|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
OP
|
$112.56
|
|
|
Service Code
|
NDC 68462011944
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$101.30 |
| Rate for Payer: Aetna American Axle |
$73.16
|
| Rate for Payer: Aetna Commercial |
$95.68
|
| Rate for Payer: Aetna Medicare |
$56.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.16
|
| Rate for Payer: BCBS Complete |
$45.02
|
| Rate for Payer: Cash Price |
$90.05
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$90.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.42
|
| Rate for Payer: PHP Commercial |
$95.68
|
| Rate for Payer: Priority Health SBD |
$70.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.16
|
| Rate for Payer: UHC Core |
$58.64
|
| Rate for Payer: UHC Exchange |
$44.24
|
| Rate for Payer: UMR Bronson Commercial |
$41.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.42
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$112.56
|
|
|
Service Code
|
NDC 68462011944
|
| 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 Advantage |
$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 Commercial |
$95.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.42
|
| Rate for Payer: PHP Commercial |
$95.68
|
| 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 |
$58.06
|
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Advantage |
$41.31
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PHP Commercial |
$50.17
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$37.18
|
| Rate for Payer: UMR Bronson Commercial |
$25.97
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$59.02
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Aetna American Axle |
$38.36
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna Commercial |
$50.17
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: BCBS Complete |
$23.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Advantage |
$41.31
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.27
|
| Rate for Payer: PHP Commercial |
$50.17
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health SBD |
$37.18
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.39
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UMR Bronson Commercial |
$21.84
|
| Rate for Payer: UMR Bronson Commercial |
$33.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
NDC 00904650161
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$723.60 |
| Rate for Payer: Aetna American Axle |
$522.60
|
| Rate for Payer: Aetna Commercial |
$683.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.60
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cofinity Advantage |
$562.80
|
| Rate for Payer: Cofinity Commercial |
$691.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.20
|
| Rate for Payer: Healthscope Commercial |
$723.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.00
|
| Rate for Payer: PHP Commercial |
$683.40
|
| Rate for Payer: Priority Health SBD |
$506.52
|
| Rate for Payer: UMR Bronson Commercial |
$353.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.00
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$813.12
|
|
|
Service Code
|
NDC 68084073501
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.77 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna American Axle |
$528.53
|
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.53
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cofinity Advantage |
$569.18
|
| Rate for Payer: Cofinity Commercial |
$699.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.50
|
| Rate for Payer: Healthscope Commercial |
$731.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.84
|
| Rate for Payer: PHP Commercial |
$691.15
|
| Rate for Payer: Priority Health SBD |
$512.27
|
| Rate for Payer: UMR Bronson Commercial |
$357.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.84
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$813.12
|
|
|
Service Code
|
NDC 68084073501
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna American Axle |
$528.53
|
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna Medicare |
$406.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.53
|
| Rate for Payer: BCBS Complete |
$325.25
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cofinity Advantage |
$569.18
|
| Rate for Payer: Cofinity Commercial |
$699.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.50
|
| Rate for Payer: Healthscope Commercial |
$731.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$609.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.84
|
| Rate for Payer: PHP Commercial |
$691.15
|
| Rate for Payer: Priority Health SBD |
$512.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.53
|
| Rate for Payer: UHC Core |
$423.64
|
| Rate for Payer: UHC Exchange |
$319.56
|
| Rate for Payer: UMR Bronson Commercial |
$300.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$609.84
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$8.14
|
|
|
Service Code
|
NDC 68084073511
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Aetna American Axle |
$5.29
|
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.29
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cofinity Advantage |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: PHP Commercial |
$6.92
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: UMR Bronson Commercial |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.11
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$8.14
|
|
|
Service Code
|
NDC 68084073511
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Aetna American Axle |
$5.29
|
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.29
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cofinity Advantage |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: PHP Commercial |
$6.92
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.29
|
| Rate for Payer: UHC Core |
$4.24
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.11
|
|
|
FLUCONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
NDC 00904650161
|
| Hospital Charge Code |
10045
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.48 |
| Max. Negotiated Rate |
$723.60 |
| Rate for Payer: Aetna American Axle |
$522.60
|
| Rate for Payer: Aetna Commercial |
$683.40
|
| Rate for Payer: Aetna Medicare |
$402.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.60
|
| Rate for Payer: BCBS Complete |
$321.60
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cofinity Advantage |
$562.80
|
| Rate for Payer: Cofinity Commercial |
$691.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.20
|
| Rate for Payer: Healthscope Commercial |
$723.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$643.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.00
|
| Rate for Payer: PHP Commercial |
$683.40
|
| Rate for Payer: Priority Health SBD |
$506.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.60
|
| Rate for Payer: UHC Core |
$418.88
|
| Rate for Payer: UHC Exchange |
$315.97
|
| Rate for Payer: UMR Bronson Commercial |
$297.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.00
|
|
|
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 |
$7.39 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$66.35
|
| Rate for Payer: Aetna American Axle |
$64.28
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$84.06
|
| Rate for Payer: Aetna Commercial |
$86.77
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna Medicare |
$51.04
|
| Rate for Payer: Aetna Medicare |
$49.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.28
|
| Rate for Payer: BCBS Complete |
$40.83
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Complete |
$39.56
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Cash Price |
$79.11
|
| Rate for Payer: Cash Price |
$79.11
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Advantage |
$69.22
|
| Rate for Payer: Cofinity Advantage |
$44.66
|
| Rate for Payer: Cofinity Advantage |
$71.46
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$85.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$89.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.17
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$86.77
|
| Rate for Payer: PHP Commercial |
$84.06
|
| Rate for Payer: Priority Health SBD |
$64.31
|
| Rate for Payer: Priority Health SBD |
$62.30
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.39
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UMR Bronson Commercial |
$36.59
|
| Rate for Payer: UMR Bronson Commercial |
$37.77
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| 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 |
$74.17
|
|
|
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 |
$64.28
|
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$86.77
|
| Rate for Payer: Aetna Commercial |
$84.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Cash Price |
$79.11
|
| Rate for Payer: Cofinity Advantage |
$69.22
|
| Rate for Payer: Cofinity Advantage |
$71.46
|
| Rate for Payer: Cofinity Advantage |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$85.05
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| 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 |
$79.11
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| 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 |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.17
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$86.77
|
| Rate for Payer: PHP Commercial |
$84.06
|
| Rate for Payer: Priority Health SBD |
$64.31
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$62.30
|
| Rate for Payer: UMR Bronson Commercial |
$44.92
|
| Rate for Payer: UMR Bronson Commercial |
$43.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| 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 |
$74.17
|
|
|
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$142.98
|
|
|
Service Code
|
NDC 57237015035
|
| Hospital Charge Code |
14233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$128.68 |
| Rate for Payer: Aetna American Axle |
$92.94
|
| Rate for Payer: Aetna Commercial |
$121.53
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.94
|
| Rate for Payer: BCBS Complete |
$57.19
|
| Rate for Payer: Cash Price |
$114.38
|
| Rate for Payer: Cofinity Advantage |
$100.09
|
| Rate for Payer: Cofinity Commercial |
$122.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.38
|
| Rate for Payer: Healthscope Commercial |
$128.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.23
|
| Rate for Payer: PHP Commercial |
$121.53
|
| Rate for Payer: Priority Health SBD |
$90.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.94
|
| Rate for Payer: UHC Core |
$74.49
|
| Rate for Payer: UHC Exchange |
$56.19
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.23
|
|
|
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$262.76
|
|
|
Service Code
|
NDC 59762503001
|
| Hospital Charge Code |
14233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$236.48 |
| Rate for Payer: Aetna American Axle |
$170.79
|
| Rate for Payer: Aetna Commercial |
$223.35
|
| Rate for Payer: Aetna Medicare |
$131.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.79
|
| Rate for Payer: BCBS Complete |
$105.10
|
| Rate for Payer: Cash Price |
$210.21
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$210.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.07
|
| Rate for Payer: PHP Commercial |
$223.35
|
| Rate for Payer: Priority Health SBD |
$165.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.79
|
| Rate for Payer: UHC Core |
$136.90
|
| Rate for Payer: UHC Exchange |
$103.26
|
| Rate for Payer: UMR Bronson Commercial |
$97.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.07
|
|
|
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$262.76
|
|
|
Service Code
|
NDC 59762503001
|
| 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 Advantage |
$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 Commercial |
$223.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.07
|
| Rate for Payer: PHP Commercial |
$223.35
|
| 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
|
$142.98
|
|
|
Service Code
|
NDC 57237015035
|
| Hospital Charge Code |
14233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.91 |
| Max. Negotiated Rate |
$128.68 |
| Rate for Payer: Aetna American Axle |
$92.94
|
| Rate for Payer: Aetna Commercial |
$121.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.94
|
| Rate for Payer: Cash Price |
$114.38
|
| Rate for Payer: Cofinity Advantage |
$100.09
|
| Rate for Payer: Cofinity Commercial |
$122.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.38
|
| Rate for Payer: Healthscope Commercial |
$128.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.23
|
| Rate for Payer: PHP Commercial |
$121.53
|
| Rate for Payer: Priority Health SBD |
$90.08
|
| Rate for Payer: UMR Bronson Commercial |
$62.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.23
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
OP
|
$6,882.00
|
|
|
Service Code
|
NDC 59651033201
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,546.34 |
| 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 Medicare |
$3,441.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,473.30
|
| Rate for Payer: BCBS Complete |
$2,752.80
|
| Rate for Payer: Cash Price |
$5,505.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$5,505.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,849.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,161.50
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| Rate for Payer: Priority Health SBD |
$4,335.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,473.30
|
| Rate for Payer: UHC Core |
$3,585.52
|
| Rate for Payer: UHC Exchange |
$2,704.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,546.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,161.50
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
OP
|
$6,882.00
|
|
|
Service Code
|
NDC 43386077001
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,546.34 |
| 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 Medicare |
$3,441.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,473.30
|
| Rate for Payer: BCBS Complete |
$2,752.80
|
| Rate for Payer: Cash Price |
$5,505.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$5,505.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,849.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,161.50
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| Rate for Payer: Priority Health SBD |
$4,335.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,473.30
|
| Rate for Payer: UHC Core |
$3,585.52
|
| Rate for Payer: UHC Exchange |
$2,704.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,546.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,161.50
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
OP
|
$5,849.70
|
|
|
Service Code
|
NDC 42794001008
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,164.39 |
| 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 Medicare |
$2,924.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,802.30
|
| Rate for Payer: BCBS Complete |
$2,339.88
|
| Rate for Payer: Cash Price |
$4,679.76
|
| Rate for Payer: Cofinity Advantage |
$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 |
$4,387.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,679.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,972.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,387.27
|
| Rate for Payer: PHP Commercial |
$4,972.24
|
| Rate for Payer: Priority Health SBD |
$3,685.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,802.30
|
| Rate for Payer: UHC Core |
$3,047.69
|
| Rate for Payer: UHC Exchange |
$2,298.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,164.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,387.27
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$5,849.70
|
|
|
Service Code
|
NDC 42794001008
|
| 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 Advantage |
$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 |
$4,387.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,972.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,387.27
|
| Rate for Payer: PHP Commercial |
$4,972.24
|
| 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 |
$4,387.27
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$6,882.00
|
|
|
Service Code
|
NDC 59651033201
|
| 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 Advantage |
$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 Commercial |
$5,849.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,161.50
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| 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
|
OP
|
$51,605.75
|
|
|
Service Code
|
NDC 00187355510
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19,094.13 |
| 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 Medicare |
$25,802.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,543.74
|
| Rate for Payer: BCBS Complete |
$20,642.30
|
| Rate for Payer: Cash Price |
$41,284.60
|
| Rate for Payer: Cofinity Advantage |
$36,124.03
|
| 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 |
$36,124.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,704.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,284.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,864.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,704.31
|
| Rate for Payer: PHP Commercial |
$43,864.89
|
| Rate for Payer: Priority Health SBD |
$32,511.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,543.74
|
| Rate for Payer: UHC Core |
$26,886.60
|
| Rate for Payer: UHC Exchange |
$20,281.06
|
| Rate for Payer: UMR Bronson Commercial |
$19,094.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,704.31
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$51,605.75
|
|
|
Service Code
|
NDC 00187355510
|
| 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 Advantage |
$36,124.03
|
| 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 |
$36,124.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,704.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,864.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,704.31
|
| Rate for Payer: PHP Commercial |
$43,864.89
|
| 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
|
$6,882.00
|
|
|
Service Code
|
NDC 43386077001
|
| 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 Advantage |
$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 Commercial |
$5,849.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,161.50
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| 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
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$361.73
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$325.56 |
| Rate for Payer: Aetna American Axle |
$235.12
|
| Rate for Payer: Aetna American Axle |
$821.73
|
| Rate for Payer: Aetna American Axle |
$608.11
|
| Rate for Payer: Aetna Commercial |
$307.47
|
| Rate for Payer: Aetna Commercial |
$795.22
|
| Rate for Payer: Aetna Commercial |
$1,074.57
|
| Rate for Payer: Aetna Medicare |
$180.87
|
| Rate for Payer: Aetna Medicare |
$632.10
|
| Rate for Payer: Aetna Medicare |
$467.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.11
|
| Rate for Payer: BCBS Complete |
$505.68
|
| Rate for Payer: BCBS Complete |
$144.69
|
| Rate for Payer: BCBS Complete |
$374.22
|
| Rate for Payer: BCBS Trust/PPO |
$263.96
|
| Rate for Payer: BCBS Trust/PPO |
$263.96
|
| Rate for Payer: BCBS Trust/PPO |
$263.96
|
| Rate for Payer: BCN Commercial |
$263.96
|
| Rate for Payer: BCN Commercial |
$263.96
|
| Rate for Payer: BCN Commercial |
$263.96
|
| Rate for Payer: Cash Price |
$1,011.36
|
| Rate for Payer: Cash Price |
$1,011.36
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cash Price |
$289.38
|
| Rate for Payer: Cash Price |
$289.38
|
| Rate for Payer: Cofinity Advantage |
$654.88
|
| Rate for Payer: Cofinity Advantage |
$253.21
|
| Rate for Payer: Cofinity Advantage |
$884.94
|
| Rate for Payer: Cofinity Commercial |
$1,087.21
|
| Rate for Payer: Cofinity Commercial |
$311.09
|
| Rate for Payer: Cofinity Commercial |
$804.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.38
|
| Rate for Payer: Healthscope Commercial |
$1,137.78
|
| Rate for Payer: Healthscope Commercial |
$325.56
|
| Rate for Payer: Healthscope Commercial |
$842.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$884.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,011.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$795.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$701.66
|
| Rate for Payer: PHP Commercial |
$307.47
|
| Rate for Payer: PHP Commercial |
$1,074.57
|
| Rate for Payer: PHP Commercial |
$795.22
|
| Rate for Payer: Priority Health SBD |
$796.45
|
| Rate for Payer: Priority Health SBD |
$589.40
|
| Rate for Payer: Priority Health SBD |
$227.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.33
|
| Rate for Payer: UHC Core |
$134.33
|
| Rate for Payer: UHC Core |
$134.33
|
| Rate for Payer: UHC Core |
$134.33
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UMR Bronson Commercial |
$346.15
|
| Rate for Payer: UMR Bronson Commercial |
$467.75
|
| Rate for Payer: UMR Bronson Commercial |
$133.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.66
|
|
