|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084060511
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 50111064801
|
| 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
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 69367023601
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| 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 |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 50111064801
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| 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 |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084060501
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 68084060501
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
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
|
$2.85
|
|
|
Service Code
|
NDC 68084060511
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 00904578561
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna American Axle |
$13.44
|
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.44
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.58
|
| Rate for Payer: PHP Commercial |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: Priority Health SBD |
$13.03
|
| Rate for Payer: UMR Bronson Commercial |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.51
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 65862019301
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: BCBS Complete |
$22.56
|
| 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 |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
FLUOXETINE 20 MG CAPSULE
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 00904734661
|
| Hospital Charge Code |
10070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$103.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$308.16
|
|
|
Service Code
|
NDC 69238167801
|
| Hospital Charge Code |
3218
|
|
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
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna American Axle |
$217.36
|
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.36
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.36
|
| Rate for Payer: Priority Health SBD |
$210.67
|
| Rate for Payer: UMR Bronson Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.41 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna American Axle |
$434.93
|
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Commercial |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.93
|
| Rate for Payer: Priority Health SBD |
$421.55
|
| Rate for Payer: UMR Bronson Commercial |
$294.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$334.40
|
|
|
Service Code
|
NDC 51079048520
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna American Axle |
$217.36
|
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna Medicare |
$167.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.36
|
| Rate for Payer: BCBS Complete |
$133.76
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.24
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.36
|
| Rate for Payer: Priority Health SBD |
$210.67
|
| Rate for Payer: UMR Bronson Commercial |
$123.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$453.15
|
|
|
Service Code
|
NDC 70954027310
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.67 |
| Max. Negotiated Rate |
$407.84 |
| Rate for Payer: Aetna American Axle |
$294.55
|
| Rate for Payer: Aetna Commercial |
$385.18
|
| Rate for Payer: Aetna Medicare |
$226.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.55
|
| Rate for Payer: BCBS Complete |
$181.26
|
| Rate for Payer: Cash Price |
$362.52
|
| Rate for Payer: Cofinity Commercial |
$317.20
|
| Rate for Payer: Cofinity Commercial |
$389.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.52
|
| Rate for Payer: Healthscope Commercial |
$407.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.18
|
| Rate for Payer: PHP Commercial |
$385.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.55
|
| Rate for Payer: Priority Health SBD |
$285.48
|
| Rate for Payer: UMR Bronson Commercial |
$167.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.86
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
OP
|
$669.12
|
|
|
Service Code
|
NDC 00527178801
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.57 |
| Max. Negotiated Rate |
$602.21 |
| Rate for Payer: Aetna American Axle |
$434.93
|
| Rate for Payer: Aetna Commercial |
$568.75
|
| Rate for Payer: Aetna Medicare |
$334.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.93
|
| Rate for Payer: BCBS Complete |
$267.65
|
| Rate for Payer: Cash Price |
$535.30
|
| Rate for Payer: Cofinity Commercial |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$575.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.30
|
| Rate for Payer: Healthscope Commercial |
$602.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: PHP Commercial |
$568.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.93
|
| Rate for Payer: Priority Health SBD |
$421.55
|
| Rate for Payer: UMR Bronson Commercial |
$247.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.84
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$308.16
|
|
|
Service Code
|
NDC 69238167801
|
| Hospital Charge Code |
3218
|
|
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
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$453.15
|
|
|
Service Code
|
NDC 70954027310
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$407.84 |
| Rate for Payer: Aetna American Axle |
$294.55
|
| Rate for Payer: Aetna Commercial |
$385.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.55
|
| Rate for Payer: Cash Price |
$362.52
|
| Rate for Payer: Cofinity Commercial |
$317.20
|
| Rate for Payer: Cofinity Commercial |
$389.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.52
|
| Rate for Payer: Healthscope Commercial |
$407.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.18
|
| Rate for Payer: PHP Commercial |
$385.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.55
|
| Rate for Payer: Priority Health SBD |
$285.48
|
| Rate for Payer: UMR Bronson Commercial |
$199.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.86
|
|
|
FLUPHENAZINE 1 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
IP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$475.38 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna American Axle |
$702.26
|
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$756.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health SBD |
$680.65
|
| Rate for Payer: UMR Bronson Commercial |
$475.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE 5 MG TABLET
|
Facility
|
OP
|
$1,080.40
|
|
|
Service Code
|
NDC 00527179001
|
| Hospital Charge Code |
3221
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$972.36 |
| Rate for Payer: Aetna American Axle |
$702.26
|
| Rate for Payer: Aetna Commercial |
$918.34
|
| Rate for Payer: Aetna Medicare |
$540.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.26
|
| Rate for Payer: BCBS Complete |
$432.16
|
| Rate for Payer: Cash Price |
$864.32
|
| Rate for Payer: Cofinity Commercial |
$756.28
|
| Rate for Payer: Cofinity Commercial |
$929.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$756.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.32
|
| Rate for Payer: Healthscope Commercial |
$972.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.34
|
| Rate for Payer: PHP Commercial |
$918.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.26
|
| Rate for Payer: Priority Health SBD |
$680.65
|
| Rate for Payer: UMR Bronson Commercial |
$399.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.30
|
|
|
FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$208.44
|
|
|
Service Code
|
HCPCS J2680
|
| Hospital Charge Code |
3215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.71 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna American Axle |
$135.49
|
| Rate for Payer: Aetna American Axle |
$216.19
|
| Rate for Payer: Aetna Commercial |
$177.17
|
| Rate for Payer: Aetna Commercial |
$282.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.19
|
| Rate for Payer: Cash Price |
$166.75
|
| Rate for Payer: Cash Price |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$286.04
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Cofinity Commercial |
$145.91
|
| Rate for Payer: Cofinity Commercial |
$179.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.08
|
| Rate for Payer: Healthscope Commercial |
$187.60
|
| Rate for Payer: Healthscope Commercial |
$299.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.17
|
| Rate for Payer: PHP Commercial |
$282.71
|
| Rate for Payer: PHP Commercial |
$177.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.19
|
| Rate for Payer: Priority Health SBD |
$131.32
|
| Rate for Payer: Priority Health SBD |
$209.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.71
|
| Rate for Payer: UMR Bronson Commercial |
$146.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.45
|
|
