|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$19.66
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna American Axle |
$12.78
|
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.78
|
| 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: 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: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.07
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna American Axle |
$16.95
|
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Advantage |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$22.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: PHP Commercial |
$22.16
|
| Rate for Payer: Priority Health SBD |
$16.42
|
| Rate for Payer: UMR Bronson Commercial |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.55
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$43.74
|
|
|
Service Code
|
NDC 96295012745
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Aetna American Axle |
$28.43
|
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.43
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Advantage |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.99
|
| Rate for Payer: Healthscope Commercial |
$39.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.80
|
| Rate for Payer: PHP Commercial |
$37.18
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.80
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.07
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna American Axle |
$16.95
|
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$13.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Advantage |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$22.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.55
|
| Rate for Payer: PHP Commercial |
$22.16
|
| Rate for Payer: Priority Health SBD |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.95
|
| Rate for Payer: UHC Core |
$13.58
|
| Rate for Payer: UHC Exchange |
$10.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.55
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna American Axle |
$23.77
|
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.77
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Advantage |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health SBD |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.77
|
| Rate for Payer: UHC Core |
$19.05
|
| Rate for Payer: UHC Exchange |
$14.37
|
| Rate for Payer: UMR Bronson Commercial |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
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
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$488.27
|
|
|
Service Code
|
NDC 62135081061
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$439.44 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Aetna Medicare |
$244.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: BCBS Complete |
$195.31
|
| 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: MI Amish Medical Board Commercial |
$390.62
|
| 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: UHC All Payor (Choice/PPO) |
$317.38
|
| Rate for Payer: UHC Core |
$254.39
|
| Rate for Payer: UHC Exchange |
$191.89
|
| Rate for Payer: UMR Bronson Commercial |
$180.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.20
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna American Axle |
$9.46
|
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.46
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Advantage |
$10.19
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.91
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health SBD |
$9.17
|
| Rate for Payer: UMR Bronson Commercial |
$6.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna American Axle |
$9.46
|
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.46
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Advantage |
$10.19
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.91
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health SBD |
$9.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.46
|
| Rate for Payer: UHC Core |
$7.58
|
| Rate for Payer: UHC Exchange |
$5.72
|
| Rate for Payer: UMR Bronson Commercial |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna American Axle |
$152.49
|
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Advantage |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: UMR Bronson Commercial |
$103.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
212355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna American Axle |
$152.49
|
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$117.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: BCBS Complete |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$274.44
|
| Rate for Payer: BCN Commercial |
$274.44
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Advantage |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.95
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: Priority Health Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.96
|
| Rate for Payer: UHC Core |
$161.96
|
| Rate for Payer: UHC Exchange |
$161.96
|
| Rate for Payer: UMR Bronson Commercial |
$86.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna American Axle |
$53.38
|
| Rate for Payer: Aetna Commercial |
$69.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.38
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Advantage |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$70.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.60
|
| Rate for Payer: PHP Commercial |
$69.81
|
| Rate for Payer: Priority Health SBD |
$51.74
|
| Rate for Payer: UMR Bronson Commercial |
$36.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.60
|
|
|
FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$82.13
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
212359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna American Axle |
$53.38
|
| Rate for Payer: Aetna Commercial |
$69.81
|
| Rate for Payer: Aetna Medicare |
$41.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.38
|
| Rate for Payer: BCBS Complete |
$32.85
|
| Rate for Payer: BCBS Trust/PPO |
$65.21
|
| Rate for Payer: BCN Commercial |
$65.21
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cofinity Advantage |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$70.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.60
|
| Rate for Payer: PHP Commercial |
$69.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.22
|
| Rate for Payer: Priority Health SBD |
$51.74
|
| Rate for Payer: Priority Health Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.31
|
| Rate for Payer: UHC Core |
$38.31
|
| Rate for Payer: UHC Exchange |
$38.31
|
| Rate for Payer: UMR Bronson Commercial |
$30.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.60
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$414.20
|
|
|
Service Code
|
NDC 51079099320
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna Medicare |
$207.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: BCBS Complete |
$165.68
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Advantage |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.65
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.23
|
| Rate for Payer: UHC Core |
$215.80
|
| Rate for Payer: UHC Exchange |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$153.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 62559016001
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna American Axle |
$142.03
|
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.03
|
| Rate for Payer: BCBS Complete |
$87.40
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Advantage |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.03
|
| Rate for Payer: UHC Core |
$113.84
|
| Rate for Payer: UHC Exchange |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$80.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
IP
|
$414.20
|
|
|
Service Code
|
NDC 51079099320
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Advantage |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.65
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UMR Bronson Commercial |
$182.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 51079099301
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
NDC 62559016001
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna American Axle |
$142.03
|
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.03
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Advantage |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 51079099301
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
FLUVOXAMINE 25 MG TABLET
|
Facility
|
IP
|
$212.80
|
|
|
Service Code
|
NDC 62559015801
|
| Hospital Charge Code |
20634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna American Axle |
$138.32
|
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UMR Bronson Commercial |
$93.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.60
|
|
|
FLUVOXAMINE 25 MG TABLET
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
NDC 62559015801
|
| Hospital Charge Code |
20634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.74 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna American Axle |
$138.32
|
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna Medicare |
$106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.32
|
| Rate for Payer: UHC Core |
$110.87
|
| Rate for Payer: UHC Exchange |
$83.63
|
| Rate for Payer: UMR Bronson Commercial |
$78.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.60
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna American Axle |
$97.24
|
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna Medicare |
$74.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.24
|
| Rate for Payer: BCBS Complete |
$59.84
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Advantage |
$104.72
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health SBD |
$94.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.24
|
| Rate for Payer: UHC Core |
$77.94
|
| Rate for Payer: UHC Exchange |
$58.79
|
| Rate for Payer: UMR Bronson Commercial |
$55.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Advantage |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UMR Bronson Commercial |
$73.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
