Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143978410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Trust/PPO	$15.38
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143978401
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Trust/PPO	$15.38
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143978401
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare	$9.44
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Complete	$7.55
Rate for Payer: BCBS Trust/PPO	$15.45
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.53
Rate for Payer: Priority Health Narrow Network	$13.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143968410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Trust/PPO	$15.38
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143968410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare	$9.44
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Complete	$7.55
Rate for Payer: BCBS Trust/PPO	$15.45
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.53
Rate for Payer: Priority Health Narrow Network	$13.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143978410
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare	$9.44
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Complete	$7.55
Rate for Payer: BCBS Trust/PPO	$15.45
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.53
Rate for Payer: Priority Health Narrow Network	$13.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 00143968401
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Trust/PPO	$15.38
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML IV (CODE)

Facility

$18.87

Service Code	NDC 00143978410
Hospital Charge Code	163712
Hospital Revenue Code	250
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Trust/PPO	$15.38
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML IV (CODE)

Facility

$18.87

Service Code	NDC 00143978410
Hospital Charge Code	163712
Hospital Revenue Code	250
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare	$9.44
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR Commercial	$18.30
Rate for Payer: BCBS Complete	$7.55
Rate for Payer: BCBS Trust/PPO	$15.45
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.04
Rate for Payer: Nomi Health Commercial	$15.47
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.53
Rate for Payer: Priority Health Narrow Network	$13.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUORESCEIN 0.6 MG EYE STRIPS

Facility

$571.05

Service Code	NDC 17478040303
Hospital Charge Code	27662
Hospital Revenue Code	250
Min. Negotiated Rate	$371.18
Max. Negotiated Rate	$571.05
Rate for Payer: Aetna Commercial	$513.94
Rate for Payer: ASR ASR	$553.92
Rate for Payer: ASR Commercial	$553.92
Rate for Payer: BCBS Trust/PPO	$465.35
Rate for Payer: BCN Commercial	$442.74
Rate for Payer: Cash Price	$456.84
Rate for Payer: Cofinity Commercial	$536.79
Rate for Payer: Encore Health Key Benefits Commercial	$456.84
Rate for Payer: Healthscope Commercial	$571.05
Rate for Payer: Healthscope Whirlpool	$553.92
Rate for Payer: Mclaren Commercial	$513.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$485.39
Rate for Payer: Nomi Health Commercial	$468.26
Rate for Payer: Priority Health Cigna Priority Health	$371.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$502.52

FLUORESCEIN 0.6 MG EYE STRIPS

Facility

$571.05

Service Code	NDC 17478040303
Hospital Charge Code	27662
Hospital Revenue Code	250
Min. Negotiated Rate	$228.42
Max. Negotiated Rate	$571.05
Rate for Payer: Aetna Commercial	$513.94
Rate for Payer: Aetna Medicare	$285.52
Rate for Payer: ASR ASR	$553.92
Rate for Payer: ASR Commercial	$553.92
Rate for Payer: BCBS Complete	$228.42
Rate for Payer: BCBS Trust/PPO	$467.63
Rate for Payer: BCN Commercial	$442.74
Rate for Payer: Cash Price	$456.84
Rate for Payer: Cofinity Commercial	$536.79
Rate for Payer: Encore Health Key Benefits Commercial	$456.84
Rate for Payer: Healthscope Commercial	$571.05
Rate for Payer: Healthscope Whirlpool	$553.92
Rate for Payer: Mclaren Commercial	$513.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$485.39
Rate for Payer: Nomi Health Commercial	$468.26
Rate for Payer: Priority Health Cigna Priority Health	$371.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$500.35
Rate for Payer: Priority Health Narrow Network	$400.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$502.52

FLUORESCEIN 1 MG EYE STRIPS

Facility

$458.25

Service Code	NDC 17238090011
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$183.30
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$412.42
Rate for Payer: Aetna Medicare	$229.12
Rate for Payer: ASR ASR	$444.50
Rate for Payer: ASR Commercial	$444.50
Rate for Payer: BCBS Complete	$183.30
Rate for Payer: BCBS Trust/PPO	$375.26
Rate for Payer: BCN Commercial	$355.28
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$430.76
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$458.25
Rate for Payer: Healthscope Whirlpool	$444.50
Rate for Payer: Mclaren Commercial	$412.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: Nomi Health Commercial	$375.76
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$401.52
Rate for Payer: Priority Health Narrow Network	$321.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.26

FLUORESCEIN 1 MG EYE STRIPS

Facility

$458.25

Service Code	NDC 17238090011
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$297.86
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$412.42
Rate for Payer: ASR ASR	$444.50
Rate for Payer: ASR Commercial	$444.50
Rate for Payer: BCBS Trust/PPO	$373.43
Rate for Payer: BCN Commercial	$355.28
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$430.76
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$458.25
Rate for Payer: Healthscope Whirlpool	$444.50
Rate for Payer: Mclaren Commercial	$412.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: Nomi Health Commercial	$375.76
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.26

FLUORESCEIN 1 MG EYE STRIPS

Facility

$4.58

Service Code	NDC 17238090099
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.58
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: ASR ASR	$4.44
Rate for Payer: ASR Commercial	$4.44
Rate for Payer: BCBS Trust/PPO	$3.73
Rate for Payer: BCN Commercial	$3.55
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cofinity Commercial	$4.31
Rate for Payer: Encore Health Key Benefits Commercial	$3.66
Rate for Payer: Healthscope Commercial	$4.58
Rate for Payer: Healthscope Whirlpool	$4.44
Rate for Payer: Mclaren Commercial	$4.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.89
Rate for Payer: Nomi Health Commercial	$3.76
Rate for Payer: Priority Health Cigna Priority Health	$2.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.03

FLUORESCEIN 1 MG EYE STRIPS

Facility

$4.58

Service Code	NDC 17238090099
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.58
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare	$2.29
Rate for Payer: ASR ASR	$4.44
Rate for Payer: ASR Commercial	$4.44
Rate for Payer: BCBS Complete	$1.83
Rate for Payer: BCBS Trust/PPO	$3.75
Rate for Payer: BCN Commercial	$3.55
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cofinity Commercial	$4.31
Rate for Payer: Encore Health Key Benefits Commercial	$3.66
Rate for Payer: Healthscope Commercial	$4.58
Rate for Payer: Healthscope Whirlpool	$4.44
Rate for Payer: Mclaren Commercial	$4.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.89
Rate for Payer: Nomi Health Commercial	$3.76
Rate for Payer: Priority Health Cigna Priority Health	$2.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.01
Rate for Payer: Priority Health Narrow Network	$3.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.03

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION

Facility

$548.20

Service Code	NDC 11980021105
Hospital Charge Code	3208
Hospital Revenue Code	637
Min. Negotiated Rate	$356.33
Max. Negotiated Rate	$548.20
Rate for Payer: Aetna Commercial	$493.38
Rate for Payer: ASR ASR	$531.75
Rate for Payer: ASR Commercial	$531.75
Rate for Payer: BCBS Trust/PPO	$446.73
Rate for Payer: BCN Commercial	$425.02
Rate for Payer: Cash Price	$438.56
Rate for Payer: Cofinity Commercial	$515.31
Rate for Payer: Encore Health Key Benefits Commercial	$438.56
Rate for Payer: Healthscope Commercial	$548.20
Rate for Payer: Healthscope Whirlpool	$531.75
Rate for Payer: Mclaren Commercial	$493.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$465.97
Rate for Payer: Nomi Health Commercial	$449.52
Rate for Payer: Priority Health Cigna Priority Health	$356.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$482.42

FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION

Facility

$548.20

Service Code	NDC 11980021105
Hospital Charge Code	3208
Hospital Revenue Code	637
Min. Negotiated Rate	$219.28
Max. Negotiated Rate	$548.20
Rate for Payer: Aetna Commercial	$493.38
Rate for Payer: Aetna Medicare	$274.10
Rate for Payer: ASR ASR	$531.75
Rate for Payer: ASR Commercial	$531.75
Rate for Payer: BCBS Complete	$219.28
Rate for Payer: BCBS Trust/PPO	$448.92
Rate for Payer: BCN Commercial	$425.02
Rate for Payer: Cash Price	$438.56
Rate for Payer: Cofinity Commercial	$515.31
Rate for Payer: Encore Health Key Benefits Commercial	$438.56
Rate for Payer: Healthscope Commercial	$548.20
Rate for Payer: Healthscope Whirlpool	$531.75
Rate for Payer: Mclaren Commercial	$493.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$465.97
Rate for Payer: Nomi Health Commercial	$449.52
Rate for Payer: Priority Health Cigna Priority Health	$356.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$480.33
Rate for Payer: Priority Health Narrow Network	$384.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$482.42

FLUOXETINE 10 MG CAPSULE

Facility

$54.05

Service Code	NDC 65862019201
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$54.05
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: ASR ASR	$52.43
Rate for Payer: ASR Commercial	$52.43
Rate for Payer: BCBS Trust/PPO	$44.05
Rate for Payer: BCN Commercial	$41.90
Rate for Payer: Cash Price	$43.24
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Encore Health Key Benefits Commercial	$43.24
Rate for Payer: Healthscope Commercial	$54.05
Rate for Payer: Healthscope Whirlpool	$52.43
Rate for Payer: Mclaren Commercial	$48.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.94
Rate for Payer: Nomi Health Commercial	$44.32
Rate for Payer: Priority Health Cigna Priority Health	$35.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.56

FLUOXETINE 10 MG CAPSULE

Facility

$19.04

Service Code	NDC 00904578461
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$19.04
Rate for Payer: Aetna Commercial	$17.14
Rate for Payer: Aetna Medicare	$9.52
Rate for Payer: ASR ASR	$18.47
Rate for Payer: ASR Commercial	$18.47
Rate for Payer: BCBS Complete	$7.62
Rate for Payer: BCBS Trust/PPO	$15.59
Rate for Payer: BCN Commercial	$14.76
Rate for Payer: Cash Price	$15.23
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Encore Health Key Benefits Commercial	$15.23
Rate for Payer: Healthscope Commercial	$19.04
Rate for Payer: Healthscope Whirlpool	$18.47
Rate for Payer: Mclaren Commercial	$17.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.18
Rate for Payer: Nomi Health Commercial	$15.61
Rate for Payer: Priority Health Cigna Priority Health	$12.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.68
Rate for Payer: Priority Health Narrow Network	$13.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.76

FLUOXETINE 10 MG CAPSULE

Facility

$54.05

Service Code	NDC 65862019201
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$54.05
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare	$27.02
Rate for Payer: ASR ASR	$52.43
Rate for Payer: ASR Commercial	$52.43
Rate for Payer: BCBS Complete	$21.62
Rate for Payer: BCBS Trust/PPO	$44.26
Rate for Payer: BCN Commercial	$41.90
Rate for Payer: Cash Price	$43.24
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Encore Health Key Benefits Commercial	$43.24
Rate for Payer: Healthscope Commercial	$54.05
Rate for Payer: Healthscope Whirlpool	$52.43
Rate for Payer: Mclaren Commercial	$48.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.94
Rate for Payer: Nomi Health Commercial	$44.32
Rate for Payer: Priority Health Cigna Priority Health	$35.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.36
Rate for Payer: Priority Health Narrow Network	$37.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.56

FLUOXETINE 10 MG CAPSULE

Facility

$19.04

Service Code	NDC 00904578461
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$19.04
Rate for Payer: Aetna Commercial	$17.14
Rate for Payer: ASR ASR	$18.47
Rate for Payer: ASR Commercial	$18.47
Rate for Payer: BCBS Trust/PPO	$15.52
Rate for Payer: BCN Commercial	$14.76
Rate for Payer: Cash Price	$15.23
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Encore Health Key Benefits Commercial	$15.23
Rate for Payer: Healthscope Commercial	$19.04
Rate for Payer: Healthscope Whirlpool	$18.47
Rate for Payer: Mclaren Commercial	$17.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.18
Rate for Payer: Nomi Health Commercial	$15.61
Rate for Payer: Priority Health Cigna Priority Health	$12.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.76

FLUOXETINE 20 MG CAPSULE

Facility

$20.68

Service Code	NDC 00904578561
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$20.68
Rate for Payer: Aetna Commercial	$18.61
Rate for Payer: ASR ASR	$20.06
Rate for Payer: ASR Commercial	$20.06
Rate for Payer: BCBS Trust/PPO	$16.85
Rate for Payer: BCN Commercial	$16.03
Rate for Payer: Cash Price	$16.54
Rate for Payer: Cofinity Commercial	$19.44
Rate for Payer: Encore Health Key Benefits Commercial	$16.54
Rate for Payer: Healthscope Commercial	$20.68
Rate for Payer: Healthscope Whirlpool	$20.06
Rate for Payer: Mclaren Commercial	$18.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.58
Rate for Payer: Nomi Health Commercial	$16.96
Rate for Payer: Priority Health Cigna Priority Health	$13.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.20

FLUOXETINE 20 MG CAPSULE

Facility

$20.68

Service Code	NDC 00904578561
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$20.68
Rate for Payer: Aetna Commercial	$18.61
Rate for Payer: Aetna Medicare	$10.34
Rate for Payer: ASR ASR	$20.06
Rate for Payer: ASR Commercial	$20.06
Rate for Payer: BCBS Complete	$8.27
Rate for Payer: BCBS Trust/PPO	$16.93
Rate for Payer: BCN Commercial	$16.03
Rate for Payer: Cash Price	$16.54
Rate for Payer: Cofinity Commercial	$19.44
Rate for Payer: Encore Health Key Benefits Commercial	$16.54
Rate for Payer: Healthscope Commercial	$20.68
Rate for Payer: Healthscope Whirlpool	$20.06
Rate for Payer: Mclaren Commercial	$18.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.58
Rate for Payer: Nomi Health Commercial	$16.96
Rate for Payer: Priority Health Cigna Priority Health	$13.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.12
Rate for Payer: Priority Health Narrow Network	$14.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.20

FLUOXETINE 20 MG CAPSULE

Facility

$206.80

Service Code	NDC 00904734661
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$82.72
Max. Negotiated Rate	$206.80
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: Aetna Medicare	$103.40
Rate for Payer: ASR ASR	$200.60
Rate for Payer: ASR Commercial	$200.60
Rate for Payer: BCBS Complete	$82.72
Rate for Payer: BCBS Trust/PPO	$169.35
Rate for Payer: BCN Commercial	$160.33
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cofinity Commercial	$194.39
Rate for Payer: Encore Health Key Benefits Commercial	$165.44
Rate for Payer: Healthscope Commercial	$206.80
Rate for Payer: Healthscope Whirlpool	$200.60
Rate for Payer: Mclaren Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.78
Rate for Payer: Nomi Health Commercial	$169.58
Rate for Payer: Priority Health Cigna Priority Health	$134.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.20
Rate for Payer: Priority Health Narrow Network	$144.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.98

FLUOXETINE 20 MG CAPSULE

Facility

$206.80

Service Code	NDC 00904734661
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$134.42
Max. Negotiated Rate	$206.80
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: ASR ASR	$200.60
Rate for Payer: ASR Commercial	$200.60
Rate for Payer: BCBS Trust/PPO	$168.52
Rate for Payer: BCN Commercial	$160.33
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cofinity Commercial	$194.39
Rate for Payer: Encore Health Key Benefits Commercial	$165.44
Rate for Payer: Healthscope Commercial	$206.80
Rate for Payer: Healthscope Whirlpool	$200.60
Rate for Payer: Mclaren Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.78
Rate for Payer: Nomi Health Commercial	$169.58
Rate for Payer: Priority Health Cigna Priority Health	$134.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.98

Know your out-of-pocket cost for care.

All Charges