|
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 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$59.02
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Aetna American Axle |
$38.36
|
| Rate for Payer: Aetna American Axle |
$43.54
|
| Rate for Payer: Aetna American Axle |
$54.95
|
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.54
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$46.89
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$57.61
|
| Rate for Payer: Cofinity Commercial |
$41.31
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.22
|
| Rate for Payer: Healthscope Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$60.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.94
|
| Rate for Payer: PHP Commercial |
$50.17
|
| Rate for Payer: PHP Commercial |
$56.94
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$42.20
|
| Rate for Payer: Priority Health SBD |
$37.18
|
| Rate for Payer: UMR Bronson Commercial |
$37.20
|
| Rate for Payer: UMR Bronson Commercial |
$25.97
|
| Rate for Payer: UMR Bronson Commercial |
$29.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.24
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$780.96
|
|
|
Service Code
|
NDC 68084-735-01
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.62 |
| Max. Negotiated Rate |
$702.86 |
| Rate for Payer: Aetna American Axle |
$507.62
|
| Rate for Payer: Aetna Commercial |
$663.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.62
|
| Rate for Payer: Cash Price |
$624.77
|
| Rate for Payer: Cofinity Commercial |
$546.67
|
| Rate for Payer: Cofinity Commercial |
$671.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.77
|
| Rate for Payer: Healthscope Commercial |
$702.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.82
|
| Rate for Payer: PHP Commercial |
$663.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.67
|
| Rate for Payer: Priority Health SBD |
$492.00
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.72
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$773.28
|
|
|
Service Code
|
NDC 0904-6501-61
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.24 |
| Max. Negotiated Rate |
$695.95 |
| Rate for Payer: Aetna American Axle |
$502.63
|
| Rate for Payer: Aetna Commercial |
$657.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.63
|
| Rate for Payer: Cash Price |
$618.62
|
| Rate for Payer: Cofinity Commercial |
$541.30
|
| Rate for Payer: Cofinity Commercial |
$665.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.62
|
| Rate for Payer: Healthscope Commercial |
$695.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.29
|
| Rate for Payer: PHP Commercial |
$657.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.30
|
| Rate for Payer: Priority Health SBD |
$487.17
|
| Rate for Payer: UMR Bronson Commercial |
$340.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.96
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
NDC 68084-735-11
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna American Axle |
$5.08
|
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.64
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
NDC 0172-5413-46
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Aetna American Axle |
$116.35
|
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.35
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Cofinity Commercial |
$153.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.20
|
| Rate for Payer: Healthscope Commercial |
$161.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.15
|
| Rate for Payer: PHP Commercial |
$152.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.30
|
| Rate for Payer: Priority Health SBD |
$112.77
|
| Rate for Payer: UMR Bronson Commercial |
$78.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.25
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$997.15
|
|
|
Service Code
|
NDC 0172-5413-60
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$897.44 |
| Rate for Payer: Aetna American Axle |
$648.15
|
| Rate for Payer: Aetna Commercial |
$847.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.15
|
| Rate for Payer: Cash Price |
$797.72
|
| Rate for Payer: Cofinity Commercial |
$698.00
|
| Rate for Payer: Cofinity Commercial |
$857.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.72
|
| Rate for Payer: Healthscope Commercial |
$897.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$847.58
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.00
|
| Rate for Payer: Priority Health SBD |
$628.20
|
| Rate for Payer: UMR Bronson Commercial |
$438.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.86
|
|
|
FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$102.08
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.92 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna American Axle |
$66.35
|
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna American Axle |
$58.18
|
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Commercial |
$86.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.18
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$76.97
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Commercial |
$71.46
|
| Rate for Payer: Cofinity Commercial |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$80.55
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$76.08
|
| Rate for Payer: PHP Commercial |
$86.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.99
|
| Rate for Payer: Priority Health SBD |
$56.38
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: Priority Health SBD |
$64.31
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$44.92
|
| Rate for Payer: UMR Bronson Commercial |
$39.38
|
| Rate for Payer: UMR Bronson Commercial |
$42.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$262.76
|
|
|
Service Code
|
NDC 59762-5030-1
|
| Hospital Charge Code |
14233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$236.48 |
| Rate for Payer: Aetna American Axle |
$170.79
|
| Rate for Payer: Aetna Commercial |
$223.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.79
|
| Rate for Payer: Cash Price |
$210.21
|
| Rate for Payer: Cofinity Commercial |
$183.93
|
| Rate for Payer: Cofinity Commercial |
$225.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.21
|
| Rate for Payer: Healthscope Commercial |
$236.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.35
|
| Rate for Payer: PHP Commercial |
$223.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.93
|
| Rate for Payer: Priority Health SBD |
$165.54
|
| Rate for Payer: UMR Bronson Commercial |
$115.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.07
|
|
|
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$139.65
|
|
|
Service Code
|
NDC 57237-150-35
|
| Hospital Charge Code |
14233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$125.68 |
| Rate for Payer: Aetna American Axle |
$90.77
|
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.77
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.70
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health SBD |
$87.98
|
| Rate for Payer: UMR Bronson Commercial |
$61.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$51,605.75
|
|
|
Service Code
|
NDC 0187-3555-10
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22,706.53 |
| Max. Negotiated Rate |
$46,445.18 |
| Rate for Payer: Aetna American Axle |
$33,543.74
|
| Rate for Payer: Aetna Commercial |
$43,864.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,543.74
|
| Rate for Payer: Cash Price |
$41,284.60
|
| Rate for Payer: Cofinity Commercial |
$36,124.02
|
| Rate for Payer: Cofinity Commercial |
$44,380.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41,284.60
|
| Rate for Payer: Healthscope Commercial |
$46,445.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36,124.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,704.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,864.89
|
| Rate for Payer: PHP Commercial |
$43,864.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,124.02
|
| Rate for Payer: Priority Health SBD |
$32,511.62
|
| Rate for Payer: UMR Bronson Commercial |
$22,706.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,704.31
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$5,849.70
|
|
|
Service Code
|
NDC 42794-010-08
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,573.87 |
| Max. Negotiated Rate |
$5,264.73 |
| Rate for Payer: Aetna American Axle |
$3,802.30
|
| Rate for Payer: Aetna Commercial |
$4,972.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,802.30
|
| Rate for Payer: Cash Price |
$4,679.76
|
| Rate for Payer: Cofinity Commercial |
$4,094.79
|
| Rate for Payer: Cofinity Commercial |
$5,030.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,679.76
|
| Rate for Payer: Healthscope Commercial |
$5,264.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,094.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,387.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,972.24
|
| Rate for Payer: PHP Commercial |
$4,972.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,094.79
|
| Rate for Payer: Priority Health SBD |
$3,685.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,573.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,387.28
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$6,882.00
|
|
|
Service Code
|
NDC 43386-770-01
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,028.08 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna American Axle |
$4,473.30
|
| Rate for Payer: Aetna Commercial |
$5,849.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,473.30
|
| Rate for Payer: Cash Price |
$5,505.60
|
| Rate for Payer: Cofinity Commercial |
$4,817.40
|
| Rate for Payer: Cofinity Commercial |
$5,918.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,505.60
|
| Rate for Payer: Healthscope Commercial |
$6,193.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,817.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,849.70
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,817.40
|
| Rate for Payer: Priority Health SBD |
$4,335.66
|
| Rate for Payer: UMR Bronson Commercial |
$3,028.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,161.50
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$7,067.00
|
|
|
Service Code
|
NDC 59651-332-01
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,109.48 |
| Max. Negotiated Rate |
$6,360.30 |
| Rate for Payer: Aetna American Axle |
$4,593.55
|
| Rate for Payer: Aetna Commercial |
$6,006.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,593.55
|
| Rate for Payer: Cash Price |
$5,653.60
|
| Rate for Payer: Cofinity Commercial |
$4,946.90
|
| Rate for Payer: Cofinity Commercial |
$6,077.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,653.60
|
| Rate for Payer: Healthscope Commercial |
$6,360.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,946.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,300.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,006.95
|
| Rate for Payer: PHP Commercial |
$6,006.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,946.90
|
| Rate for Payer: Priority Health SBD |
$4,452.21
|
| Rate for Payer: UMR Bronson Commercial |
$3,109.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,300.25
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$394.01
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.36 |
| Max. Negotiated Rate |
$354.61 |
| Rate for Payer: Aetna American Axle |
$256.11
|
| Rate for Payer: Aetna American Axle |
$634.72
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.72
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cofinity Commercial |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Cofinity Commercial |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$354.61
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$830.02
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: PHP Commercial |
$334.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.55
|
| Rate for Payer: Priority Health SBD |
$248.23
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UMR Bronson Commercial |
$173.36
|
| Rate for Payer: UMR Bronson Commercial |
$429.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.51
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$935.55
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$1,469.80 |
| Rate for Payer: Aetna American Axle |
$608.11
|
| Rate for Payer: Aetna Commercial |
$795.22
|
| Rate for Payer: Aetna Medicare |
$180.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.46
|
| Rate for Payer: BCBS Complete |
$99.93
|
| Rate for Payer: BCBS MAPPO |
$173.97
|
| Rate for Payer: BCBS Trust/PPO |
$562.18
|
| Rate for Payer: BCN Medicare Advantage |
$173.97
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cofinity Commercial |
$804.57
|
| Rate for Payer: Cofinity Commercial |
$654.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.97
|
| Rate for Payer: Healthscope Commercial |
$842.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.66
|
| Rate for Payer: Mclaren Medicaid |
$95.16
|
| Rate for Payer: Mclaren Medicare |
$173.97
|
| Rate for Payer: Meridian Medicaid |
$99.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$795.22
|
| Rate for Payer: PACE Medicare |
$165.27
|
| Rate for Payer: PACE SWMI |
$173.97
|
| Rate for Payer: PHP Commercial |
$795.22
|
| Rate for Payer: PHP Medicare Advantage |
$173.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,469.80
|
| Rate for Payer: Priority Health Medicare |
$173.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,175.84
|
| Rate for Payer: Priority Health SBD |
$589.40
|
| Rate for Payer: Railroad Medicare Medicare |
$173.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.97
|
| Rate for Payer: UHC Medicare Advantage |
$179.19
|
| Rate for Payer: UMR Bronson Commercial |
$346.15
|
| Rate for Payer: VA VA |
$173.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.66
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$951.64
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
10053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$418.72 |
| Max. Negotiated Rate |
$856.48 |
| Rate for Payer: Aetna American Axle |
$618.57
|
| Rate for Payer: Aetna Commercial |
$808.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.57
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cofinity Commercial |
$666.15
|
| Rate for Payer: Cofinity Commercial |
$818.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.31
|
| Rate for Payer: Healthscope Commercial |
$856.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$666.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$808.89
|
| Rate for Payer: PHP Commercial |
$808.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.15
|
| Rate for Payer: Priority Health SBD |
$599.53
|
| Rate for Payer: UMR Bronson Commercial |
$418.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.73
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$361.44
|
|
|
Service Code
|
NDC 68084-288-01
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$325.30 |
| Rate for Payer: Aetna American Axle |
$234.94
|
| Rate for Payer: Aetna Commercial |
$307.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.94
|
| Rate for Payer: Cash Price |
$289.15
|
| Rate for Payer: Cofinity Commercial |
$253.01
|
| Rate for Payer: Cofinity Commercial |
$310.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.15
|
| Rate for Payer: Healthscope Commercial |
$325.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.22
|
| Rate for Payer: PHP Commercial |
$307.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.01
|
| Rate for Payer: Priority Health SBD |
$227.71
|
| Rate for Payer: UMR Bronson Commercial |
$159.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.08
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 68084-288-11
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 50268-330-11
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$120.24
|
|
|
Service Code
|
NDC 50268-330-15
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$108.22 |
| Rate for Payer: Aetna American Axle |
$78.16
|
| Rate for Payer: Aetna Commercial |
$102.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.16
|
| Rate for Payer: Cash Price |
$96.19
|
| Rate for Payer: Cofinity Commercial |
$103.41
|
| Rate for Payer: Cofinity Commercial |
$84.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.19
|
| Rate for Payer: Healthscope Commercial |
$108.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.20
|
| Rate for Payer: PHP Commercial |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.17
|
| Rate for Payer: Priority Health SBD |
$75.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.18
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 0115-7033-01
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.74 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna American Axle |
$170.98
|
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$184.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.13
|
| Rate for Payer: Priority Health SBD |
$165.72
|
| Rate for Payer: UMR Bronson Commercial |
$115.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 0555-0997-02
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.36
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323-424-05
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.07
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.47
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$13.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
