|
FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$184.04
|
|
|
Service Code
|
CPT 77002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.73 |
| Max. Negotiated Rate |
$184.04 |
| Rate for Payer: BCBS Trust/PPO |
$184.04
|
| Rate for Payer: BCN Commercial |
$184.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.30
|
| Rate for Payer: UHC Exchange |
$105.73
|
|
|
FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$124.88
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$112.39 |
| Rate for Payer: Aetna American Axle |
$81.17
|
| Rate for Payer: Aetna Commercial |
$106.15
|
| Rate for Payer: Aetna Medicare |
$62.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.17
|
| Rate for Payer: BCBS Complete |
$49.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cofinity Commercial |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$87.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.90
|
| Rate for Payer: Healthscope Commercial |
$112.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.15
|
| Rate for Payer: PHP Commercial |
$106.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.17
|
| Rate for Payer: Priority Health SBD |
$78.67
|
| Rate for Payer: UMR Bronson Commercial |
$46.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.66
|
|
|
FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$169.13
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$152.22 |
| Rate for Payer: Aetna American Axle |
$109.93
|
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Aetna Medicare |
$84.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.93
|
| Rate for Payer: BCBS Complete |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$118.39
|
| Rate for Payer: Cofinity Commercial |
$145.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$152.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.76
|
| Rate for Payer: PHP Commercial |
$143.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health SBD |
$106.55
|
| Rate for Payer: UMR Bronson Commercial |
$62.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.85
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$109.19
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Aetna American Axle |
$70.97
|
| Rate for Payer: Aetna American Axle |
$84.62
|
| Rate for Payer: Aetna Commercial |
$110.65
|
| Rate for Payer: Aetna Commercial |
$92.81
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Aetna Medicare |
$65.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.62
|
| Rate for Payer: BCBS Complete |
$52.07
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cash Price |
$87.35
|
| Rate for Payer: Cash Price |
$87.35
|
| Rate for Payer: Cofinity Commercial |
$91.13
|
| Rate for Payer: Cofinity Commercial |
$76.43
|
| Rate for Payer: Cofinity Commercial |
$111.95
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.35
|
| Rate for Payer: Healthscope Commercial |
$117.16
|
| Rate for Payer: Healthscope Commercial |
$98.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.65
|
| Rate for Payer: PHP Commercial |
$92.81
|
| Rate for Payer: PHP Commercial |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.62
|
| Rate for Payer: Priority Health SBD |
$82.01
|
| Rate for Payer: Priority Health SBD |
$68.79
|
| Rate for Payer: UMR Bronson Commercial |
$40.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.89
|
|
|
FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.18
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
82200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$117.16 |
| Rate for Payer: Aetna American Axle |
$84.62
|
| Rate for Payer: Aetna American Axle |
$70.97
|
| Rate for Payer: Aetna Commercial |
$92.81
|
| Rate for Payer: Aetna Commercial |
$110.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.62
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Cash Price |
$87.35
|
| Rate for Payer: Cofinity Commercial |
$76.43
|
| Rate for Payer: Cofinity Commercial |
$91.13
|
| Rate for Payer: Cofinity Commercial |
$111.95
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.35
|
| Rate for Payer: Healthscope Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$117.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.65
|
| Rate for Payer: PHP Commercial |
$110.65
|
| Rate for Payer: PHP Commercial |
$92.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.62
|
| Rate for Payer: Priority Health SBD |
$68.79
|
| Rate for Payer: Priority Health SBD |
$82.01
|
| Rate for Payer: UMR Bronson Commercial |
$48.04
|
| Rate for Payer: UMR Bronson Commercial |
$57.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.64
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$994.30
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$894.87 |
| Rate for Payer: Aetna American Axle |
$646.30
|
| Rate for Payer: Aetna American Axle |
$515.45
|
| Rate for Payer: Aetna American Axle |
$2,141.10
|
| Rate for Payer: Aetna American Axle |
$2,355.21
|
| Rate for Payer: Aetna Commercial |
$845.16
|
| Rate for Payer: Aetna Commercial |
$3,079.89
|
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: Aetna Medicare |
$1,811.70
|
| Rate for Payer: Aetna Medicare |
$1,647.00
|
| Rate for Payer: Aetna Medicare |
$497.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,141.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.21
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS Complete |
$1,317.60
|
| Rate for Payer: BCBS Complete |
$397.72
|
| Rate for Payer: BCBS Complete |
$1,449.36
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$3,116.12
|
| Rate for Payer: Cofinity Commercial |
$2,305.80
|
| Rate for Payer: Cofinity Commercial |
$2,832.84
|
| Rate for Payer: Cofinity Commercial |
$2,536.38
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,536.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,305.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,898.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,635.20
|
| Rate for Payer: Healthscope Commercial |
$2,964.60
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Healthscope Commercial |
$713.70
|
| Rate for Payer: Healthscope Commercial |
$3,261.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,305.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,536.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$696.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,470.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,717.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,079.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,799.90
|
| Rate for Payer: PHP Commercial |
$845.16
|
| Rate for Payer: PHP Commercial |
$3,079.89
|
| Rate for Payer: PHP Commercial |
$2,799.90
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,355.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health SBD |
$2,075.22
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: Priority Health SBD |
$2,282.74
|
| Rate for Payer: Priority Health SBD |
$626.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,218.78
|
| Rate for Payer: UMR Bronson Commercial |
$293.41
|
| Rate for Payer: UMR Bronson Commercial |
$367.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,340.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,717.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,470.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.72
|
|
|
FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$793.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
98249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna American Axle |
$515.45
|
| Rate for Payer: Aetna American Axle |
$2,355.21
|
| Rate for Payer: Aetna American Axle |
$2,141.10
|
| Rate for Payer: Aetna American Axle |
$646.30
|
| Rate for Payer: Aetna Commercial |
$674.05
|
| Rate for Payer: Aetna Commercial |
$845.16
|
| Rate for Payer: Aetna Commercial |
$3,079.89
|
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,141.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.45
|
| Rate for Payer: Cash Price |
$2,898.72
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$795.44
|
| Rate for Payer: Cofinity Commercial |
$2,305.80
|
| Rate for Payer: Cofinity Commercial |
$855.10
|
| Rate for Payer: Cofinity Commercial |
$696.01
|
| Rate for Payer: Cofinity Commercial |
$555.10
|
| Rate for Payer: Cofinity Commercial |
$2,536.38
|
| Rate for Payer: Cofinity Commercial |
$3,116.12
|
| Rate for Payer: Cofinity Commercial |
$681.98
|
| Rate for Payer: Cofinity Commercial |
$2,832.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,536.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$696.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,305.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,635.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,898.72
|
| Rate for Payer: Healthscope Commercial |
$713.70
|
| Rate for Payer: Healthscope Commercial |
$2,964.60
|
| Rate for Payer: Healthscope Commercial |
$3,261.06
|
| Rate for Payer: Healthscope Commercial |
$894.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,305.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,536.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$696.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,717.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,470.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,799.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,079.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$674.05
|
| Rate for Payer: PHP Commercial |
$845.16
|
| Rate for Payer: PHP Commercial |
$2,799.90
|
| Rate for Payer: PHP Commercial |
$3,079.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,355.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,141.10
|
| Rate for Payer: Priority Health SBD |
$626.41
|
| Rate for Payer: Priority Health SBD |
$2,075.22
|
| Rate for Payer: Priority Health SBD |
$2,282.74
|
| Rate for Payer: Priority Health SBD |
$499.59
|
| Rate for Payer: UMR Bronson Commercial |
$348.92
|
| Rate for Payer: UMR Bronson Commercial |
$437.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,594.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,449.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,470.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,717.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.75
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 50111064701
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 00904578461
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 69367023501
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna American Axle |
$35.13
|
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UMR Bronson Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna American Axle |
$35.13
|
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.13
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UMR Bronson Commercial |
$23.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 69367023501
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
FLUOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 50111064701
|
| Hospital Charge Code |
10069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$250.80
|
|
|
Service Code
|
NDC 00121072104
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$308.16
|
|
|
Service Code
|
NDC 54838052340
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.59 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna American Axle |
$200.30
|
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Commercial |
$215.71
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.30
|
| Rate for Payer: Priority Health SBD |
$194.14
|
| Rate for Payer: UMR Bronson Commercial |
$135.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$443.46
|
|
|
Service Code
|
NDC 00832603212
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.08 |
| Max. Negotiated Rate |
$399.11 |
| Rate for Payer: Aetna American Axle |
$288.25
|
| Rate for Payer: Aetna Commercial |
$376.94
|
| Rate for Payer: Aetna Medicare |
$221.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.25
|
| Rate for Payer: BCBS Complete |
$177.38
|
| Rate for Payer: Cash Price |
$354.77
|
| Rate for Payer: Cofinity Commercial |
$310.42
|
| Rate for Payer: Cofinity Commercial |
$381.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.77
|
| Rate for Payer: Healthscope Commercial |
$399.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.94
|
| Rate for Payer: PHP Commercial |
$376.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.25
|
| Rate for Payer: Priority Health SBD |
$279.38
|
| Rate for Payer: UMR Bronson Commercial |
$164.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.60
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$231.42
|
|
|
Service Code
|
NDC 70954060010
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$208.28 |
| Rate for Payer: Aetna American Axle |
$150.42
|
| Rate for Payer: Aetna Commercial |
$196.71
|
| Rate for Payer: Aetna Medicare |
$115.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.42
|
| Rate for Payer: BCBS Complete |
$92.57
|
| Rate for Payer: Cash Price |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$161.99
|
| Rate for Payer: Cofinity Commercial |
$199.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.14
|
| Rate for Payer: Healthscope Commercial |
$208.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.71
|
| Rate for Payer: PHP Commercial |
$196.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.42
|
| Rate for Payer: Priority Health SBD |
$145.79
|
| Rate for Payer: UMR Bronson Commercial |
$85.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.56
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$443.46
|
|
|
Service Code
|
NDC 00832603212
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$399.11 |
| Rate for Payer: Aetna American Axle |
$288.25
|
| Rate for Payer: Aetna Commercial |
$376.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.25
|
| Rate for Payer: Cash Price |
$354.77
|
| Rate for Payer: Cofinity Commercial |
$310.42
|
| Rate for Payer: Cofinity Commercial |
$381.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.77
|
| Rate for Payer: Healthscope Commercial |
$399.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.94
|
| Rate for Payer: PHP Commercial |
$376.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.25
|
| Rate for Payer: Priority Health SBD |
$279.38
|
| Rate for Payer: UMR Bronson Commercial |
$195.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.60
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$308.16
|
|
|
Service Code
|
NDC 54838052340
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.02 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna American Axle |
$200.30
|
| Rate for Payer: Aetna Commercial |
$261.94
|
| Rate for Payer: Aetna Medicare |
$154.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.30
|
| Rate for Payer: BCBS Complete |
$123.26
|
| Rate for Payer: Cash Price |
$246.53
|
| Rate for Payer: Cofinity Commercial |
$215.71
|
| Rate for Payer: Cofinity Commercial |
$265.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.53
|
| Rate for Payer: Healthscope Commercial |
$277.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.94
|
| Rate for Payer: PHP Commercial |
$261.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.30
|
| Rate for Payer: Priority Health SBD |
$194.14
|
| Rate for Payer: UMR Bronson Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.12
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$231.42
|
|
|
Service Code
|
NDC 70954060010
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$208.28 |
| Rate for Payer: Aetna American Axle |
$150.42
|
| Rate for Payer: Aetna Commercial |
$196.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.42
|
| Rate for Payer: Cash Price |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$161.99
|
| Rate for Payer: Cofinity Commercial |
$199.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.14
|
| Rate for Payer: Healthscope Commercial |
$208.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.71
|
| Rate for Payer: PHP Commercial |
$196.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.42
|
| Rate for Payer: Priority Health SBD |
$145.79
|
| Rate for Payer: UMR Bronson Commercial |
$101.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.56
|
|
|
FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$250.80
|
|
|
Service Code
|
NDC 00121072104
|
| Hospital Charge Code |
38488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Medicare |
$125.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: BCBS Complete |
$100.32
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.66
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UMR Bronson Commercial |
$24.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 69367023601
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
