|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$177.66
|
|
|
Service Code
|
NDC 65862-149-90
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna American Axle |
$115.48
|
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$124.36
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.01
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.36
|
| Rate for Payer: Priority Health SBD |
$111.93
|
| Rate for Payer: UMR Bronson Commercial |
$78.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.24
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 50268-314-11
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.74
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 50268-314-15
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 0904-6830-06
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.66
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16729-090-01
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.64
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; EACH ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 10006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$582.64
|
| Rate for Payer: BCCCP Commercial |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.31
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$48.46
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$778.18
|
| Rate for Payer: BCCCP Commercial |
$141.12
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.80
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$70.73
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$7,856.86
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.96 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,340.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.56
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$335.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$960.71 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.78
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$960.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,065.50 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,172.05
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$1,065.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
FLAVOXATE 100 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 0574-0115-01
|
| Hospital Charge Code |
10039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$375.34 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.49
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.94
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UMR Bronson Commercial |
$183.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$427.68
|
|
|
Service Code
|
NDC 0054-0011-25
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.18 |
| Max. Negotiated Rate |
$384.91 |
| Rate for Payer: Aetna American Axle |
$277.99
|
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.99
|
| Rate for Payer: Cash Price |
$342.14
|
| Rate for Payer: Cofinity Commercial |
$299.38
|
| Rate for Payer: Cofinity Commercial |
$367.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.14
|
| Rate for Payer: Healthscope Commercial |
$384.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.53
|
| Rate for Payer: PHP Commercial |
$363.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.38
|
| Rate for Payer: Priority Health SBD |
$269.44
|
| Rate for Payer: UMR Bronson Commercial |
$188.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.76
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$455.90
|
|
|
Service Code
|
NDC 65162-642-10
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna American Axle |
$296.34
|
| Rate for Payer: Aetna Commercial |
$387.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.34
|
| Rate for Payer: Cash Price |
$364.72
|
| Rate for Payer: Cofinity Commercial |
$319.13
|
| Rate for Payer: Cofinity Commercial |
$392.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.72
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.52
|
| Rate for Payer: PHP Commercial |
$387.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.13
|
| Rate for Payer: Priority Health SBD |
$287.22
|
| Rate for Payer: UMR Bronson Commercial |
$200.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.92
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 53746-642-01
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 0054-0010-20
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
FLOXURIDINE 0.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$666.93
|
|
|
Service Code
|
HCPCS J9200
|
| Hospital Charge Code |
3177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.45 |
| Max. Negotiated Rate |
$600.24 |
| Rate for Payer: Aetna American Axle |
$433.50
|
| Rate for Payer: Aetna Commercial |
$566.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.50
|
| Rate for Payer: Cash Price |
$533.54
|
| Rate for Payer: Cofinity Commercial |
$466.85
|
| Rate for Payer: Cofinity Commercial |
$573.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.54
|
| Rate for Payer: Healthscope Commercial |
$600.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$566.89
|
| Rate for Payer: PHP Commercial |
$566.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.85
|
| Rate for Payer: Priority Health SBD |
$420.17
|
| Rate for Payer: UMR Bronson Commercial |
$293.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.20
|
|
|
FLOXURIDINE 0.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$666.93
|
|
|
Service Code
|
HCPCS J9200
|
| Hospital Charge Code |
3177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.76 |
| Max. Negotiated Rate |
$10,428.85 |
| Rate for Payer: Aetna American Axle |
$433.50
|
| Rate for Payer: Aetna Commercial |
$566.89
|
| Rate for Payer: Aetna Medicare |
$3,870.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,652.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,652.55
|
| Rate for Payer: BCBS Complete |
$2,137.94
|
| Rate for Payer: BCBS MAPPO |
$3,722.04
|
| Rate for Payer: BCBS Trust/PPO |
$293.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,722.04
|
| Rate for Payer: Cash Price |
$533.54
|
| Rate for Payer: Cash Price |
$533.54
|
| Rate for Payer: Cofinity Commercial |
$466.85
|
| Rate for Payer: Cofinity Commercial |
$573.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,722.04
|
| Rate for Payer: Healthscope Commercial |
$600.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.20
|
| Rate for Payer: Mclaren Medicaid |
$2,035.96
|
| Rate for Payer: Mclaren Medicare |
$3,722.04
|
| Rate for Payer: Meridian Medicaid |
$2,137.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,908.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,280.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$566.89
|
| Rate for Payer: PACE Medicare |
$3,535.94
|
| Rate for Payer: PACE SWMI |
$3,722.04
|
| Rate for Payer: PHP Commercial |
$566.89
|
| Rate for Payer: PHP Medicare Advantage |
$3,722.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,035.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,428.85
|
| Rate for Payer: Priority Health Medicare |
$3,722.04
|
| Rate for Payer: Priority Health Narrow Network |
$8,343.08
|
| Rate for Payer: Priority Health SBD |
$420.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3,722.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,722.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,833.70
|
| Rate for Payer: UMR Bronson Commercial |
$246.76
|
| Rate for Payer: VA VA |
$3,722.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.20
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$791.04
|
|
|
Service Code
|
NDC 0172-5411-60
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.06 |
| Max. Negotiated Rate |
$711.94 |
| Rate for Payer: Aetna American Axle |
$514.18
|
| Rate for Payer: Aetna Commercial |
$672.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.18
|
| Rate for Payer: Cash Price |
$632.83
|
| Rate for Payer: Cofinity Commercial |
$553.73
|
| Rate for Payer: Cofinity Commercial |
$680.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.83
|
| Rate for Payer: Healthscope Commercial |
$711.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$672.38
|
| Rate for Payer: PHP Commercial |
$672.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.73
|
| Rate for Payer: Priority Health SBD |
$498.36
|
| Rate for Payer: UMR Bronson Commercial |
$348.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.28
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$541.44
|
|
|
Service Code
|
NDC 0904-6500-61
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.23 |
| Max. Negotiated Rate |
$487.30 |
| Rate for Payer: Aetna American Axle |
$351.94
|
| Rate for Payer: Aetna Commercial |
$460.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.94
|
| Rate for Payer: Cash Price |
$433.15
|
| Rate for Payer: Cofinity Commercial |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$465.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.15
|
| Rate for Payer: Healthscope Commercial |
$487.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.22
|
| Rate for Payer: PHP Commercial |
$460.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.01
|
| Rate for Payer: Priority Health SBD |
$341.11
|
| Rate for Payer: UMR Bronson Commercial |
$238.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.08
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 68084-728-11
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$568.32
|
|
|
Service Code
|
NDC 68084-728-01
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$511.49 |
| Rate for Payer: Aetna American Axle |
$369.41
|
| Rate for Payer: Aetna Commercial |
$483.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.41
|
| Rate for Payer: Cash Price |
$454.66
|
| Rate for Payer: Cofinity Commercial |
$397.82
|
| Rate for Payer: Cofinity Commercial |
$488.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.66
|
| Rate for Payer: Healthscope Commercial |
$511.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$397.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.07
|
| Rate for Payer: PHP Commercial |
$483.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health SBD |
$358.04
|
| Rate for Payer: UMR Bronson Commercial |
$250.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.24
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$112.56
|
|
|
Service Code
|
NDC 68462-119-44
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.53 |
| Max. Negotiated Rate |
$101.30 |
| Rate for Payer: Aetna American Axle |
$73.16
|
| Rate for Payer: Aetna Commercial |
$95.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.16
|
| Rate for Payer: Cash Price |
$90.05
|
| Rate for Payer: Cofinity Commercial |
$78.79
|
| Rate for Payer: Cofinity Commercial |
$96.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.05
|
| Rate for Payer: Healthscope Commercial |
$101.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.68
|
| Rate for Payer: PHP Commercial |
$95.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.79
|
| Rate for Payer: Priority Health SBD |
$70.91
|
| Rate for Payer: UMR Bronson Commercial |
$49.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.42
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 68462-103-40
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.62
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$60.25
|
|
|
Service Code
|
NDC 57237-005-11
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna American Axle |
$39.16
|
| Rate for Payer: Aetna Commercial |
$51.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.16
|
| Rate for Payer: Cash Price |
$48.20
|
| Rate for Payer: Cofinity Commercial |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.20
|
| Rate for Payer: Healthscope Commercial |
$54.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.21
|
| Rate for Payer: PHP Commercial |
$51.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.18
|
| Rate for Payer: Priority Health SBD |
$37.96
|
| Rate for Payer: UMR Bronson Commercial |
$26.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.19
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 68462-119-40
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna American Axle |
$6.10
|
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
