|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.83
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS MAPPO |
$15.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$49.33
|
| Rate for Payer: BCN Medicare Advantage |
$15.86
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: PACE Senior Care Partners |
$15.07
|
| Rate for Payer: PACE SWMI |
$15.86
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicare Advantage |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO |
$55.20
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.51
|
| Rate for Payer: Railroad Medicare Medicare |
$15.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.86
|
| Rate for Payer: UHC Exchange |
$15.86
|
| Rate for Payer: UHC Medicare Advantage |
$15.86
|
| Rate for Payer: VA VA |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| 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 |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| 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 Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| 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 Dual Complete DSNP |
$2.40
|
| Rate for Payer: UHC Exchange |
$2.40
|
| Rate for Payer: UHC Medicare Advantage |
$2.40
|
| Rate for Payer: VA VA |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.42
|
| 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: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| 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
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.73 |
| 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 |
$21.43
|
| Rate for Payer: BCBS MAPPO |
$13.40
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$41.66
|
| Rate for Payer: BCN Medicare Advantage |
$13.40
|
| 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 |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: PACE Senior Care Partners |
$12.73
|
| Rate for Payer: PACE SWMI |
$13.40
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: PHP Medicare Advantage |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: Priority Health HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Medicare |
$13.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$44.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.40
|
| Rate for Payer: UHC Exchange |
$13.40
|
| Rate for Payer: UHC Medicare Advantage |
$13.40
|
| Rate for Payer: VA VA |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.18
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$257.76
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$231.98 |
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: Aetna Medicare |
$67.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.55
|
| Rate for Payer: BCBS Complete |
$103.10
|
| Rate for Payer: BCBS MAPPO |
$64.44
|
| Rate for Payer: BCBS Trust/PPO |
$211.90
|
| Rate for Payer: BCN Commercial |
$200.41
|
| Rate for Payer: BCN Medicare Advantage |
$64.44
|
| Rate for Payer: Cash Price |
$206.21
|
| Rate for Payer: Cofinity Commercial |
$221.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.44
|
| Rate for Payer: Healthscope Commercial |
$231.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.36
|
| Rate for Payer: PACE Senior Care Partners |
$61.22
|
| Rate for Payer: PACE SWMI |
$64.44
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: PHP Medicare Advantage |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.54
|
| Rate for Payer: Priority Health HMO/PPO |
$224.25
|
| Rate for Payer: Priority Health Medicare |
$65.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.70
|
| Rate for Payer: Railroad Medicare Medicare |
$64.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.83
|
| Rate for Payer: UHC Core |
$215.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.44
|
| Rate for Payer: UHC Exchange |
$64.44
|
| Rate for Payer: UHC Medicare Advantage |
$64.44
|
| Rate for Payer: VA VA |
$64.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.32
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$159.75
|
| Rate for Payer: BCN Commercial |
$151.24
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: BCBS Trust/PPO |
$43.74
|
| Rate for Payer: BCN Commercial |
$41.41
|
| 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 |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.83
|
| Rate for Payer: Priority Health HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.90
|
| 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 |
$40.18
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$85.31
|
|
|
Service Code
|
NDC 65862014930
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.45 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$72.51
|
| Rate for Payer: BCBS Trust/PPO |
$69.64
|
| Rate for Payer: BCN Commercial |
$65.93
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.25
|
| Rate for Payer: Healthscope Commercial |
$76.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.51
|
| Rate for Payer: Nomi Health Commercial |
$69.95
|
| Rate for Payer: PHP Commercial |
$72.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.45
|
| Rate for Payer: Priority Health HMO/PPO |
$74.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.07
|
| Rate for Payer: UHC Core |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.98
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.16
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCBS Trust/PPO |
$160.88
|
| Rate for Payer: BCN Commercial |
$152.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: PACE Senior Care Partners |
$46.48
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Medicare |
$49.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.12
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.92
|
| Rate for Payer: UHC Exchange |
$48.92
|
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$257.76
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.54 |
| Max. Negotiated Rate |
$231.98 |
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: BCBS Trust/PPO |
$210.41
|
| Rate for Payer: BCN Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$206.21
|
| Rate for Payer: Cofinity Commercial |
$221.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.21
|
| Rate for Payer: Healthscope Commercial |
$231.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.36
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.54
|
| Rate for Payer: Priority Health HMO/PPO |
$224.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.83
|
| Rate for Payer: UHC Core |
$215.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.32
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$85.31
|
|
|
Service Code
|
NDC 65862014930
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$72.51
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.66
|
| Rate for Payer: BCBS Complete |
$34.12
|
| Rate for Payer: BCBS MAPPO |
$21.33
|
| Rate for Payer: BCBS Trust/PPO |
$70.13
|
| Rate for Payer: BCN Commercial |
$66.33
|
| Rate for Payer: BCN Medicare Advantage |
$21.33
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.33
|
| Rate for Payer: Healthscope Commercial |
$76.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.51
|
| Rate for Payer: Nomi Health Commercial |
$69.95
|
| Rate for Payer: PACE Senior Care Partners |
$20.26
|
| Rate for Payer: PACE SWMI |
$21.33
|
| Rate for Payer: PHP Commercial |
$72.51
|
| Rate for Payer: PHP Medicare Advantage |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.45
|
| Rate for Payer: Priority Health HMO/PPO |
$74.22
|
| Rate for Payer: Priority Health Medicare |
$21.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.16
|
| Rate for Payer: Railroad Medicare Medicare |
$21.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.07
|
| Rate for Payer: UHC Core |
$71.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.33
|
| Rate for Payer: UHC Exchange |
$21.33
|
| Rate for Payer: UHC Medicare Advantage |
$21.33
|
| Rate for Payer: VA VA |
$21.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.98
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.53 |
| 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 |
$61.52
|
| Rate for Payer: BCBS MAPPO |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$126.44
|
| Rate for Payer: BCN Commercial |
$119.58
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.73
|
| Rate for Payer: Nomi Health Commercial |
$126.12
|
| 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 Cigna Priority Health |
$99.97
|
| Rate for Payer: Priority Health HMO/PPO |
$133.81
|
| Rate for Payer: Priority Health Medicare |
$38.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.05
|
| 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 Dual Complete DSNP |
$38.45
|
| Rate for Payer: UHC Exchange |
$38.45
|
| Rate for Payer: UHC Medicare Advantage |
$38.45
|
| Rate for Payer: VA VA |
$38.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.35
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$196.23
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health HMO/PPO |
$220.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.45
|
| Rate for Payer: UHC Core |
$212.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.31 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Medicare |
$66.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.35
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: BCBS MAPPO |
$63.48
|
| Rate for Payer: BCBS Trust/PPO |
$208.75
|
| Rate for Payer: BCN Commercial |
$197.42
|
| Rate for Payer: BCN Medicare Advantage |
$63.48
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: PACE Senior Care Partners |
$60.31
|
| Rate for Payer: PACE SWMI |
$63.48
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: PHP Medicare Advantage |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health HMO/PPO |
$220.91
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.13
|
| Rate for Payer: Railroad Medicare Medicare |
$63.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.45
|
| Rate for Payer: UHC Core |
$212.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.48
|
| Rate for Payer: UHC Exchange |
$63.48
|
| Rate for Payer: UHC Medicare Advantage |
$63.48
|
| Rate for Payer: VA VA |
$63.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$197.28
|
|
|
Service Code
|
NDC 50268032015
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.85 |
| Max. Negotiated Rate |
$177.55 |
| Rate for Payer: Aetna Commercial |
$167.69
|
| Rate for Payer: Aetna Medicare |
$51.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.65
|
| Rate for Payer: BCBS Complete |
$78.91
|
| Rate for Payer: BCBS MAPPO |
$49.32
|
| Rate for Payer: BCBS Trust/PPO |
$162.18
|
| Rate for Payer: BCN Commercial |
$153.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.32
|
| Rate for Payer: Cash Price |
$157.82
|
| Rate for Payer: Cofinity Commercial |
$169.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.32
|
| Rate for Payer: Healthscope Commercial |
$177.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.69
|
| Rate for Payer: Nomi Health Commercial |
$161.77
|
| Rate for Payer: PACE Senior Care Partners |
$46.85
|
| Rate for Payer: PACE SWMI |
$49.32
|
| Rate for Payer: PHP Commercial |
$167.69
|
| Rate for Payer: PHP Medicare Advantage |
$49.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.23
|
| Rate for Payer: Priority Health HMO/PPO |
$171.63
|
| Rate for Payer: Priority Health Medicare |
$49.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.18
|
| Rate for Payer: Railroad Medicare Medicare |
$49.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.61
|
| Rate for Payer: UHC Core |
$164.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.32
|
| Rate for Payer: UHC Exchange |
$49.32
|
| Rate for Payer: UHC Medicare Advantage |
$49.32
|
| Rate for Payer: VA VA |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.96
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$3.95
|
|
|
Service Code
|
NDC 50268032011
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.23
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| 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 |
$2.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$3.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$3.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO |
$3.44
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.65
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.99
|
| Rate for Payer: UHC Exchange |
$0.99
|
| Rate for Payer: UHC Medicare Advantage |
$0.99
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.96
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$153.80
|
|
|
Service Code
|
NDC 00054001021
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: BCBS Trust/PPO |
$125.55
|
| Rate for Payer: BCN Commercial |
$118.86
|
| 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: PHP Commercial |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.97
|
| Rate for Payer: Priority Health HMO/PPO |
$133.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.05
|
| 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
|
$197.28
|
|
|
Service Code
|
NDC 50268032015
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$177.55 |
| Rate for Payer: Aetna Commercial |
$167.69
|
| Rate for Payer: BCBS Trust/PPO |
$161.04
|
| Rate for Payer: BCN Commercial |
$152.46
|
| Rate for Payer: Cash Price |
$157.82
|
| Rate for Payer: Cofinity Commercial |
$169.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.82
|
| Rate for Payer: Healthscope Commercial |
$177.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.69
|
| Rate for Payer: Nomi Health Commercial |
$161.77
|
| Rate for Payer: PHP Commercial |
$167.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.23
|
| Rate for Payer: Priority Health HMO/PPO |
$171.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.61
|
| Rate for Payer: UHC Core |
$164.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.96
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$3.95
|
|
|
Service Code
|
NDC 50268032011
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$3.22
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO |
$3.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.96
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$5.96
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.86
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$1.49
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$5.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.07
|
| Rate for Payer: Nomi Health Commercial |
$4.89
|
| Rate for Payer: PACE Senior Care Partners |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.49
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: PHP Medicare Advantage |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health HMO/PPO |
$5.19
|
| Rate for Payer: Priority Health Medicare |
$1.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.24
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.49
|
| Rate for Payer: UHC Exchange |
$1.49
|
| Rate for Payer: UHC Medicare Advantage |
$1.49
|
| Rate for Payer: VA VA |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.47
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$256.08
|
|
|
Service Code
|
NDC 00904650006
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.45 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$217.67
|
| Rate for Payer: BCBS Trust/PPO |
$209.04
|
| Rate for Payer: BCN Commercial |
$197.90
|
| Rate for Payer: Cash Price |
$204.86
|
| Rate for Payer: Cofinity Commercial |
$220.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.86
|
| Rate for Payer: Healthscope Commercial |
$230.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.67
|
| Rate for Payer: Nomi Health Commercial |
$209.99
|
| Rate for Payer: PHP Commercial |
$217.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.45
|
| Rate for Payer: Priority Health HMO/PPO |
$222.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.35
|
| Rate for Payer: UHC Core |
$213.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.06
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$595.20
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna Medicare |
$154.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.00
|
| Rate for Payer: BCBS Complete |
$238.08
|
| Rate for Payer: BCBS MAPPO |
$148.80
|
| Rate for Payer: BCBS Trust/PPO |
$489.31
|
| Rate for Payer: BCN Commercial |
$462.77
|
| Rate for Payer: BCN Medicare Advantage |
$148.80
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: Nomi Health Commercial |
$488.06
|
| Rate for Payer: PACE Senior Care Partners |
$141.36
|
| Rate for Payer: PACE SWMI |
$148.80
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: PHP Medicare Advantage |
$148.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: Priority Health HMO/PPO |
$517.82
|
| Rate for Payer: Priority Health Medicare |
$150.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.78
|
| Rate for Payer: Railroad Medicare Medicare |
$148.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.78
|
| Rate for Payer: UHC Core |
$496.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.80
|
| Rate for Payer: UHC Exchange |
$148.80
|
| Rate for Payer: UHC Medicare Advantage |
$148.80
|
| Rate for Payer: VA VA |
$148.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$240.92
|
|
|
Service Code
|
NDC 55111014430
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$216.83 |
| Rate for Payer: Aetna Commercial |
$204.78
|
| Rate for Payer: BCBS Trust/PPO |
$196.66
|
| Rate for Payer: BCN Commercial |
$186.18
|
| Rate for Payer: Cash Price |
$192.74
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.74
|
| Rate for Payer: Healthscope Commercial |
$216.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.78
|
| Rate for Payer: Nomi Health Commercial |
$197.55
|
| Rate for Payer: PHP Commercial |
$204.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.60
|
| Rate for Payer: Priority Health HMO/PPO |
$209.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.01
|
| Rate for Payer: UHC Core |
$201.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.69
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$105.68 |
| Rate for Payer: Aetna Commercial |
$99.81
|
| Rate for Payer: Aetna Medicare |
$30.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.69
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS MAPPO |
$29.36
|
| Rate for Payer: BCBS Trust/PPO |
$96.53
|
| Rate for Payer: BCN Commercial |
$91.29
|
| Rate for Payer: BCN Medicare Advantage |
$29.36
|
| 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: Health Alliance Plan Medicare Advantage |
$29.36
|
| Rate for Payer: Healthscope Commercial |
$105.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.81
|
| Rate for Payer: Nomi Health Commercial |
$96.28
|
| Rate for Payer: PACE Senior Care Partners |
$27.89
|
| Rate for Payer: PACE SWMI |
$29.36
|
| Rate for Payer: PHP Commercial |
$99.81
|
| Rate for Payer: PHP Medicare Advantage |
$29.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.32
|
| Rate for Payer: Priority Health HMO/PPO |
$102.16
|
| Rate for Payer: Priority Health Medicare |
$29.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.67
|
| Rate for Payer: Railroad Medicare Medicare |
$29.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.33
|
| Rate for Payer: UHC Core |
$98.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.36
|
| Rate for Payer: UHC Exchange |
$29.36
|
| Rate for Payer: UHC Medicare Advantage |
$29.36
|
| Rate for Payer: VA VA |
$29.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.06
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$240.92
|
|
|
Service Code
|
NDC 55111014430
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$216.83 |
| Rate for Payer: Aetna Commercial |
$204.78
|
| Rate for Payer: Aetna Medicare |
$62.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.29
|
| Rate for Payer: BCBS Complete |
$96.37
|
| Rate for Payer: BCBS MAPPO |
$60.23
|
| Rate for Payer: BCBS Trust/PPO |
$198.06
|
| Rate for Payer: BCN Commercial |
$187.32
|
| Rate for Payer: BCN Medicare Advantage |
$60.23
|
| Rate for Payer: Cash Price |
$192.74
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.23
|
| Rate for Payer: Healthscope Commercial |
$216.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.78
|
| Rate for Payer: Nomi Health Commercial |
$197.55
|
| Rate for Payer: PACE Senior Care Partners |
$57.22
|
| Rate for Payer: PACE SWMI |
$60.23
|
| Rate for Payer: PHP Commercial |
$204.78
|
| Rate for Payer: PHP Medicare Advantage |
$60.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.60
|
| Rate for Payer: Priority Health HMO/PPO |
$209.60
|
| Rate for Payer: Priority Health Medicare |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.42
|
| Rate for Payer: Railroad Medicare Medicare |
$60.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.01
|
| Rate for Payer: UHC Core |
$201.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.23
|
| Rate for Payer: UHC Exchange |
$60.23
|
| Rate for Payer: UHC Medicare Advantage |
$60.23
|
| Rate for Payer: VA VA |
$60.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.69
|
|
