|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.89
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.43
|
| Rate for Payer: BCN Commercial |
$44.43
|
| Rate for Payer: BCN Medicare Advantage |
$13.51
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Mclaren Medicaid |
$9.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.19
|
| Rate for Payer: Meridian Medicaid |
$10.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.51
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: PHP Medicare Advantage |
$13.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.02
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.56
|
| Rate for Payer: UHC Core |
$45.13
|
| Rate for Payer: UHC Exchange |
$13.51
|
| Rate for Payer: UHC Medicaid |
$9.53
|
| Rate for Payer: UHC Medicare Advantage |
$13.51
|
| Rate for Payer: UHCCP Medicaid |
$9.53
|
| Rate for Payer: VA VA |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.73
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$308.16
|
|
|
Service Code
|
NDC 54838052340
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: Aetna Medicare |
$80.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.30
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$77.04
|
| Rate for Payer: BCBS Trust/PPO |
$253.34
|
| Rate for Payer: BCN Commercial |
$253.34
|
| Rate for Payer: BCN Medicare Advantage |
$77.04
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.04
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Mclaren Medicaid |
$54.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.89
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: Nomi Health Commercial |
$252.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.12
|
| Rate for Payer: PACE Senior Care Partners |
$73.19
|
| Rate for Payer: PACE SWMI |
$77.04
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: PHP Medicare Advantage |
$77.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.10
|
| Rate for Payer: Priority Health Medicare |
$77.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.48
|
| Rate for Payer: Railroad Medicare Medicare |
$77.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.18
|
| Rate for Payer: UHC Core |
$257.31
|
| Rate for Payer: UHC Exchange |
$77.04
|
| Rate for Payer: UHC Medicaid |
$54.33
|
| Rate for Payer: UHC Medicare Advantage |
$77.04
|
| Rate for Payer: UHCCP Medicaid |
$54.33
|
| Rate for Payer: VA VA |
$77.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$308.16
|
|
|
Service Code
|
NDC 54838052340
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.48 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: BCBS Trust/PPO |
$254.51
|
| Rate for Payer: BCN Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: Nomi Health Commercial |
$252.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.12
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.18
|
| Rate for Payer: UHC Core |
$257.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.08
|
| Rate for Payer: BCN Commercial |
$17.08
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.20
|
| Rate for Payer: UHC Core |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: BCBS Trust/PPO |
$178.56
|
| Rate for Payer: BCN Commercial |
$178.56
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.26
|
| Rate for Payer: UHC Core |
$180.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.46
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.17
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Medicaid |
$3.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PACE Senior Care Partners |
$4.91
|
| Rate for Payer: PACE SWMI |
$5.17
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.99
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.20
|
| Rate for Payer: UHC Core |
$17.27
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$56.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.56
|
| Rate for Payer: BCBS Complete |
$40.02
|
| Rate for Payer: BCBS MAPPO |
$54.05
|
| Rate for Payer: BCBS Trust/PPO |
$177.74
|
| Rate for Payer: BCN Commercial |
$177.74
|
| Rate for Payer: BCN Medicare Advantage |
$54.05
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.05
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Mclaren Medicaid |
$38.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.75
|
| Rate for Payer: Meridian Medicaid |
$40.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$177.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PACE Senior Care Partners |
$51.35
|
| Rate for Payer: PACE SWMI |
$54.05
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.09
|
| Rate for Payer: Priority Health Medicare |
$54.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.48
|
| Rate for Payer: Railroad Medicare Medicare |
$54.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.26
|
| Rate for Payer: UHC Core |
$180.53
|
| Rate for Payer: UHC Exchange |
$54.05
|
| Rate for Payer: UHC Medicaid |
$38.12
|
| Rate for Payer: UHC Medicare Advantage |
$54.05
|
| Rate for Payer: UHCCP Medicaid |
$38.12
|
| Rate for Payer: VA VA |
$54.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.47 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna Medicare |
$280.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$337.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$337.62
|
| Rate for Payer: BCBS Complete |
$199.98
|
| Rate for Payer: BCBS MAPPO |
$270.10
|
| Rate for Payer: BCBS Trust/PPO |
$888.20
|
| Rate for Payer: BCN Commercial |
$888.20
|
| Rate for Payer: BCN Medicare Advantage |
$270.10
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.10
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Mclaren Medicaid |
$190.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.61
|
| Rate for Payer: Meridian Medicaid |
$199.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Nomi Health Commercial |
$885.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: PACE Senior Care Partners |
$256.60
|
| Rate for Payer: PACE SWMI |
$270.10
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: PHP Medicare Advantage |
$270.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$939.95
|
| Rate for Payer: Priority Health Medicare |
$272.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.96
|
| Rate for Payer: Railroad Medicare Medicare |
$270.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.75
|
| Rate for Payer: UHC Core |
$902.13
|
| Rate for Payer: UHC Exchange |
$270.10
|
| Rate for Payer: UHC Medicaid |
$190.47
|
| Rate for Payer: UHC Medicare Advantage |
$270.10
|
| Rate for Payer: UHCCP Medicaid |
$190.47
|
| Rate for Payer: VA VA |
$270.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$751.96 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: BCBS Trust/PPO |
$892.30
|
| Rate for Payer: BCN Commercial |
$892.30
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Nomi Health Commercial |
$885.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$939.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.75
|
| Rate for Payer: UHC Core |
$902.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,187.33
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$826.38 |
| Max. Negotiated Rate |
$1,068.60 |
| Rate for Payer: Aetna Commercial |
$1,009.23
|
| Rate for Payer: BCBS Trust/PPO |
$980.62
|
| Rate for Payer: BCN Commercial |
$980.62
|
| Rate for Payer: Cash Price |
$949.86
|
| Rate for Payer: Cofinity Commercial |
$1,021.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.86
|
| Rate for Payer: Healthscope Commercial |
$1,068.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,009.23
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$890.50
|
| Rate for Payer: PHP Commercial |
$1,009.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,032.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.85
|
| Rate for Payer: UHC Core |
$991.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.50
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,187.33
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.33 |
| Max. Negotiated Rate |
$1,068.60 |
| Rate for Payer: Aetna Commercial |
$1,009.23
|
| Rate for Payer: Aetna Medicare |
$308.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.04
|
| Rate for Payer: BCBS Complete |
$219.77
|
| Rate for Payer: BCBS MAPPO |
$296.83
|
| Rate for Payer: BCBS Trust/PPO |
$976.10
|
| Rate for Payer: BCN Commercial |
$976.10
|
| Rate for Payer: BCN Medicare Advantage |
$296.83
|
| Rate for Payer: Cash Price |
$949.86
|
| Rate for Payer: Cofinity Commercial |
$1,021.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.83
|
| Rate for Payer: Healthscope Commercial |
$1,068.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.50
|
| Rate for Payer: Mclaren Medicaid |
$209.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.67
|
| Rate for Payer: Meridian Medicaid |
$219.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,009.23
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$890.50
|
| Rate for Payer: PACE Senior Care Partners |
$281.99
|
| Rate for Payer: PACE SWMI |
$296.83
|
| Rate for Payer: PHP Commercial |
$1,009.23
|
| Rate for Payer: PHP Medicare Advantage |
$296.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,032.98
|
| Rate for Payer: Priority Health Medicare |
$299.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.38
|
| Rate for Payer: Railroad Medicare Medicare |
$296.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.85
|
| Rate for Payer: UHC Core |
$991.42
|
| Rate for Payer: UHC Exchange |
$296.83
|
| Rate for Payer: UHC Medicaid |
$209.33
|
| Rate for Payer: UHC Medicare Advantage |
$296.83
|
| Rate for Payer: UHCCP Medicaid |
$209.33
|
| Rate for Payer: VA VA |
$296.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.50
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$332.60
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$299.34 |
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna Medicare |
$86.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.94
|
| Rate for Payer: BCBS Complete |
$61.56
|
| Rate for Payer: BCBS MAPPO |
$83.15
|
| Rate for Payer: BCBS Trust/PPO |
$273.43
|
| Rate for Payer: BCN Commercial |
$273.43
|
| Rate for Payer: BCN Medicare Advantage |
$83.15
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.15
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Mclaren Medicaid |
$58.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.31
|
| Rate for Payer: Meridian Medicaid |
$61.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Nomi Health Commercial |
$272.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: PACE Senior Care Partners |
$78.99
|
| Rate for Payer: PACE SWMI |
$83.15
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: PHP Medicare Advantage |
$83.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$289.36
|
| Rate for Payer: Priority Health Medicare |
$83.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.49
|
| Rate for Payer: Railroad Medicare Medicare |
$83.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.69
|
| Rate for Payer: UHC Core |
$277.72
|
| Rate for Payer: UHC Exchange |
$83.15
|
| Rate for Payer: UHC Medicaid |
$58.64
|
| Rate for Payer: UHC Medicare Advantage |
$83.15
|
| Rate for Payer: UHCCP Medicaid |
$58.64
|
| Rate for Payer: VA VA |
$83.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$332.60
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$299.34 |
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: BCBS Trust/PPO |
$274.69
|
| Rate for Payer: BCN Commercial |
$274.69
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Nomi Health Commercial |
$272.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$289.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.69
|
| Rate for Payer: UHC Core |
$277.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna Medicare |
$106.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.95
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$336.61
|
| Rate for Payer: BCN Commercial |
$336.61
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Mclaren Medicaid |
$72.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Meridian Medicaid |
$75.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PACE Senior Care Partners |
$97.24
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Medicare |
$103.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.98
|
| Rate for Payer: Railroad Medicare Medicare |
$102.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: UHC Exchange |
$102.36
|
| Rate for Payer: UHC Medicaid |
$72.19
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: UHCCP Medicaid |
$72.19
|
| Rate for Payer: VA VA |
$102.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.98 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: BCBS Trust/PPO |
$338.16
|
| Rate for Payer: BCN Commercial |
$338.16
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.32
|
| Rate for Payer: UHC Core |
$341.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLUTAMIDE 125 MG CAPSULE
|
Facility
|
OP
|
$19,026.96
|
|
|
Service Code
|
NDC 80725060018
|
| Hospital Charge Code |
10081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,354.45 |
| Max. Negotiated Rate |
$17,124.26 |
| Rate for Payer: Aetna Commercial |
$16,172.92
|
| Rate for Payer: Aetna Medicare |
$4,947.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,945.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,945.93
|
| Rate for Payer: BCBS Complete |
$3,521.89
|
| Rate for Payer: BCBS MAPPO |
$4,756.74
|
| Rate for Payer: BCBS Trust/PPO |
$15,642.06
|
| Rate for Payer: BCN Commercial |
$15,642.06
|
| Rate for Payer: BCN Medicare Advantage |
$4,756.74
|
| Rate for Payer: Cash Price |
$15,221.57
|
| Rate for Payer: Cofinity Commercial |
$16,363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,221.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,756.74
|
| Rate for Payer: Healthscope Commercial |
$17,124.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,270.22
|
| Rate for Payer: Mclaren Medicaid |
$3,354.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,994.58
|
| Rate for Payer: Meridian Medicaid |
$3,521.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,470.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,232.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,172.92
|
| Rate for Payer: Nomi Health Commercial |
$15,602.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,270.22
|
| Rate for Payer: PACE Senior Care Partners |
$4,518.90
|
| Rate for Payer: PACE SWMI |
$4,756.74
|
| Rate for Payer: PHP Commercial |
$16,172.92
|
| Rate for Payer: PHP Medicare Advantage |
$4,756.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,553.46
|
| Rate for Payer: Priority Health Medicare |
$4,804.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,242.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4,756.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,743.72
|
| Rate for Payer: UHC Core |
$15,887.51
|
| Rate for Payer: UHC Exchange |
$4,756.74
|
| Rate for Payer: UHC Medicaid |
$3,354.45
|
| Rate for Payer: UHC Medicare Advantage |
$4,756.74
|
| Rate for Payer: UHCCP Medicaid |
$3,354.45
|
| Rate for Payer: VA VA |
$4,756.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,270.22
|
|
|
FLUTAMIDE 125 MG CAPSULE
|
Facility
|
IP
|
$19,026.96
|
|
|
Service Code
|
NDC 80725060018
|
| Hospital Charge Code |
10081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13,242.76 |
| Max. Negotiated Rate |
$17,124.26 |
| Rate for Payer: Aetna Commercial |
$16,172.92
|
| Rate for Payer: BCBS Trust/PPO |
$15,714.37
|
| Rate for Payer: BCN Commercial |
$15,714.37
|
| Rate for Payer: Cash Price |
$15,221.57
|
| Rate for Payer: Cofinity Commercial |
$16,363.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,221.57
|
| Rate for Payer: Healthscope Commercial |
$17,124.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,270.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,172.92
|
| Rate for Payer: Nomi Health Commercial |
$15,602.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,270.22
|
| Rate for Payer: PHP Commercial |
$16,172.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,553.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,242.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,743.72
|
| Rate for Payer: UHC Core |
$15,887.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,270.22
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: Aetna Medicare |
$61.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.08
|
| Rate for Payer: BCBS Complete |
$43.88
|
| Rate for Payer: BCBS MAPPO |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$194.89
|
| Rate for Payer: BCN Commercial |
$194.89
|
| Rate for Payer: BCN Medicare Advantage |
$59.27
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.27
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: Mclaren Medicaid |
$41.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.23
|
| Rate for Payer: Meridian Medicaid |
$43.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: PACE Senior Care Partners |
$56.30
|
| Rate for Payer: PACE SWMI |
$59.27
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: PHP Medicare Advantage |
$59.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.24
|
| Rate for Payer: Priority Health Medicare |
$59.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.99
|
| Rate for Payer: Railroad Medicare Medicare |
$59.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.61
|
| Rate for Payer: UHC Core |
$197.95
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicaid |
$41.79
|
| Rate for Payer: UHC Medicare Advantage |
$59.27
|
| Rate for Payer: UHCCP Medicaid |
$41.79
|
| Rate for Payer: VA VA |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.99 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: BCBS Trust/PPO |
$195.79
|
| Rate for Payer: BCN Commercial |
$195.79
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Nomi Health Commercial |
$194.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.61
|
| Rate for Payer: UHC Core |
$197.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.90 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: BCBS Trust/PPO |
$262.12
|
| Rate for Payer: BCN Commercial |
$262.12
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.29
|
| Rate for Payer: UHC Core |
$265.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.95 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Medicare |
$82.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.18
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: BCBS MAPPO |
$79.34
|
| Rate for Payer: BCBS Trust/PPO |
$260.92
|
| Rate for Payer: BCN Commercial |
$260.92
|
| Rate for Payer: BCN Medicare Advantage |
$79.34
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.34
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: Mclaren Medicaid |
$55.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.31
|
| Rate for Payer: Meridian Medicaid |
$58.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Nomi Health Commercial |
$260.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: PACE Senior Care Partners |
$75.38
|
| Rate for Payer: PACE SWMI |
$79.34
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: PHP Medicare Advantage |
$79.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.12
|
| Rate for Payer: Priority Health Medicare |
$80.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.90
|
| Rate for Payer: Railroad Medicare Medicare |
$79.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.29
|
| Rate for Payer: UHC Core |
$265.01
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicaid |
$55.95
|
| Rate for Payer: UHC Medicare Advantage |
$79.34
|
| Rate for Payer: UHCCP Medicaid |
$55.95
|
| Rate for Payer: VA VA |
$79.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.07
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: BCBS Trust/PPO |
$21.53
|
| Rate for Payer: BCN Commercial |
$21.53
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$22.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.16
|
| Rate for Payer: Nomi Health Commercial |
$21.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: PHP Commercial |
$22.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Core |
$21.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.55
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.07
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$6.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.15
|
| Rate for Payer: BCBS Complete |
$4.83
|
| Rate for Payer: BCBS MAPPO |
$6.52
|
| Rate for Payer: BCBS Trust/PPO |
$21.43
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.52
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$22.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.52
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.55
|
| Rate for Payer: Mclaren Medicaid |
$4.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$4.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.16
|
| Rate for Payer: Nomi Health Commercial |
$21.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: PACE Senior Care Partners |
$6.19
|
| Rate for Payer: PACE SWMI |
$6.52
|
| Rate for Payer: PHP Commercial |
$22.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.68
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Core |
$21.77
|
| Rate for Payer: UHC Exchange |
$6.52
|
| Rate for Payer: UHC Medicaid |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$6.52
|
| Rate for Payer: UHCCP Medicaid |
$4.60
|
| Rate for Payer: VA VA |
$6.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.55
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: BCBS Trust/PPO |
$12.02
|
| Rate for Payer: BCN Commercial |
$12.02
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Nomi Health Commercial |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.91
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$12.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
