|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$72.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 16729009001
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$181.89
|
|
|
Service Code
|
NDC 65862014990
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna American Axle |
$118.23
|
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.23
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Commercial |
$156.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.51
|
| Rate for Payer: Healthscope Commercial |
$163.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.23
|
| Rate for Payer: Priority Health SBD |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$80.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 50268031411
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
FINASTERIDE 5 MG TABLET
|
Facility
|
OP
|
$215.18
|
|
|
Service Code
|
NDC 50268031415
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$193.66 |
| Rate for Payer: Aetna American Axle |
$139.87
|
| Rate for Payer: Aetna Commercial |
$182.90
|
| Rate for Payer: Aetna Medicare |
$107.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.87
|
| Rate for Payer: BCBS Complete |
$86.07
|
| Rate for Payer: Cash Price |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Cofinity Commercial |
$185.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.14
|
| Rate for Payer: Healthscope Commercial |
$193.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.90
|
| Rate for Payer: PHP Commercial |
$182.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.87
|
| Rate for Payer: Priority Health SBD |
$135.56
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.38
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
FLAVOXATE 100 MG TABLET
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 00574011501
|
| Hospital Charge Code |
10039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$186.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
FLAVOXATE 100 MG TABLET
|
Facility
|
OP
|
$424.65
|
|
|
Service Code
|
NDC 00574011501
|
| Hospital Charge Code |
10039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna Medicare |
$212.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$157.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$427.68
|
|
|
Service Code
|
NDC 00054001125
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.24 |
| Max. Negotiated Rate |
$384.91 |
| Rate for Payer: Aetna American Axle |
$277.99
|
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: Aetna Medicare |
$213.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.99
|
| Rate for Payer: BCBS Complete |
$171.07
|
| Rate for Payer: Cash Price |
$342.14
|
| Rate for Payer: Cofinity Commercial |
$299.38
|
| Rate for Payer: Cofinity Commercial |
$367.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.14
|
| Rate for Payer: Healthscope Commercial |
$384.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.53
|
| Rate for Payer: PHP Commercial |
$363.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.99
|
| Rate for Payer: Priority Health SBD |
$269.44
|
| Rate for Payer: UMR Bronson Commercial |
$158.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.76
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$427.68
|
|
|
Service Code
|
NDC 00054001125
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.18 |
| Max. Negotiated Rate |
$384.91 |
| Rate for Payer: Aetna American Axle |
$277.99
|
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.99
|
| Rate for Payer: Cash Price |
$342.14
|
| Rate for Payer: Cofinity Commercial |
$299.38
|
| Rate for Payer: Cofinity Commercial |
$367.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.14
|
| Rate for Payer: Healthscope Commercial |
$384.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.53
|
| Rate for Payer: PHP Commercial |
$363.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.99
|
| Rate for Payer: Priority Health SBD |
$269.44
|
| Rate for Payer: UMR Bronson Commercial |
$188.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.76
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.95 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Medicare |
$126.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$177.74
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: UMR Bronson Commercial |
$93.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$177.74
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: UMR Bronson Commercial |
$111.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$253.44
|
|
|
Service Code
|
NDC 00054001025
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.51 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna American Axle |
$164.74
|
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Commercial |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.74
|
| Rate for Payer: Priority Health SBD |
$159.67
|
| Rate for Payer: UMR Bronson Commercial |
$111.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.08
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$253.44
|
|
|
Service Code
|
NDC 00054001025
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna American Axle |
$164.74
|
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: BCBS Complete |
$101.38
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Commercial |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.74
|
| Rate for Payer: Priority Health SBD |
$159.67
|
| Rate for Payer: UMR Bronson Commercial |
$93.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.08
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$5.96
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna American Axle |
$3.87
|
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.87
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Cofinity Commercial |
$5.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.07
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health SBD |
$3.75
|
| Rate for Payer: UMR Bronson Commercial |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.47
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.89 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna American Axle |
$386.88
|
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.88
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$416.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: Priority Health SBD |
$374.98
|
| Rate for Payer: UMR Bronson Commercial |
$261.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$554.40
|
|
|
Service Code
|
NDC 00904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.13 |
| Max. Negotiated Rate |
$498.96 |
| Rate for Payer: Aetna American Axle |
$360.36
|
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Aetna Medicare |
$277.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.36
|
| Rate for Payer: BCBS Complete |
$221.76
|
| Rate for Payer: Cash Price |
$443.52
|
| Rate for Payer: Cofinity Commercial |
$388.08
|
| Rate for Payer: Cofinity Commercial |
$476.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.52
|
| Rate for Payer: Healthscope Commercial |
$498.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$388.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.24
|
| Rate for Payer: PHP Commercial |
$471.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.36
|
| Rate for Payer: Priority Health SBD |
$349.27
|
| Rate for Payer: UMR Bronson Commercial |
$205.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.80
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$595.20
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna American Axle |
$386.88
|
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna Medicare |
$297.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.88
|
| Rate for Payer: BCBS Complete |
$238.08
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$416.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.92
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.88
|
| Rate for Payer: Priority Health SBD |
$374.98
|
| Rate for Payer: UMR Bronson Commercial |
$220.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
