|
FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
OP
|
$146.97
|
|
|
Service Code
|
NDC 00173069504
|
| Hospital Charge Code |
26537
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$132.27 |
| Rate for Payer: Aetna American Axle |
$95.53
|
| Rate for Payer: Aetna Commercial |
$124.92
|
| Rate for Payer: Aetna Medicare |
$73.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.53
|
| Rate for Payer: BCBS Complete |
$58.79
|
| 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: MI Amish Medical Board Commercial |
$117.58
|
| 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: UHC All Payor (Choice/PPO) |
$95.53
|
| Rate for Payer: UHC Core |
$76.57
|
| Rate for Payer: UHC Exchange |
$57.76
|
| Rate for Payer: UMR Bronson Commercial |
$54.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.23
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
OP
|
$146.97
|
|
|
Service Code
|
NDC 00173069604
|
| Hospital Charge Code |
26538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$132.27 |
| Rate for Payer: Aetna American Axle |
$95.53
|
| Rate for Payer: Aetna Commercial |
$124.92
|
| Rate for Payer: Aetna Medicare |
$73.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.53
|
| Rate for Payer: BCBS Complete |
$58.79
|
| 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: MI Amish Medical Board Commercial |
$117.58
|
| 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: UHC All Payor (Choice/PPO) |
$95.53
|
| Rate for Payer: UHC Core |
$76.57
|
| Rate for Payer: UHC Exchange |
$57.76
|
| Rate for Payer: UMR Bronson Commercial |
$54.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.23
|
|
|
FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
IP
|
$146.97
|
|
|
Service Code
|
NDC 00173069604
|
| Hospital Charge Code |
26538
|
|
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
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
OP
|
$241.50
|
|
|
Service Code
|
NDC 00173069704
|
| Hospital Charge Code |
104566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Aetna American Axle |
$156.97
|
| Rate for Payer: Aetna Commercial |
$205.28
|
| Rate for Payer: Aetna Medicare |
$120.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.97
|
| Rate for Payer: BCBS Complete |
$96.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cofinity Advantage |
$169.05
|
| Rate for Payer: Cofinity Commercial |
$207.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.20
|
| Rate for Payer: Healthscope Commercial |
$217.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.12
|
| Rate for Payer: PHP Commercial |
$205.28
|
| Rate for Payer: Priority Health SBD |
$152.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.97
|
| Rate for Payer: UHC Core |
$125.82
|
| Rate for Payer: UHC Exchange |
$94.91
|
| Rate for Payer: UMR Bronson Commercial |
$89.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.12
|
|
|
FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION
|
Facility
|
IP
|
$241.50
|
|
|
Service Code
|
NDC 00173069704
|
| Hospital Charge Code |
104566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.26 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Aetna American Axle |
$156.97
|
| Rate for Payer: Aetna Commercial |
$205.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.97
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cofinity Advantage |
$169.05
|
| Rate for Payer: Cofinity Commercial |
$207.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.20
|
| Rate for Payer: Healthscope Commercial |
$217.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.12
|
| Rate for Payer: PHP Commercial |
$205.28
|
| Rate for Payer: Priority Health SBD |
$152.15
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.12
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna American Axle |
$154.09
|
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: Aetna Medicare |
$118.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.09
|
| Rate for Payer: BCBS Complete |
$94.82
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Advantage |
$165.94
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: Priority Health SBD |
$149.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.09
|
| Rate for Payer: UHC Core |
$123.51
|
| Rate for Payer: UHC Exchange |
$93.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$237.06
|
|
|
Service Code
|
NDC 00173087414
|
| Hospital Charge Code |
173282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Aetna American Axle |
$154.09
|
| Rate for Payer: Aetna Commercial |
$201.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.09
|
| Rate for Payer: Cash Price |
$189.65
|
| Rate for Payer: Cofinity Advantage |
$165.94
|
| Rate for Payer: Cofinity Commercial |
$203.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.65
|
| Rate for Payer: Healthscope Commercial |
$213.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.79
|
| Rate for Payer: PHP Commercial |
$201.50
|
| Rate for Payer: Priority Health SBD |
$149.35
|
| Rate for Payer: UMR Bronson Commercial |
$104.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.79
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Advantage |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: UMR Bronson Commercial |
$139.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$317.38
|
|
|
Service Code
|
NDC 00173087614
|
| Hospital Charge Code |
173283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: BCBS Complete |
$126.95
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cofinity Advantage |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.03
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.30
|
| Rate for Payer: UHC Core |
$165.35
|
| Rate for Payer: UHC Exchange |
$124.73
|
| Rate for Payer: UMR Bronson Commercial |
$117.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.03
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$1,103.04
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$485.34 |
| Max. Negotiated Rate |
$992.74 |
| Rate for Payer: Aetna American Axle |
$716.98
|
| Rate for Payer: Aetna Commercial |
$937.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.98
|
| Rate for Payer: Cash Price |
$882.43
|
| Rate for Payer: Cofinity Advantage |
$772.13
|
| Rate for Payer: Cofinity Commercial |
$948.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.43
|
| Rate for Payer: Healthscope Commercial |
$992.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$827.28
|
| Rate for Payer: PHP Commercial |
$937.58
|
| Rate for Payer: Priority Health SBD |
$694.92
|
| Rate for Payer: UMR Bronson Commercial |
$485.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.28
|
|
|
FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$1,103.04
|
|
|
Service Code
|
NDC 00173071920
|
| Hospital Charge Code |
40698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.12 |
| Max. Negotiated Rate |
$992.74 |
| Rate for Payer: Aetna American Axle |
$716.98
|
| Rate for Payer: Aetna Commercial |
$937.58
|
| Rate for Payer: Aetna Medicare |
$551.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.98
|
| Rate for Payer: BCBS Complete |
$441.22
|
| Rate for Payer: Cash Price |
$882.43
|
| Rate for Payer: Cofinity Advantage |
$772.13
|
| Rate for Payer: Cofinity Commercial |
$948.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.43
|
| Rate for Payer: Healthscope Commercial |
$992.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$882.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$827.28
|
| Rate for Payer: PHP Commercial |
$937.58
|
| Rate for Payer: Priority Health SBD |
$694.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.98
|
| Rate for Payer: UHC Core |
$574.68
|
| Rate for Payer: UHC Exchange |
$433.49
|
| Rate for Payer: UMR Bronson Commercial |
$408.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.28
|
|
|
FLUTICASONE PROPIONATE 115 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
IP
|
$504.26
|
|
|
Service Code
|
NDC 00173071622
|
| Hospital Charge Code |
77174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.87 |
| Max. Negotiated Rate |
$453.83 |
| Rate for Payer: Aetna American Axle |
$327.77
|
| Rate for Payer: Aetna Commercial |
$428.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.77
|
| Rate for Payer: Cash Price |
$403.41
|
| Rate for Payer: Cofinity Advantage |
$352.98
|
| Rate for Payer: Cofinity Commercial |
$433.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.41
|
| Rate for Payer: Healthscope Commercial |
$453.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.19
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: Priority Health SBD |
$317.68
|
| Rate for Payer: UMR Bronson Commercial |
$221.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.19
|
|
|
FLUTICASONE PROPIONATE 115 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
OP
|
$504.26
|
|
|
Service Code
|
NDC 00173071622
|
| Hospital Charge Code |
77174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.58 |
| Max. Negotiated Rate |
$453.83 |
| Rate for Payer: Aetna American Axle |
$327.77
|
| Rate for Payer: Aetna Commercial |
$428.62
|
| Rate for Payer: Aetna Medicare |
$252.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.77
|
| Rate for Payer: BCBS Complete |
$201.70
|
| Rate for Payer: Cash Price |
$403.41
|
| Rate for Payer: Cofinity Advantage |
$352.98
|
| Rate for Payer: Cofinity Commercial |
$433.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.41
|
| Rate for Payer: Healthscope Commercial |
$453.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.19
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: Priority Health SBD |
$317.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.77
|
| Rate for Payer: UHC Core |
$262.72
|
| Rate for Payer: UHC Exchange |
$198.17
|
| Rate for Payer: UMR Bronson Commercial |
$186.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.19
|
|
|
FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$1,463.43
|
|
|
Service Code
|
NDC 00173072020
|
| Hospital Charge Code |
40699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$643.91 |
| Max. Negotiated Rate |
$1,317.09 |
| Rate for Payer: Aetna American Axle |
$951.23
|
| Rate for Payer: Aetna Commercial |
$1,243.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.23
|
| Rate for Payer: Cash Price |
$1,170.74
|
| Rate for Payer: Cofinity Advantage |
$1,024.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.74
|
| Rate for Payer: Healthscope Commercial |
$1,317.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,024.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,097.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,243.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,097.57
|
| Rate for Payer: PHP Commercial |
$1,243.92
|
| Rate for Payer: Priority Health SBD |
$921.96
|
| Rate for Payer: UMR Bronson Commercial |
$643.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,097.57
|
|
|
FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$1,463.43
|
|
|
Service Code
|
NDC 00173072020
|
| Hospital Charge Code |
40699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$541.47 |
| Max. Negotiated Rate |
$1,317.09 |
| Rate for Payer: Aetna American Axle |
$951.23
|
| Rate for Payer: Aetna Commercial |
$1,243.92
|
| Rate for Payer: Aetna Medicare |
$731.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.23
|
| Rate for Payer: BCBS Complete |
$585.37
|
| Rate for Payer: Cash Price |
$1,170.74
|
| Rate for Payer: Cofinity Advantage |
$1,024.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.74
|
| Rate for Payer: Healthscope Commercial |
$1,317.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,024.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,097.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,170.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,243.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,097.57
|
| Rate for Payer: PHP Commercial |
$1,243.92
|
| Rate for Payer: Priority Health SBD |
$921.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$951.23
|
| Rate for Payer: UHC Core |
$762.45
|
| Rate for Payer: UHC Exchange |
$575.13
|
| Rate for Payer: UMR Bronson Commercial |
$541.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,097.57
|
|
|
FLUTICASONE PROPIONATE 230 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
OP
|
$824.16
|
|
|
Service Code
|
NDC 00173071722
|
| Hospital Charge Code |
77175
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$741.74 |
| Rate for Payer: Aetna American Axle |
$535.70
|
| Rate for Payer: Aetna Commercial |
$700.54
|
| Rate for Payer: Aetna Medicare |
$412.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.70
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: Cash Price |
$659.33
|
| Rate for Payer: Cofinity Advantage |
$576.91
|
| Rate for Payer: Cofinity Commercial |
$708.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$659.33
|
| Rate for Payer: Healthscope Commercial |
$741.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$659.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$700.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$618.12
|
| Rate for Payer: PHP Commercial |
$700.54
|
| Rate for Payer: Priority Health SBD |
$519.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.70
|
| Rate for Payer: UHC Core |
$429.39
|
| Rate for Payer: UHC Exchange |
$323.89
|
| Rate for Payer: UMR Bronson Commercial |
$304.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.12
|
|
|
FLUTICASONE PROPIONATE 230 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
IP
|
$824.16
|
|
|
Service Code
|
NDC 00173071722
|
| Hospital Charge Code |
77175
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.63 |
| Max. Negotiated Rate |
$741.74 |
| Rate for Payer: Aetna American Axle |
$535.70
|
| Rate for Payer: Aetna Commercial |
$700.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.70
|
| Rate for Payer: Cash Price |
$659.33
|
| Rate for Payer: Cofinity Advantage |
$576.91
|
| Rate for Payer: Cofinity Commercial |
$708.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$659.33
|
| Rate for Payer: Healthscope Commercial |
$741.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$700.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$618.12
|
| Rate for Payer: PHP Commercial |
$700.54
|
| Rate for Payer: Priority Health SBD |
$519.22
|
| Rate for Payer: UMR Bronson Commercial |
$362.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.12
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$468.84
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.47 |
| Max. Negotiated Rate |
$421.96 |
| Rate for Payer: Aetna American Axle |
$304.75
|
| Rate for Payer: Aetna Commercial |
$398.51
|
| Rate for Payer: Aetna Medicare |
$234.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.75
|
| Rate for Payer: BCBS Complete |
$187.54
|
| Rate for Payer: Cash Price |
$375.07
|
| Rate for Payer: Cofinity Advantage |
$328.19
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.07
|
| Rate for Payer: Healthscope Commercial |
$421.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.63
|
| Rate for Payer: PHP Commercial |
$398.51
|
| Rate for Payer: Priority Health SBD |
$295.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.75
|
| Rate for Payer: UHC Core |
$244.27
|
| Rate for Payer: UHC Exchange |
$184.25
|
| Rate for Payer: UMR Bronson Commercial |
$173.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.63
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$468.84
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$421.96 |
| Rate for Payer: Aetna American Axle |
$304.75
|
| Rate for Payer: Aetna Commercial |
$398.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.75
|
| Rate for Payer: Cash Price |
$375.07
|
| Rate for Payer: Cofinity Advantage |
$328.19
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.07
|
| Rate for Payer: Healthscope Commercial |
$421.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.63
|
| Rate for Payer: PHP Commercial |
$398.51
|
| Rate for Payer: Priority Health SBD |
$295.37
|
| Rate for Payer: UMR Bronson Commercial |
$206.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.63
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
OP
|
$635.21
|
|
|
Service Code
|
NDC 00173071820
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.03 |
| Max. Negotiated Rate |
$571.69 |
| Rate for Payer: Aetna American Axle |
$412.89
|
| Rate for Payer: Aetna Commercial |
$539.93
|
| Rate for Payer: Aetna Medicare |
$317.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.89
|
| Rate for Payer: BCBS Complete |
$254.08
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cofinity Advantage |
$444.65
|
| Rate for Payer: Cofinity Commercial |
$546.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.17
|
| Rate for Payer: Healthscope Commercial |
$571.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.41
|
| Rate for Payer: PHP Commercial |
$539.93
|
| Rate for Payer: Priority Health SBD |
$400.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.89
|
| Rate for Payer: UHC Core |
$330.94
|
| Rate for Payer: UHC Exchange |
$249.64
|
| Rate for Payer: UMR Bronson Commercial |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.41
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$635.21
|
|
|
Service Code
|
NDC 00173071820
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.49 |
| Max. Negotiated Rate |
$571.69 |
| Rate for Payer: Aetna American Axle |
$412.89
|
| Rate for Payer: Aetna Commercial |
$539.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.89
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cofinity Advantage |
$444.65
|
| Rate for Payer: Cofinity Commercial |
$546.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.17
|
| Rate for Payer: Healthscope Commercial |
$571.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.41
|
| Rate for Payer: PHP Commercial |
$539.93
|
| Rate for Payer: Priority Health SBD |
$400.18
|
| Rate for Payer: UMR Bronson Commercial |
$279.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.41
|
|
|
FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
IP
|
$543.01
|
|
|
Service Code
|
NDC 00173071522
|
| Hospital Charge Code |
77173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$488.71 |
| Rate for Payer: Aetna American Axle |
$352.96
|
| Rate for Payer: Aetna Commercial |
$461.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.96
|
| Rate for Payer: Cash Price |
$434.41
|
| Rate for Payer: Cofinity Advantage |
$380.11
|
| Rate for Payer: Cofinity Commercial |
$466.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.41
|
| Rate for Payer: Healthscope Commercial |
$488.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.26
|
| Rate for Payer: PHP Commercial |
$461.56
|
| Rate for Payer: Priority Health SBD |
$342.10
|
| Rate for Payer: UMR Bronson Commercial |
$238.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.26
|
|
|
FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
OP
|
$543.01
|
|
|
Service Code
|
NDC 00173071522
|
| Hospital Charge Code |
77173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.91 |
| Max. Negotiated Rate |
$488.71 |
| Rate for Payer: Aetna American Axle |
$352.96
|
| Rate for Payer: Aetna Commercial |
$461.56
|
| Rate for Payer: Aetna Medicare |
$271.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.96
|
| Rate for Payer: BCBS Complete |
$217.20
|
| Rate for Payer: Cash Price |
$434.41
|
| Rate for Payer: Cofinity Advantage |
$380.11
|
| Rate for Payer: Cofinity Commercial |
$466.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.41
|
| Rate for Payer: Healthscope Commercial |
$488.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.26
|
| Rate for Payer: PHP Commercial |
$461.56
|
| Rate for Payer: Priority Health SBD |
$342.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.96
|
| Rate for Payer: UHC Core |
$282.91
|
| Rate for Payer: UHC Exchange |
$213.40
|
| Rate for Payer: UMR Bronson Commercial |
$200.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.26
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$19.66
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna American Axle |
$12.78
|
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$9.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.78
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.73
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.71
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.78
|
| Rate for Payer: UHC Core |
$10.24
|
| Rate for Payer: UHC Exchange |
$7.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$488.27
|
|
|
Service Code
|
NDC 62135081061
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.84 |
| Max. Negotiated Rate |
$439.44 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Advantage |
$341.79
|
| Rate for Payer: Cofinity Commercial |
$419.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.20
|
| Rate for Payer: PHP Commercial |
$415.03
|
| Rate for Payer: Priority Health SBD |
$307.61
|
| Rate for Payer: UMR Bronson Commercial |
$214.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.20
|
|
