|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 69367023601
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Advantage |
$90.47
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.94
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna American Axle |
$13.44
|
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.44
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Advantage |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health SBD |
$13.03
|
| Rate for Payer: UMR Bronson Commercial |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Advantage |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.30
|
| Rate for Payer: UHC Core |
$35.51
|
| Rate for Payer: UHC Exchange |
$26.78
|
| Rate for Payer: UMR Bronson Commercial |
$25.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna American Axle |
$13.44
|
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.44
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Advantage |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health SBD |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.44
|
| Rate for Payer: UHC Core |
$10.77
|
| Rate for Payer: UHC Exchange |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna American Axle |
$217.36
|
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna Medicare |
$167.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.36
|
| Rate for Payer: BCBS Complete |
$133.76
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Advantage |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.80
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health SBD |
$210.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$174.22
|
| Rate for Payer: UHC Exchange |
$131.42
|
| Rate for Payer: UMR Bronson Commercial |
$123.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna American Axle |
$217.36
|
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.36
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Advantage |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.80
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health SBD |
$210.67
|
| Rate for Payer: UMR Bronson Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.57 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna American Axle |
$434.93
|
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna Medicare |
$334.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: BCBS Complete |
$267.65
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Advantage |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.84
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health SBD |
$421.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.93
|
| Rate for Payer: UHC Core |
$348.61
|
| Rate for Payer: UHC Exchange |
$262.96
|
| Rate for Payer: UMR Bronson Commercial |
$247.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$308.16
|
|
|
Service Code
|
NDC 69238167801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.59 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna American Axle |
$200.30
|
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Advantage |
$215.71
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.12
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health SBD |
$194.14
|
| Rate for Payer: UMR Bronson Commercial |
$135.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 70954027310
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.51
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 70954027310
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.51
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.41 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna American Axle |
$434.93
|
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Advantage |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.84
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health SBD |
$421.55
|
| Rate for Payer: UMR Bronson Commercial |
$294.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$308.16
|
|
|
Service Code
|
NDC 69238167801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.02 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna American Axle |
$200.30
|
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: Aetna Medicare |
$154.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: BCBS Complete |
$123.26
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Advantage |
$215.71
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.12
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health SBD |
$194.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.30
|
| Rate for Payer: UHC Core |
$160.55
|
| Rate for Payer: UHC Exchange |
$121.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna American Axle |
$702.26
|
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna Medicare |
$540.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: BCBS Complete |
$432.16
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Advantage |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$864.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health SBD |
$680.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.26
|
| Rate for Payer: UHC Core |
$562.89
|
| Rate for Payer: UHC Exchange |
$424.60
|
| Rate for Payer: UMR Bronson Commercial |
$399.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$475.38 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna American Axle |
$702.26
|
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Advantage |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$810.30
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health SBD |
$680.65
|
| Rate for Payer: UMR Bronson Commercial |
$475.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$214.45
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna American Axle |
$139.39
|
| Rate for Payer: Aetna American Axle |
$129.99
|
| Rate for Payer: Aetna American Axle |
$216.19
|
| Rate for Payer: Aetna Commercial |
$182.28
|
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna Commercial |
$169.98
|
| Rate for Payer: Aetna Medicare |
$107.22
|
| Rate for Payer: Aetna Medicare |
$99.99
|
| Rate for Payer: Aetna Medicare |
$166.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.19
|
| Rate for Payer: BCBS Complete |
$79.99
|
| Rate for Payer: BCBS Complete |
$85.78
|
| Rate for Payer: BCBS Complete |
$133.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.08
|
| Rate for Payer: BCN Commercial |
$20.08
|
| Rate for Payer: BCN Commercial |
$20.08
|
| Rate for Payer: BCN Commercial |
$20.08
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cash Price |
$171.56
|
| Rate for Payer: Cash Price |
$171.56
|
| Rate for Payer: Cofinity Advantage |
$232.82
|
| Rate for Payer: Cofinity Advantage |
$150.12
|
| Rate for Payer: Cofinity Advantage |
$139.99
|
| Rate for Payer: Cofinity Commercial |
$171.98
|
| Rate for Payer: Cofinity Commercial |
$184.43
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.56
|
| Rate for Payer: Healthscope Commercial |
$179.98
|
| Rate for Payer: Healthscope Commercial |
$193.00
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: PHP Commercial |
$182.28
|
| Rate for Payer: PHP Commercial |
$169.98
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health SBD |
$125.99
|
| Rate for Payer: Priority Health SBD |
$209.54
|
| Rate for Payer: Priority Health SBD |
$135.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.23
|
| Rate for Payer: UHC Core |
$10.23
|
| Rate for Payer: UHC Core |
$10.23
|
| Rate for Payer: UHC Core |
$10.23
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$123.06
|
| Rate for Payer: UMR Bronson Commercial |
$73.99
|
| Rate for Payer: UMR Bronson Commercial |
$79.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$214.45
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna American Axle |
$139.39
|
| Rate for Payer: Aetna American Axle |
$216.19
|
| Rate for Payer: Aetna Commercial |
$182.28
|
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.19
|
| Rate for Payer: Cash Price |
$171.56
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Advantage |
$232.82
|
| Rate for Payer: Cofinity Advantage |
$150.12
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Cofinity Commercial |
$184.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$193.00
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.45
|
| Rate for Payer: PHP Commercial |
$182.28
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: Priority Health SBD |
$209.54
|
| Rate for Payer: Priority Health SBD |
$135.10
|
| Rate for Payer: UMR Bronson Commercial |
$94.36
|
| Rate for Payer: UMR Bronson Commercial |
$146.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.16 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna American Axle |
$266.14
|
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.14
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Advantage |
$286.62
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health SBD |
$257.95
|
| Rate for Payer: UMR Bronson Commercial |
$180.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLURAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 00378441501
|
| Hospital Charge Code |
3223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna American Axle |
$266.14
|
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna Medicare |
$204.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.14
|
| Rate for Payer: BCBS Complete |
$163.78
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Advantage |
$286.62
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health SBD |
$257.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.14
|
| Rate for Payer: UHC Core |
$213.32
|
| Rate for Payer: UHC Exchange |
$160.91
|
| Rate for Payer: UMR Bronson Commercial |
$151.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.09
|
|
|
FLURBIPROFEN 0.03 % EYE DROPS
|
Facility
|
IP
|
$117.43
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
10080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$105.69 |
| Rate for Payer: Aetna American Axle |
$76.33
|
| Rate for Payer: Aetna Commercial |
$99.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.33
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Advantage |
$82.20
|
| Rate for Payer: Cofinity Commercial |
$100.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$105.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.07
|
| Rate for Payer: PHP Commercial |
$99.82
|
| Rate for Payer: Priority Health SBD |
$73.98
|
| Rate for Payer: UMR Bronson Commercial |
$51.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.07
|
|
|
FLURBIPROFEN 0.03 % EYE DROPS
|
Facility
|
OP
|
$117.43
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
10080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$105.69 |
| Rate for Payer: Aetna American Axle |
$76.33
|
| Rate for Payer: Aetna Commercial |
$99.82
|
| Rate for Payer: Aetna Medicare |
$58.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.33
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: Cash Price |
$93.94
|
| Rate for Payer: Cofinity Advantage |
$82.20
|
| Rate for Payer: Cofinity Commercial |
$100.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$105.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.07
|
| Rate for Payer: PHP Commercial |
$99.82
|
| Rate for Payer: Priority Health SBD |
$73.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.33
|
| Rate for Payer: UHC Core |
$61.18
|
| Rate for Payer: UHC Exchange |
$46.15
|
| Rate for Payer: UMR Bronson Commercial |
$43.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.07
|
|
|
FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
IP
|
$146.97
|
|
|
Service Code
|
NDC 00173069504
|
| Hospital Charge Code |
26537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$132.27 |
| Rate for Payer: Aetna American Axle |
$95.53
|
| Rate for Payer: Aetna Commercial |
$124.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.53
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Advantage |
$102.88
|
| Rate for Payer: Cofinity Commercial |
$126.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$132.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.23
|
| Rate for Payer: PHP Commercial |
$124.92
|
| Rate for Payer: Priority Health SBD |
$92.59
|
| Rate for Payer: UMR Bronson Commercial |
$64.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.23
|
|
