|
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
|
$117.42
|
|
|
Service Code
|
NDC 68462010230
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$105.68 |
| Rate for Payer: Aetna Commercial |
$99.81
|
| Rate for Payer: BCBS Trust/PPO |
$95.85
|
| Rate for Payer: BCN Commercial |
$90.74
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Commercial |
$100.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$105.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.81
|
| Rate for Payer: Nomi Health Commercial |
$96.28
|
| Rate for Payer: PHP Commercial |
$99.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.32
|
| Rate for Payer: Priority Health HMO/PPO |
$102.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.33
|
| Rate for Payer: UHC Core |
$98.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.06
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: BCBS Trust/PPO |
$485.86
|
| Rate for Payer: BCN Commercial |
$459.97
|
| 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: Healthscope Commercial |
$535.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: Nomi Health Commercial |
$488.06
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: Priority Health HMO/PPO |
$517.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.78
|
| Rate for Payer: UHC Core |
$496.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$5.96
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: BCBS Trust/PPO |
$4.87
|
| Rate for Payer: BCN Commercial |
$4.61
|
| 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: Healthscope Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.07
|
| Rate for Payer: Nomi Health Commercial |
$4.89
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health HMO/PPO |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.24
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.47
|
|
|
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 |
$58.06 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: BCBS Trust/PPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$69.03
|
| 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: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health HMO/PPO |
$77.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.84
|
| 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 |
$21.21 |
| 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 |
$35.73
|
| Rate for Payer: BCBS MAPPO |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$73.43
|
| Rate for Payer: BCN Commercial |
$69.45
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| 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 Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health HMO/PPO |
$77.71
|
| Rate for Payer: Priority Health Medicare |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.84
|
| 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 Dual Complete DSNP |
$22.33
|
| Rate for Payer: UHC Exchange |
$22.33
|
| Rate for Payer: UHC Medicare Advantage |
$22.33
|
| Rate for Payer: VA VA |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$207.34 |
| Rate for Payer: Aetna Commercial |
$195.82
|
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.99
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$189.40
|
| Rate for Payer: BCN Commercial |
$179.12
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: Nomi Health Commercial |
$188.91
|
| Rate for Payer: PACE Senior Care Partners |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Commercial |
$195.82
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: Priority Health HMO/PPO |
$200.43
|
| Rate for Payer: Priority Health Medicare |
$58.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.35
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.73
|
| Rate for Payer: UHC Core |
$192.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Exchange |
$57.60
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: VA VA |
$57.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.78
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.75 |
| Max. Negotiated Rate |
$207.34 |
| Rate for Payer: Aetna Commercial |
$195.82
|
| Rate for Payer: BCBS Trust/PPO |
$188.06
|
| Rate for Payer: BCN Commercial |
$178.04
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: Nomi Health Commercial |
$188.91
|
| Rate for Payer: PHP Commercial |
$195.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: Priority Health HMO/PPO |
$200.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.73
|
| Rate for Payer: UHC Core |
$192.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.78
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.92 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: BCBS Trust/PPO |
$307.58
|
| Rate for Payer: BCN Commercial |
$291.19
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health HMO/PPO |
$327.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.58
|
| Rate for Payer: UHC Core |
$314.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.47 |
| 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 |
$105.22
|
| Rate for Payer: BCBS MAPPO |
$65.76
|
| Rate for Payer: BCBS Trust/PPO |
$216.25
|
| Rate for Payer: BCN Commercial |
$204.51
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: Nomi Health Commercial |
$215.69
|
| 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 Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health HMO/PPO |
$228.84
|
| Rate for Payer: Priority Health Medicare |
$66.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.24
|
| 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 Dual Complete DSNP |
$65.76
|
| Rate for Payer: UHC Exchange |
$65.76
|
| Rate for Payer: UHC Medicare Advantage |
$65.76
|
| Rate for Payer: VA VA |
$65.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.98 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: BCBS Trust/PPO |
$214.72
|
| Rate for Payer: BCN Commercial |
$203.28
|
| 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: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health HMO/PPO |
$228.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.24
|
| 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
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.49 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.75
|
| Rate for Payer: BCBS Complete |
$150.72
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCBS Trust/PPO |
$309.77
|
| Rate for Payer: BCN Commercial |
$292.96
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: Nomi Health Commercial |
$308.98
|
| Rate for Payer: PACE Senior Care Partners |
$89.49
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health HMO/PPO |
$327.82
|
| Rate for Payer: Priority Health Medicare |
$95.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.46
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.58
|
| Rate for Payer: UHC Core |
$314.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.20
|
| Rate for Payer: UHC Exchange |
$94.20
|
| Rate for Payer: UHC Medicare Advantage |
$94.20
|
| Rate for Payer: VA VA |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.90
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Medicare |
$0.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.94
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| 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: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| 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: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| 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 |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| 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 Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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 Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| 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 00143968410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| 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: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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
|
|
|
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 |
$12.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| 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: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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
|
|
|
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 |
$4.39 |
| 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 |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| 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 Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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 Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| 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 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| 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 |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| 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 Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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 Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| 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 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| 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 |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| 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 Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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 Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143968410
|
| Hospital Charge Code |
163712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.30
|
| 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: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health HMO/PPO |
$16.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.40
|
| 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
|
|
