|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$635.21
|
|
|
Service Code
|
NDC 00173071820
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.49 |
| Max. Negotiated Rate |
$571.69 |
| Rate for Payer: Aetna American Axle |
$412.89
|
| Rate for Payer: Aetna Commercial |
$539.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.89
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cofinity Commercial |
$444.65
|
| Rate for Payer: Cofinity Commercial |
$546.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.17
|
| Rate for Payer: Healthscope Commercial |
$571.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.93
|
| Rate for Payer: PHP Commercial |
$539.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.89
|
| Rate for Payer: Priority Health SBD |
$400.18
|
| Rate for Payer: UMR Bronson Commercial |
$279.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.41
|
|
|
FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$457.43
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
40697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.27 |
| Max. Negotiated Rate |
$411.69 |
| Rate for Payer: Aetna American Axle |
$297.33
|
| Rate for Payer: Aetna Commercial |
$388.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.33
|
| Rate for Payer: Cash Price |
$365.94
|
| Rate for Payer: Cofinity Commercial |
$320.20
|
| Rate for Payer: Cofinity Commercial |
$393.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.94
|
| Rate for Payer: Healthscope Commercial |
$411.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.82
|
| Rate for Payer: PHP Commercial |
$388.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.33
|
| Rate for Payer: Priority Health SBD |
$288.18
|
| Rate for Payer: UMR Bronson Commercial |
$201.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.07
|
|
|
FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
IP
|
$543.01
|
|
|
Service Code
|
NDC 00173071522
|
| Hospital Charge Code |
77173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$488.71 |
| Rate for Payer: Aetna American Axle |
$352.96
|
| Rate for Payer: Aetna Commercial |
$461.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.96
|
| Rate for Payer: Cash Price |
$434.41
|
| Rate for Payer: Cofinity Commercial |
$380.11
|
| Rate for Payer: Cofinity Commercial |
$466.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.41
|
| Rate for Payer: Healthscope Commercial |
$488.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.56
|
| Rate for Payer: PHP Commercial |
$461.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.96
|
| Rate for Payer: Priority Health SBD |
$342.10
|
| Rate for Payer: UMR Bronson Commercial |
$238.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.26
|
|
|
FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER
|
Facility
|
OP
|
$543.01
|
|
|
Service Code
|
NDC 00173071522
|
| Hospital Charge Code |
77173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.91 |
| Max. Negotiated Rate |
$488.71 |
| Rate for Payer: Aetna American Axle |
$352.96
|
| Rate for Payer: Aetna Commercial |
$461.56
|
| Rate for Payer: Aetna Medicare |
$271.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.96
|
| Rate for Payer: BCBS Complete |
$217.20
|
| Rate for Payer: Cash Price |
$434.41
|
| Rate for Payer: Cofinity Commercial |
$380.11
|
| Rate for Payer: Cofinity Commercial |
$466.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.41
|
| Rate for Payer: Healthscope Commercial |
$488.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.56
|
| Rate for Payer: PHP Commercial |
$461.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.96
|
| Rate for Payer: Priority Health SBD |
$342.10
|
| Rate for Payer: UMR Bronson Commercial |
$200.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.26
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna American Axle |
$23.77
|
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.77
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: Priority Health SBD |
$23.04
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$19.66
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna American Axle |
$12.78
|
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.78
|
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.73
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.71
|
| Rate for Payer: PHP Commercial |
$16.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.78
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$36.57
|
|
|
Service Code
|
NDC 00054327099
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna American Axle |
$23.77
|
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.77
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$31.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.08
|
| Rate for Payer: PHP Commercial |
$31.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.77
|
| Rate for Payer: Priority Health SBD |
$23.04
|
| Rate for Payer: UMR Bronson Commercial |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$488.27
|
|
|
Service Code
|
NDC 62135081061
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$439.44 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Aetna Medicare |
$244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: BCBS Complete |
$195.31
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$341.79
|
| Rate for Payer: Cofinity Commercial |
$419.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.03
|
| Rate for Payer: PHP Commercial |
$415.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health SBD |
$307.61
|
| Rate for Payer: UMR Bronson Commercial |
$180.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.20
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$23.53 |
| Rate for Payer: Aetna American Axle |
$16.99
|
| Rate for Payer: Aetna Commercial |
$22.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.99
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$23.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: PHP Commercial |
$22.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: Priority Health SBD |
$16.47
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$19.66
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna American Axle |
$12.78
|
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$9.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.78
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.73
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.71
|
| Rate for Payer: PHP Commercial |
$16.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.78
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna American Axle |
$9.46
|
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.46
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.46
|
| Rate for Payer: Priority Health SBD |
$9.17
|
| Rate for Payer: UMR Bronson Commercial |
$6.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$43.74
|
|
|
Service Code
|
NDC 96295012745
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Aetna American Axle |
$28.43
|
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: Aetna Medicare |
$21.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.43
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.99
|
| Rate for Payer: Healthscope Commercial |
$39.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.18
|
| Rate for Payer: PHP Commercial |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.43
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$16.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.80
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$26.14
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$23.53 |
| Rate for Payer: Aetna American Axle |
$16.99
|
| Rate for Payer: Aetna Commercial |
$22.22
|
| Rate for Payer: Aetna Medicare |
$13.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.99
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: Cash Price |
$20.91
|
| Rate for Payer: Cofinity Commercial |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$23.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: PHP Commercial |
$22.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: Priority Health SBD |
$16.47
|
| Rate for Payer: UMR Bronson Commercial |
$9.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
NDC 60432026415
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna American Axle |
$9.46
|
| Rate for Payer: Aetna Commercial |
$12.37
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.46
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$12.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.37
|
| Rate for Payer: PHP Commercial |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.46
|
| Rate for Payer: Priority Health SBD |
$9.17
|
| Rate for Payer: UMR Bronson Commercial |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.91
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$488.27
|
|
|
Service Code
|
NDC 62135081061
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.84 |
| Max. Negotiated Rate |
$439.44 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$341.79
|
| Rate for Payer: Cofinity Commercial |
$419.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.03
|
| Rate for Payer: PHP Commercial |
$415.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health SBD |
$307.61
|
| Rate for Payer: UMR Bronson Commercial |
$214.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.20
|
|
|
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION
|
Facility
|
IP
|
$43.74
|
|
|
Service Code
|
NDC 96295012745
|
| Hospital Charge Code |
70536
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Aetna American Axle |
$28.43
|
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.43
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.99
|
| Rate for Payer: Healthscope Commercial |
$39.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.18
|
| Rate for Payer: PHP Commercial |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.43
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.80
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$205.06 |
| Rate for Payer: Aetna American Axle |
$148.10
|
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Aetna Medicare |
$113.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.10
|
| Rate for Payer: BCBS Complete |
$91.14
|
| Rate for Payer: BCBS Trust/PPO |
$190.70
|
| Rate for Payer: BCN Commercial |
$190.70
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$159.49
|
| Rate for Payer: Cofinity Commercial |
$195.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Healthscope Commercial |
$205.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: PHP Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.49
|
| Rate for Payer: Priority Health Narrow Network |
$66.79
|
| Rate for Payer: Priority Health SBD |
$143.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.18
|
| Rate for Payer: UHC Exchange |
$71.18
|
| Rate for Payer: UMR Bronson Commercial |
$84.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.88
|
|
|
FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$227.84
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
207828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$205.06 |
| Rate for Payer: Aetna American Axle |
$148.10
|
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.10
|
| Rate for Payer: Cash Price |
$182.27
|
| Rate for Payer: Cofinity Commercial |
$159.49
|
| Rate for Payer: Cofinity Commercial |
$195.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.27
|
| Rate for Payer: Healthscope Commercial |
$205.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: PHP Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.10
|
| Rate for Payer: Priority Health SBD |
$143.54
|
| Rate for Payer: UMR Bronson Commercial |
$100.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.88
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
IP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.79 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Aetna American Axle |
$52.88
|
| Rate for Payer: Aetna Commercial |
$69.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.88
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cofinity Commercial |
$56.94
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: PHP Commercial |
$69.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: Priority Health SBD |
$51.25
|
| Rate for Payer: UMR Bronson Commercial |
$35.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.01
|
|
|
FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE
|
Facility
|
OP
|
$81.35
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
207827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Cofinity Commercial |
$56.94
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.94
|
| Rate for Payer: Aetna American Axle |
$52.88
|
| Rate for Payer: Aetna Commercial |
$69.15
|
| Rate for Payer: Aetna Medicare |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.88
|
| Rate for Payer: BCBS Complete |
$32.54
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Commercial |
$55.89
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Cash Price |
$65.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.15
|
| Rate for Payer: PHP Commercial |
$69.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.35
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: Priority Health SBD |
$51.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UMR Bronson Commercial |
$30.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.01
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 51079099301
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 62559016001
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 62559016001
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
OP
|
$414.20
|
|
|
Service Code
|
NDC 51079099320
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna Medicare |
$207.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: BCBS Complete |
$165.68
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.07
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.23
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UMR Bronson Commercial |
$153.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
FLUVOXAMINE 100 MG TABLET
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 51079099301
|
| Hospital Charge Code |
10084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
