|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 17238090099
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FLUORESCEIN 1 MG EYE STRIPS
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
27663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.56
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.84 |
| 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 |
$21.62
|
| Rate for Payer: BCBS MAPPO |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.43
|
| Rate for Payer: BCN Commercial |
$42.02
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| 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 Cigna Priority Health |
$35.13
|
| Rate for Payer: Priority Health HMO/PPO |
$47.02
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.21
|
| 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 Dual Complete DSNP |
$13.51
|
| Rate for Payer: UHC Exchange |
$13.51
|
| Rate for Payer: UHC Medicare Advantage |
$13.51
|
| 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 |
$12.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Commercial |
$14.71
|
| 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: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.76
|
| 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 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.65
|
| Rate for Payer: BCN Commercial |
$14.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| 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: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.76
|
| Rate for Payer: VA VA |
$4.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.12
|
| Rate for Payer: BCN Commercial |
$41.77
|
| 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: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: Priority Health HMO/PPO |
$47.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.56
|
| Rate for Payer: UHC Core |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
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 |
$200.30 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: BCBS Trust/PPO |
$251.55
|
| Rate for Payer: BCN Commercial |
$238.15
|
| 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: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.30
|
| Rate for Payer: Priority Health HMO/PPO |
$268.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.47
|
| 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/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 |
$73.19 |
| 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 |
$123.26
|
| Rate for Payer: BCBS MAPPO |
$77.04
|
| Rate for Payer: BCBS Trust/PPO |
$253.34
|
| Rate for Payer: BCN Commercial |
$239.59
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: Nomi Health Commercial |
$252.69
|
| 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 Cigna Priority Health |
$200.30
|
| Rate for Payer: Priority Health HMO/PPO |
$268.10
|
| Rate for Payer: Priority Health Medicare |
$77.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.47
|
| 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 Dual Complete DSNP |
$77.04
|
| Rate for Payer: UHC Exchange |
$77.04
|
| Rate for Payer: UHC Medicare Advantage |
$77.04
|
| Rate for Payer: VA VA |
$77.04
|
| 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 |
$13.44 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCN Commercial |
$15.98
|
| 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: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: Priority Health HMO/PPO |
$17.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.86
|
| 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
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| 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 |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$16.08
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| 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 Cigna Priority Health |
$13.44
|
| Rate for Payer: Priority Health HMO/PPO |
$17.99
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.86
|
| 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 Dual Complete DSNP |
$5.17
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$318.48
|
|
|
Service Code
|
NDC 50268036615
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.01 |
| Max. Negotiated Rate |
$286.63 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: BCBS Trust/PPO |
$259.98
|
| Rate for Payer: BCN Commercial |
$246.12
|
| Rate for Payer: Cash Price |
$254.78
|
| Rate for Payer: Cofinity Commercial |
$273.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.78
|
| Rate for Payer: Healthscope Commercial |
$286.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.71
|
| Rate for Payer: Nomi Health Commercial |
$261.15
|
| Rate for Payer: PHP Commercial |
$270.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.01
|
| Rate for Payer: Priority Health HMO/PPO |
$277.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.26
|
| Rate for Payer: UHC Core |
$265.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.86
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.50
|
| Rate for Payer: BCBS Complete |
$133.76
|
| Rate for Payer: BCBS MAPPO |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$274.91
|
| Rate for Payer: BCN Commercial |
$260.00
|
| Rate for Payer: BCN Medicare Advantage |
$83.60
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.60
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: Nomi Health Commercial |
$274.21
|
| Rate for Payer: PACE Senior Care Partners |
$79.42
|
| Rate for Payer: PACE SWMI |
$83.60
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: PHP Medicare Advantage |
$83.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.36
|
| Rate for Payer: Priority Health HMO/PPO |
$290.93
|
| Rate for Payer: Priority Health Medicare |
$84.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.05
|
| Rate for Payer: Railroad Medicare Medicare |
$83.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.27
|
| Rate for Payer: UHC Core |
$279.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.60
|
| Rate for Payer: UHC Exchange |
$83.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.60
|
| Rate for Payer: VA VA |
$83.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna Medicare |
$173.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.10
|
| Rate for Payer: BCBS Complete |
$267.65
|
| Rate for Payer: BCBS MAPPO |
$167.28
|
| Rate for Payer: BCBS Trust/PPO |
$550.08
|
| Rate for Payer: BCN Commercial |
$520.24
|
| Rate for Payer: BCN Medicare Advantage |
$167.28
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.28
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Nomi Health Commercial |
$548.68
|
| Rate for Payer: PACE Senior Care Partners |
$158.92
|
| Rate for Payer: PACE SWMI |
$167.28
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: PHP Medicare Advantage |
$167.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.93
|
| Rate for Payer: Priority Health HMO/PPO |
$582.13
|
| Rate for Payer: Priority Health Medicare |
$168.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.31
|
| Rate for Payer: Railroad Medicare Medicare |
$167.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.83
|
| Rate for Payer: UHC Core |
$558.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.28
|
| Rate for Payer: UHC Exchange |
$167.28
|
| Rate for Payer: UHC Medicare Advantage |
$167.28
|
| Rate for Payer: VA VA |
$167.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 50268036611
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCN Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health HMO/PPO |
$5.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 50268036611
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health HMO/PPO |
$5.54
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.59
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: BCBS Trust/PPO |
$272.97
|
| Rate for Payer: BCN Commercial |
$258.42
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: Nomi Health Commercial |
$274.21
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.36
|
| Rate for Payer: Priority Health HMO/PPO |
$290.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.27
|
| Rate for Payer: UHC Core |
$279.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.93 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: BCBS Trust/PPO |
$546.20
|
| Rate for Payer: BCN Commercial |
$517.10
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Nomi Health Commercial |
$548.68
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.93
|
| Rate for Payer: Priority Health HMO/PPO |
$582.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.83
|
| Rate for Payer: UHC Core |
$558.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$318.48
|
|
|
Service Code
|
NDC 50268036615
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$286.63 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Medicare |
$82.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.53
|
| Rate for Payer: BCBS Complete |
$127.39
|
| Rate for Payer: BCBS MAPPO |
$79.62
|
| Rate for Payer: BCBS Trust/PPO |
$261.82
|
| Rate for Payer: BCN Commercial |
$247.62
|
| Rate for Payer: BCN Medicare Advantage |
$79.62
|
| Rate for Payer: Cash Price |
$254.78
|
| Rate for Payer: Cofinity Commercial |
$273.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$286.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.71
|
| Rate for Payer: Nomi Health Commercial |
$261.15
|
| Rate for Payer: PACE Senior Care Partners |
$75.64
|
| Rate for Payer: PACE SWMI |
$79.62
|
| Rate for Payer: PHP Commercial |
$270.71
|
| Rate for Payer: PHP Medicare Advantage |
$79.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.01
|
| Rate for Payer: Priority Health HMO/PPO |
$277.08
|
| Rate for Payer: Priority Health Medicare |
$80.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.38
|
| Rate for Payer: Railroad Medicare Medicare |
$79.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.26
|
| Rate for Payer: UHC Core |
$265.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.62
|
| Rate for Payer: UHC Exchange |
$79.62
|
| Rate for Payer: UHC Medicare Advantage |
$79.62
|
| Rate for Payer: VA VA |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.86
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$702.26 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: BCBS Trust/PPO |
$881.93
|
| Rate for Payer: BCN Commercial |
$834.93
|
| 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: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health HMO/PPO |
$939.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$723.87
|
| 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
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.60 |
| 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 |
$432.16
|
| Rate for Payer: BCBS MAPPO |
$270.10
|
| Rate for Payer: BCBS Trust/PPO |
$888.20
|
| Rate for Payer: BCN Commercial |
$840.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Nomi Health Commercial |
$885.93
|
| 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 Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health HMO/PPO |
$939.95
|
| Rate for Payer: Priority Health Medicare |
$272.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$723.87
|
| 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 Dual Complete DSNP |
$270.10
|
| Rate for Payer: UHC Exchange |
$270.10
|
| Rate for Payer: UHC Medicare Advantage |
$270.10
|
| Rate for Payer: VA VA |
$270.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,253.56
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$814.81 |
| Max. Negotiated Rate |
$1,128.20 |
| Rate for Payer: Aetna Commercial |
$1,065.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.28
|
| Rate for Payer: BCN Commercial |
$968.75
|
| Rate for Payer: Cash Price |
$1,002.85
|
| Rate for Payer: Cofinity Commercial |
$1,078.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.85
|
| Rate for Payer: Healthscope Commercial |
$1,128.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.53
|
| Rate for Payer: Nomi Health Commercial |
$1,027.92
|
| Rate for Payer: PHP Commercial |
$1,065.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1,090.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$839.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.13
|
| Rate for Payer: UHC Core |
$1,046.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.17
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,253.56
|
|
|
Service Code
|
NDC 00904715961
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.72 |
| Max. Negotiated Rate |
$1,128.20 |
| Rate for Payer: Aetna Commercial |
$1,065.53
|
| Rate for Payer: Aetna Medicare |
$325.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$391.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$391.74
|
| Rate for Payer: BCBS Complete |
$501.42
|
| Rate for Payer: BCBS MAPPO |
$313.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.55
|
| Rate for Payer: BCN Commercial |
$974.64
|
| Rate for Payer: BCN Medicare Advantage |
$313.39
|
| Rate for Payer: Cash Price |
$1,002.85
|
| Rate for Payer: Cofinity Commercial |
$1,078.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.39
|
| Rate for Payer: Healthscope Commercial |
$1,128.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.53
|
| Rate for Payer: Nomi Health Commercial |
$1,027.92
|
| Rate for Payer: PACE Senior Care Partners |
$297.72
|
| Rate for Payer: PACE SWMI |
$313.39
|
| Rate for Payer: PHP Commercial |
$1,065.53
|
| Rate for Payer: PHP Medicare Advantage |
$313.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1,090.60
|
| Rate for Payer: Priority Health Medicare |
$316.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$839.89
|
| Rate for Payer: Railroad Medicare Medicare |
$313.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.13
|
| Rate for Payer: UHC Core |
$1,046.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.39
|
| Rate for Payer: UHC Exchange |
$313.39
|
| Rate for Payer: UHC Medicare Advantage |
$313.39
|
| Rate for Payer: VA VA |
$313.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.17
|
|
|
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 |
$216.19 |
| Max. Negotiated Rate |
$299.34 |
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: BCBS Trust/PPO |
$271.50
|
| Rate for Payer: BCN Commercial |
$257.03
|
| 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: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health HMO/PPO |
$289.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.84
|
| 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
|
|
