Mclaren Medicaid |
$63.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.37
|
| Rate for Payer: Meridian Medicaid |
$66.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Nomi Health Commercial |
$294.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PACE Senior Care Partners |
$85.39
|
| Rate for Payer: PACE SWMI |
$89.88
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: PHP Medicare Advantage |
$89.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.78
|
| Rate for Payer: Priority Health Medicare |
$90.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.23
|
| Rate for Payer: Railroad Medicare Medicare |
$89.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.38
|
| Rate for Payer: UHC Core |
$300.20
|
| Rate for Payer: UHC Exchange |
$89.88
|
| Rate for Payer: UHC Medicaid |
$63.38
|
| Rate for Payer: UHC Medicare Advantage |
$89.88
|
| Rate for Payer: UHCCP Medicaid |
$63.38
|
| Rate for Payer: VA VA |
$89.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna Medicare |
$68.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.20
|
| Rate for Payer: BCBS Complete |
$48.69
|
| Rate for Payer: BCBS MAPPO |
$65.76
|
| Rate for Payer: BCBS Trust/PPO |
$216.25
|
| Rate for Payer: BCN Commercial |
$216.25
|
| Rate for Payer: BCN Medicare Advantage |
$65.76
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.76
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Mclaren Medicaid |
$46.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.05
|
| Rate for Payer: Meridian Medicaid |
$48.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: Nomi Health Commercial |
$215.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.28
|
| Rate for Payer: PACE Senior Care Partners |
$62.47
|
| Rate for Payer: PACE SWMI |
$65.76
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: PHP Medicare Advantage |
$65.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.84
|
| Rate for Payer: Priority Health Medicare |
$66.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.08
|
| Rate for Payer: Railroad Medicare Medicare |
$65.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.64
|
| Rate for Payer: UHC Exchange |
$65.76
|
| Rate for Payer: UHC Medicaid |
$46.37
|
| Rate for Payer: UHC Medicare Advantage |
$65.76
|
| Rate for Payer: UHCCP Medicaid |
$46.37
|
| Rate for Payer: VA VA |
$65.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: Meridian Medicaid |
$0.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PACE Senior Care Partners |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.45
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$0.99
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.99
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.08 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: BCBS Trust/PPO |
$217.24
|
| Rate for Payer: BCN Commercial |
$217.24
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: Nomi Health Commercial |
$215.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.28
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.45
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$1.16
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: PACE Senior Care Partners |
$1.10
|
| Rate for Payer: PACE SWMI |
$1.16
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: PHP Medicare Advantage |
$1.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Medicare |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.09
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.16
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$3.84
|
| Rate for Payer: BCN Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Nomi Health Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.09
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$209.05 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$60.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.59
|
| Rate for Payer: BCBS Complete |
$43.00
|
| Rate for Payer: BCBS MAPPO |
$58.07
|
| Rate for Payer: BCBS Trust/PPO |
$190.96
|
| Rate for Payer: BCN Commercial |
$190.96
|
| Rate for Payer: BCN Medicare Advantage |
$58.07
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.07
|
| Rate for Payer: Healthscope Commercial |
$209.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.21
|
| Rate for Payer: Mclaren Medicaid |
$40.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.97
|
| Rate for Payer: Meridian Medicaid |
$43.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.44
|
| Rate for Payer: Nomi Health Commercial |
$190.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: PACE Senior Care Partners |
$55.17
|
| Rate for Payer: PACE SWMI |
$58.07
|
| Rate for Payer: PHP Commercial |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$58.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.08
|
| Rate for Payer: Priority Health Medicare |
$58.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: Railroad Medicare Medicare |
$58.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.41
|
| Rate for Payer: UHC Core |
$193.95
|
| Rate for Payer: UHC Exchange |
$58.07
|
| Rate for Payer: UHC Medicaid |
$40.95
|
| Rate for Payer: UHC Medicare Advantage |
$58.07
|
| Rate for Payer: UHCCP Medicaid |
$40.95
|
| Rate for Payer: VA VA |
$58.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.21
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$355.97 |
| Rate for Payer: Aetna Commercial |
$336.19
|
| Rate for Payer: Aetna Medicare |
$102.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.60
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$98.88
|
| Rate for Payer: BCBS Trust/PPO |
$325.16
|
| Rate for Payer: BCN Commercial |
$325.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.88
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Commercial |
$340.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$355.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.64
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.82
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Nomi Health Commercial |
$324.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: PACE Senior Care Partners |
$93.94
|
| Rate for Payer: PACE SWMI |
$98.88
|
| Rate for Payer: PHP Commercial |
$336.19
|
| Rate for Payer: PHP Medicare Advantage |
$98.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.10
|
| Rate for Payer: Priority Health Medicare |
$99.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.28
|
| Rate for Payer: Railroad Medicare Medicare |
$98.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.06
|
| Rate for Payer: UHC Core |
$330.26
|
| Rate for Payer: UHC Exchange |
$98.88
|
| Rate for Payer: UHC Medicaid |
$69.73
|
| Rate for Payer: UHC Medicare Advantage |
$98.88
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$98.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.28 |
| Max. Negotiated Rate |
$355.97 |
| Rate for Payer: Aetna Commercial |
$336.19
|
| Rate for Payer: BCBS Trust/PPO |
$326.66
|
| Rate for Payer: BCN Commercial |
$326.66
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Commercial |
$340.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$355.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Nomi Health Commercial |
$324.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: PHP Commercial |
$336.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.06
|
| Rate for Payer: UHC Core |
$330.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.67 |
| Max. Negotiated Rate |
$209.05 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$191.84
|
| Rate for Payer: BCN Commercial |
$191.84
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Healthscope Commercial |
$209.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.44
|
| Rate for Payer: Nomi Health Commercial |
$190.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: PHP Commercial |
$197.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.41
|
| Rate for Payer: UHC Core |
$193.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.21
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$3.42
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$15.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicaid |
$3.26
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: UHCCP Medicaid |
$3.26
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$3.42
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$15.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicaid |
$3.26
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: UHCCP Medicaid |
$3.26
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
