|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$5,849.70
|
|
|
Service Code
|
NDC 42794001008
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,573.87 |
| Max. Negotiated Rate |
$5,264.73 |
| Rate for Payer: Aetna American Axle |
$3,802.30
|
| Rate for Payer: Aetna Commercial |
$4,972.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,802.30
|
| Rate for Payer: Cash Price |
$4,679.76
|
| Rate for Payer: Cofinity Commercial |
$4,094.79
|
| Rate for Payer: Cofinity Commercial |
$5,030.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,094.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,679.76
|
| Rate for Payer: Healthscope Commercial |
$5,264.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,094.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,387.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,972.24
|
| Rate for Payer: PHP Commercial |
$4,972.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,802.30
|
| Rate for Payer: Priority Health SBD |
$3,685.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,573.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,387.28
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$6,882.00
|
|
|
Service Code
|
NDC 43386077001
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,028.08 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna American Axle |
$4,473.30
|
| Rate for Payer: Aetna Commercial |
$5,849.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,473.30
|
| Rate for Payer: Cash Price |
$5,505.60
|
| Rate for Payer: Cofinity Commercial |
$4,817.40
|
| Rate for Payer: Cofinity Commercial |
$5,918.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,817.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,505.60
|
| Rate for Payer: Healthscope Commercial |
$6,193.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,817.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,849.70
|
| Rate for Payer: PHP Commercial |
$5,849.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,473.30
|
| Rate for Payer: Priority Health SBD |
$4,335.66
|
| Rate for Payer: UMR Bronson Commercial |
$3,028.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,161.50
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
OP
|
$5,849.70
|
|
|
Service Code
|
NDC 42794001008
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,164.39 |
| Max. Negotiated Rate |
$5,264.73 |
| Rate for Payer: Aetna American Axle |
$3,802.30
|
| Rate for Payer: Aetna Commercial |
$4,972.24
|
| Rate for Payer: Aetna Medicare |
$2,924.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,802.30
|
| Rate for Payer: BCBS Complete |
$2,339.88
|
| Rate for Payer: Cash Price |
$4,679.76
|
| Rate for Payer: Cofinity Commercial |
$4,094.79
|
| Rate for Payer: Cofinity Commercial |
$5,030.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,094.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,679.76
|
| Rate for Payer: Healthscope Commercial |
$5,264.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,094.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,387.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,972.24
|
| Rate for Payer: PHP Commercial |
$4,972.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,802.30
|
| Rate for Payer: Priority Health SBD |
$3,685.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,164.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,387.28
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$51,605.75
|
|
|
Service Code
|
NDC 00187355510
|
| Hospital Charge Code |
10052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22,706.53 |
| Max. Negotiated Rate |
$46,445.18 |
| Rate for Payer: Aetna American Axle |
$33,543.74
|
| Rate for Payer: Aetna Commercial |
$43,864.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,543.74
|
| Rate for Payer: Cash Price |
$41,284.60
|
| Rate for Payer: Cofinity Commercial |
$36,124.02
|
| Rate for Payer: Cofinity Commercial |
$44,380.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$36,124.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41,284.60
|
| Rate for Payer: Healthscope Commercial |
$46,445.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36,124.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38,704.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,864.89
|
| Rate for Payer: PHP Commercial |
$43,864.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,543.74
|
| Rate for Payer: Priority Health SBD |
$32,511.62
|
| Rate for Payer: UMR Bronson Commercial |
$22,706.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38,704.31
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$394.01
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Aetna American Axle |
$256.11
|
| Rate for Payer: Aetna American Axle |
$464.11
|
| Rate for Payer: Aetna American Axle |
$608.11
|
| Rate for Payer: Aetna Commercial |
$795.22
|
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Aetna Commercial |
$606.91
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$361.71
|
| Rate for Payer: BCBS Trust/PPO |
$361.71
|
| Rate for Payer: BCBS Trust/PPO |
$361.71
|
| Rate for Payer: BCN Commercial |
$361.71
|
| Rate for Payer: BCN Commercial |
$361.71
|
| Rate for Payer: BCN Commercial |
$361.71
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$748.44
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cofinity Commercial |
$804.57
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Cofinity Commercial |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$614.05
|
| Rate for Payer: Cofinity Commercial |
$499.81
|
| Rate for Payer: Cofinity Commercial |
$654.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$654.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$354.61
|
| Rate for Payer: Healthscope Commercial |
$842.00
|
| Rate for Payer: Healthscope Commercial |
$642.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.51
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$795.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.91
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$606.91
|
| Rate for Payer: PHP Commercial |
$334.91
|
| Rate for Payer: PHP Commercial |
$795.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health SBD |
$248.23
|
| Rate for Payer: Priority Health SBD |
$449.83
|
| Rate for Payer: Priority Health SBD |
$589.40
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$321.64
|
| Rate for Payer: UHC Exchange |
$321.64
|
| Rate for Payer: UHC Exchange |
$321.64
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$90.21
|
| Rate for Payer: UMR Bronson Commercial |
$264.18
|
| Rate for Payer: UMR Bronson Commercial |
$145.78
|
| Rate for Payer: UMR Bronson Commercial |
$346.15
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.51
|
|
|
FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$394.01
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
41294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.36 |
| Max. Negotiated Rate |
$354.61 |
| Rate for Payer: Aetna American Axle |
$256.11
|
| Rate for Payer: Aetna American Axle |
$464.11
|
| Rate for Payer: Aetna Commercial |
$334.91
|
| Rate for Payer: Aetna Commercial |
$606.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.11
|
| Rate for Payer: Cash Price |
$315.21
|
| Rate for Payer: Cash Price |
$571.21
|
| Rate for Payer: Cofinity Commercial |
$614.05
|
| Rate for Payer: Cofinity Commercial |
$499.81
|
| Rate for Payer: Cofinity Commercial |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$338.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.21
|
| Rate for Payer: Healthscope Commercial |
$354.61
|
| Rate for Payer: Healthscope Commercial |
$642.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.91
|
| Rate for Payer: PHP Commercial |
$606.91
|
| Rate for Payer: PHP Commercial |
$334.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.11
|
| Rate for Payer: Priority Health SBD |
$248.23
|
| Rate for Payer: Priority Health SBD |
$449.83
|
| Rate for Payer: UMR Bronson Commercial |
$173.36
|
| Rate for Payer: UMR Bronson Commercial |
$314.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.51
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$951.64
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
10053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$856.48 |
| Rate for Payer: Aetna American Axle |
$618.57
|
| Rate for Payer: Aetna Commercial |
$808.89
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$361.71
|
| Rate for Payer: BCN Commercial |
$361.71
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cofinity Commercial |
$818.41
|
| Rate for Payer: Cofinity Commercial |
$666.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$856.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$666.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.73
|
| Rate for Payer: Mclaren Medicaid |
$90.21
|
| Rate for Payer: Mclaren Medicare |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$94.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.89
|
| Rate for Payer: Nomi Health Commercial |
$504.90
|
| Rate for Payer: PACE Medicare |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$808.89
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.10
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health Narrow Network |
$308.88
|
| Rate for Payer: Priority Health SBD |
$599.53
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$321.64
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$90.21
|
| Rate for Payer: UMR Bronson Commercial |
$352.11
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.73
|
|
|
FLUDARABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$951.64
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
10053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$418.72 |
| Max. Negotiated Rate |
$856.48 |
| Rate for Payer: Aetna American Axle |
$618.57
|
| Rate for Payer: Aetna Commercial |
$808.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.57
|
| Rate for Payer: Cash Price |
$761.31
|
| Rate for Payer: Cofinity Commercial |
$666.15
|
| Rate for Payer: Cofinity Commercial |
$818.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.31
|
| Rate for Payer: Healthscope Commercial |
$856.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$666.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.89
|
| Rate for Payer: PHP Commercial |
$808.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.57
|
| Rate for Payer: Priority Health SBD |
$599.53
|
| Rate for Payer: UMR Bronson Commercial |
$418.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.73
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.24 |
| Max. Negotiated Rate |
$207.34 |
| Rate for Payer: Aetna American Axle |
$149.75
|
| Rate for Payer: Aetna Commercial |
$195.82
|
| Rate for Payer: Aetna Medicare |
$115.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.75
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$161.27
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: PHP Commercial |
$195.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: Priority Health SBD |
$145.14
|
| Rate for Payer: UMR Bronson Commercial |
$85.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.78
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna American Axle |
$2.45
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
NDC 00555099702
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$90.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 68084028811
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna American Axle |
$2.45
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.45
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$342.24
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.59 |
| Max. Negotiated Rate |
$308.02 |
| Rate for Payer: Aetna American Axle |
$222.46
|
| Rate for Payer: Aetna Commercial |
$290.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.46
|
| Rate for Payer: Cash Price |
$273.79
|
| Rate for Payer: Cofinity Commercial |
$239.57
|
| Rate for Payer: Cofinity Commercial |
$294.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.79
|
| Rate for Payer: Healthscope Commercial |
$308.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.90
|
| Rate for Payer: PHP Commercial |
$290.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.46
|
| Rate for Payer: Priority Health SBD |
$215.61
|
| Rate for Payer: UMR Bronson Commercial |
$150.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.68
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.74 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna American Axle |
$170.98
|
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
| Rate for Payer: UMR Bronson Commercial |
$115.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 00555099702
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.79 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna American Axle |
$244.92
|
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.92
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health SBD |
$237.38
|
| Rate for Payer: UMR Bronson Commercial |
$165.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$263.04
|
|
|
Service Code
|
NDC 00115703301
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.32 |
| Max. Negotiated Rate |
$236.74 |
| Rate for Payer: Aetna American Axle |
$170.98
|
| Rate for Payer: Aetna Commercial |
$223.58
|
| Rate for Payer: Aetna Medicare |
$131.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: BCBS Complete |
$105.22
|
| Rate for Payer: Cash Price |
$210.43
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.43
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.58
|
| Rate for Payer: PHP Commercial |
$223.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
| Rate for Payer: UMR Bronson Commercial |
$97.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.28
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$342.24
|
|
|
Service Code
|
NDC 00904731761
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.63 |
| Max. Negotiated Rate |
$308.02 |
| Rate for Payer: Aetna American Axle |
$222.46
|
| Rate for Payer: Aetna Commercial |
$290.90
|
| Rate for Payer: Aetna Medicare |
$171.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.46
|
| Rate for Payer: BCBS Complete |
$136.90
|
| Rate for Payer: Cash Price |
$273.79
|
| Rate for Payer: Cofinity Commercial |
$239.57
|
| Rate for Payer: Cofinity Commercial |
$294.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.79
|
| Rate for Payer: Healthscope Commercial |
$308.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.90
|
| Rate for Payer: PHP Commercial |
$290.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.46
|
| Rate for Payer: Priority Health SBD |
$215.61
|
| Rate for Payer: UMR Bronson Commercial |
$126.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.68
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
OP
|
$376.80
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.42 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna American Axle |
$244.92
|
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna Medicare |
$188.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.92
|
| Rate for Payer: BCBS Complete |
$150.72
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.28
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.92
|
| Rate for Payer: Priority Health SBD |
$237.38
|
| Rate for Payer: UMR Bronson Commercial |
$139.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
FLUDROCORTISONE 0.1 MG TABLET
|
Facility
|
IP
|
$230.38
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.37 |
| Max. Negotiated Rate |
$207.34 |
| Rate for Payer: Aetna American Axle |
$149.75
|
| Rate for Payer: Aetna Commercial |
$195.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.75
|
| Rate for Payer: Cash Price |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$161.27
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.82
|
| Rate for Payer: PHP Commercial |
$195.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.75
|
| Rate for Payer: Priority Health SBD |
$145.14
|
| Rate for Payer: UMR Bronson Commercial |
$101.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.78
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$13.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00143978410
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.02
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.02
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health SBD |
$11.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
10055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
