|
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
|
|
|
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 Advantage |
$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 Commercial |
$808.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$713.73
|
| Rate for Payer: PHP Commercial |
$808.89
|
| 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
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$951.64
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
10053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$856.48 |
| Rate for Payer: Aetna American Axle |
$618.57
|
| Rate for Payer: Aetna Commercial |
$808.89
|
| Rate for Payer: Aetna Medicare |
$475.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.57
|
| Rate for Payer: BCBS Complete |
$380.66
|
| Rate for Payer: BCBS Trust/PPO |
$263.96
|
| Rate for Payer: BCN Commercial |
$263.96
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$761.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$713.73
|
| Rate for Payer: PHP Commercial |
$808.89
|
| Rate for Payer: Priority Health SBD |
$599.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.33
|
| Rate for Payer: UHC Core |
$134.33
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UMR Bronson Commercial |
$352.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.73
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$359.52
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.02 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna American Axle |
$233.69
|
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna Medicare |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.69
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Advantage |
$251.66
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: Priority Health SBD |
$226.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.69
|
| Rate for Payer: UHC Core |
$187.31
|
| Rate for Payer: UHC Exchange |
$141.29
|
| Rate for Payer: UMR Bronson Commercial |
$133.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health SBD |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Exchange |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.03 |
| Max. Negotiated Rate |
$355.97 |
| Rate for Payer: Aetna American Axle |
$257.09
|
| Rate for Payer: Aetna Commercial |
$336.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.09
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Advantage |
$276.86
|
| Rate for Payer: Cofinity Commercial |
$340.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$355.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: PHP Commercial |
$336.19
|
| Rate for Payer: Priority Health SBD |
$249.18
|
| Rate for Payer: UMR Bronson Commercial |
$174.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.32 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna American Axle |
$170.98
|
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna Medicare |
$131.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: BCBS Complete |
$105.22
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$210.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.28
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health SBD |
$165.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.98
|
| Rate for Payer: UHC Core |
$137.04
|
| Rate for Payer: UHC Exchange |
$103.37
|
| Rate for Payer: UMR Bronson Commercial |
$97.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
NDC 00555099702
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$195.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.60
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.12
|
| Rate for Payer: UHC Core |
$127.54
|
| Rate for Payer: UHC Exchange |
$96.21
|
| Rate for Payer: UMR Bronson Commercial |
$90.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 00555099702
|
| 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 Advantage |
$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 Commercial |
$208.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.60
|
| Rate for Payer: PHP Commercial |
$208.08
|
| 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
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$395.52
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.34 |
| Max. Negotiated Rate |
$355.97 |
| Rate for Payer: Aetna American Axle |
$257.09
|
| Rate for Payer: Aetna Commercial |
$336.19
|
| Rate for Payer: Aetna Medicare |
$197.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.09
|
| Rate for Payer: BCBS Complete |
$158.21
|
| Rate for Payer: Cash Price |
$316.42
|
| Rate for Payer: Cofinity Advantage |
$276.86
|
| Rate for Payer: Cofinity Commercial |
$340.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.42
|
| Rate for Payer: Healthscope Commercial |
$355.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.64
|
| Rate for Payer: PHP Commercial |
$336.19
|
| Rate for Payer: Priority Health SBD |
$249.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.09
|
| Rate for Payer: UHC Core |
$206.07
|
| Rate for Payer: UHC Exchange |
$155.44
|
| Rate for Payer: UMR Bronson Commercial |
$146.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$209.05 |
| Rate for Payer: Aetna American Axle |
$150.98
|
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.98
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Advantage |
$162.60
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Healthscope Commercial |
$209.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: PHP Commercial |
$197.44
|
| Rate for Payer: Priority Health SBD |
$146.34
|
| Rate for Payer: UMR Bronson Commercial |
$102.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.21
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$359.52
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.19 |
| Max. Negotiated Rate |
$323.57 |
| Rate for Payer: Aetna American Axle |
$233.69
|
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.69
|
| Rate for Payer: Cash Price |
$287.62
|
| Rate for Payer: Cofinity Advantage |
$251.66
|
| Rate for Payer: Cofinity Commercial |
$309.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.62
|
| Rate for Payer: Healthscope Commercial |
$323.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.64
|
| Rate for Payer: PHP Commercial |
$305.59
|
| Rate for Payer: Priority Health SBD |
$226.50
|
| Rate for Payer: UMR Bronson Commercial |
$158.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.64
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$232.28
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.94 |
| Max. Negotiated Rate |
$209.05 |
| Rate for Payer: Aetna American Axle |
$150.98
|
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$116.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.98
|
| Rate for Payer: BCBS Complete |
$92.91
|
| Rate for Payer: Cash Price |
$185.82
|
| Rate for Payer: Cofinity Advantage |
$162.60
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.82
|
| Rate for Payer: Healthscope Commercial |
$209.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.21
|
| Rate for Payer: PHP Commercial |
$197.44
|
| Rate for Payer: Priority Health SBD |
$146.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.98
|
| Rate for Payer: UHC Core |
$121.02
|
| Rate for Payer: UHC Exchange |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$85.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.21
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| 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 Advantage |
$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 Commercial |
$223.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.28
|
| Rate for Payer: PHP Commercial |
$223.58
|
| 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
|
$4.65
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health SBD |
$2.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.94
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.22
|
|
|
Service Code
|
NDC 36000014801
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.54
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.49
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.54
|
| Rate for Payer: Priority Health SBD |
$19.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Exchange |
$12.27
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978401
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.22
|
|
|
Service Code
|
NDC 36000014810
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.54
|
| Rate for Payer: Priority Health SBD |
$19.67
|
| Rate for Payer: UMR Bronson Commercial |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| 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 Advantage |
$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 Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| 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
|
|
