Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

FINASTERIDE 5 MG TABLET

Facility

$100.82

Service Code	NDC 57237-062-30
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$70.57
Max. Negotiated Rate	$100.82
Rate for Payer: Aetna Commercial	$90.74
Rate for Payer: ASR ASR	$97.80
Rate for Payer: BCBS Trust/PPO	$78.17
Rate for Payer: BCN Commercial	$78.17
Rate for Payer: Cash Price	$80.65
Rate for Payer: Cofinity Commercial	$94.77
Rate for Payer: Encore Health Key Benefits Commercial	$80.66
Rate for Payer: Healthscope Commercial	$100.82
Rate for Payer: Healthscope Whirlpool	$97.80
Rate for Payer: Mclaren Commercial	$90.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.70
Rate for Payer: Priority Health Cigna Priority Health	$70.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$88.72

FINASTERIDE 5 MG TABLET

Facility

$193.80

Service Code	NDC 0904-6830-06
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$135.66
Max. Negotiated Rate	$193.80
Rate for Payer: Aetna Commercial	$174.42
Rate for Payer: ASR ASR	$187.99
Rate for Payer: BCBS Trust/PPO	$150.25
Rate for Payer: BCN Commercial	$150.25
Rate for Payer: Cash Price	$155.04
Rate for Payer: Cofinity Commercial	$182.17
Rate for Payer: Encore Health Key Benefits Commercial	$155.04
Rate for Payer: Healthscope Commercial	$193.80
Rate for Payer: Healthscope Whirlpool	$187.99
Rate for Payer: Mclaren Commercial	$174.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$164.73
Rate for Payer: Priority Health Cigna Priority Health	$135.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$170.54

FINASTERIDE 5 MG TABLET

Facility

$256.80

Service Code	NDC 60687-428-01
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$179.76
Max. Negotiated Rate	$256.80
Rate for Payer: Aetna Commercial	$231.12
Rate for Payer: ASR ASR	$249.10
Rate for Payer: BCBS Trust/PPO	$199.10
Rate for Payer: BCN Commercial	$199.10
Rate for Payer: Cash Price	$205.44
Rate for Payer: Cofinity Commercial	$241.39
Rate for Payer: Encore Health Key Benefits Commercial	$205.44
Rate for Payer: Healthscope Commercial	$256.80
Rate for Payer: Healthscope Whirlpool	$249.10
Rate for Payer: Mclaren Commercial	$231.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$218.28
Rate for Payer: Priority Health Cigna Priority Health	$179.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$225.98

FINASTERIDE 5 MG TABLET

Facility

$53.58

Service Code	NDC 16729-090-10
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$37.51
Max. Negotiated Rate	$53.58
Rate for Payer: Aetna Commercial	$48.22
Rate for Payer: ASR ASR	$51.97
Rate for Payer: BCBS Trust/PPO	$41.54
Rate for Payer: BCN Commercial	$41.54
Rate for Payer: Cash Price	$42.86
Rate for Payer: Cofinity Commercial	$50.37
Rate for Payer: Encore Health Key Benefits Commercial	$42.86
Rate for Payer: Healthscope Commercial	$53.58
Rate for Payer: Healthscope Whirlpool	$51.97
Rate for Payer: Mclaren Commercial	$48.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.54
Rate for Payer: Priority Health Cigna Priority Health	$37.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.15

FINASTERIDE 5 MG TABLET

Facility

$2.57

Service Code	NDC 60687-428-11
Hospital Charge Code	10037
Hospital Revenue Code	637
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.57
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: ASR ASR	$2.49
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: Cash Price	$2.05
Rate for Payer: Cofinity Commercial	$2.42
Rate for Payer: Encore Health Key Benefits Commercial	$2.06
Rate for Payer: Healthscope Commercial	$2.57
Rate for Payer: Healthscope Whirlpool	$2.49
Rate for Payer: Mclaren Commercial	$2.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.18
Rate for Payer: Priority Health Cigna Priority Health	$1.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.26

FLECAINIDE 100 MG TABLET

Facility

$455.90

Service Code	NDC 65162-642-10
Hospital Charge Code	10041
Hospital Revenue Code	637
Min. Negotiated Rate	$319.13
Max. Negotiated Rate	$455.90
Rate for Payer: Aetna Commercial	$410.31
Rate for Payer: ASR ASR	$442.22
Rate for Payer: BCBS Trust/PPO	$353.46
Rate for Payer: BCN Commercial	$353.46
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$428.55
Rate for Payer: Encore Health Key Benefits Commercial	$364.72
Rate for Payer: Healthscope Commercial	$455.90
Rate for Payer: Healthscope Whirlpool	$442.22
Rate for Payer: Mclaren Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$387.52
Rate for Payer: Priority Health Cigna Priority Health	$319.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$401.19

FLECAINIDE 100 MG TABLET

Facility

$251.14

Service Code	NDC 0054-0011-21
Hospital Charge Code	10041
Hospital Revenue Code	637
Min. Negotiated Rate	$175.80
Max. Negotiated Rate	$251.14
Rate for Payer: Aetna Commercial	$226.03
Rate for Payer: ASR ASR	$243.61
Rate for Payer: BCBS Trust/PPO	$194.71
Rate for Payer: BCN Commercial	$194.71
Rate for Payer: Cash Price	$200.91
Rate for Payer: Cofinity Commercial	$236.07
Rate for Payer: Encore Health Key Benefits Commercial	$200.91
Rate for Payer: Healthscope Commercial	$251.14
Rate for Payer: Healthscope Whirlpool	$243.61
Rate for Payer: Mclaren Commercial	$226.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$213.47
Rate for Payer: Priority Health Cigna Priority Health	$175.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$221.00

FLUCONAZOLE 100 MG TABLET

Facility

$251.28

Service Code	NDC 0904-6500-06
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$175.90
Max. Negotiated Rate	$251.28
Rate for Payer: Aetna Commercial	$226.15
Rate for Payer: ASR ASR	$243.74
Rate for Payer: BCBS Trust/PPO	$194.82
Rate for Payer: BCN Commercial	$194.82
Rate for Payer: Cash Price	$201.02
Rate for Payer: Cofinity Commercial	$236.20
Rate for Payer: Encore Health Key Benefits Commercial	$201.02
Rate for Payer: Healthscope Commercial	$251.28
Rate for Payer: Healthscope Whirlpool	$243.74
Rate for Payer: Mclaren Commercial	$226.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$213.59
Rate for Payer: Priority Health Cigna Priority Health	$175.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$221.13

FLUCONAZOLE 100 MG TABLET

Facility

$792.48

Service Code	NDC 0172-5411-60
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$554.74
Max. Negotiated Rate	$792.48
Rate for Payer: Aetna Commercial	$713.23
Rate for Payer: ASR ASR	$768.71
Rate for Payer: BCBS Trust/PPO	$614.41
Rate for Payer: BCN Commercial	$614.41
Rate for Payer: Cash Price	$633.98
Rate for Payer: Cofinity Commercial	$744.93
Rate for Payer: Encore Health Key Benefits Commercial	$633.98
Rate for Payer: Healthscope Commercial	$792.48
Rate for Payer: Healthscope Whirlpool	$768.71
Rate for Payer: Mclaren Commercial	$713.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$673.61
Rate for Payer: Priority Health Cigna Priority Health	$554.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$697.38

FLUCONAZOLE 100 MG TABLET

Facility

$76.03

Service Code	NDC 0049-3420-30
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$53.22
Max. Negotiated Rate	$76.03
Rate for Payer: Aetna Commercial	$68.43
Rate for Payer: ASR ASR	$73.75
Rate for Payer: BCBS Trust/PPO	$58.95
Rate for Payer: BCN Commercial	$58.95
Rate for Payer: Cash Price	$60.83
Rate for Payer: Cofinity Commercial	$71.47
Rate for Payer: Encore Health Key Benefits Commercial	$60.82
Rate for Payer: Healthscope Commercial	$76.03
Rate for Payer: Healthscope Whirlpool	$73.75
Rate for Payer: Mclaren Commercial	$68.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.63
Rate for Payer: Priority Health Cigna Priority Health	$53.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$66.91

FLUCONAZOLE 100 MG TABLET

Facility

$541.44

Service Code	NDC 0904-6500-61
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$379.01
Max. Negotiated Rate	$541.44
Rate for Payer: Aetna Commercial	$487.30
Rate for Payer: ASR ASR	$525.20
Rate for Payer: BCBS Trust/PPO	$419.78
Rate for Payer: BCN Commercial	$419.78
Rate for Payer: Cash Price	$433.15
Rate for Payer: Cofinity Commercial	$508.95
Rate for Payer: Encore Health Key Benefits Commercial	$433.15
Rate for Payer: Healthscope Commercial	$541.44
Rate for Payer: Healthscope Whirlpool	$525.20
Rate for Payer: Mclaren Commercial	$487.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.22
Rate for Payer: Priority Health Cigna Priority Health	$379.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$476.47

FLUCONAZOLE 100 MG TABLET

Facility

$115.71

Service Code	NDC 68462-102-30
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$115.71
Rate for Payer: Aetna Commercial	$104.14
Rate for Payer: ASR ASR	$112.24
Rate for Payer: BCBS Trust/PPO	$89.71
Rate for Payer: BCN Commercial	$89.71
Rate for Payer: Cash Price	$92.57
Rate for Payer: Cofinity Commercial	$108.77
Rate for Payer: Encore Health Key Benefits Commercial	$92.57
Rate for Payer: Healthscope Commercial	$115.71
Rate for Payer: Healthscope Whirlpool	$112.24
Rate for Payer: Mclaren Commercial	$104.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.35
Rate for Payer: Priority Health Cigna Priority Health	$81.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.82

FLUCONAZOLE 100 MG TABLET

Facility

$133.78

Service Code	NDC 0172-5411-46
Hospital Charge Code	10044
Hospital Revenue Code	637
Min. Negotiated Rate	$93.65
Max. Negotiated Rate	$133.78
Rate for Payer: Aetna Commercial	$120.40
Rate for Payer: ASR ASR	$129.77
Rate for Payer: BCBS Trust/PPO	$103.72
Rate for Payer: BCN Commercial	$103.72
Rate for Payer: Cash Price	$107.02
Rate for Payer: Cofinity Commercial	$125.75
Rate for Payer: Encore Health Key Benefits Commercial	$107.02
Rate for Payer: Healthscope Commercial	$133.78
Rate for Payer: Healthscope Whirlpool	$129.77
Rate for Payer: Mclaren Commercial	$120.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.71
Rate for Payer: Priority Health Cigna Priority Health	$93.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$117.73

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK

Facility

$14.80

Service Code	HCPCS J1450
Hospital Charge Code	10049
Hospital Revenue Code	636
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$14.80
Rate for Payer: Aetna Commercial	$13.32
Rate for Payer: ASR ASR	$14.36
Rate for Payer: BCBS Trust/PPO	$11.47
Rate for Payer: BCN Commercial	$11.47
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cofinity Commercial	$13.91
Rate for Payer: Encore Health Key Benefits Commercial	$11.84
Rate for Payer: Healthscope Commercial	$14.80
Rate for Payer: Healthscope Whirlpool	$14.36
Rate for Payer: Mclaren Commercial	$13.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.58
Rate for Payer: Priority Health Cigna Priority Health	$10.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.02

FLUDROCORTISONE 0.1 MG TABLET

Facility

$361.44

Service Code	NDC 68084-288-01
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$253.01
Max. Negotiated Rate	$361.44
Rate for Payer: Aetna Commercial	$325.30
Rate for Payer: ASR ASR	$350.60
Rate for Payer: BCBS Trust/PPO	$280.22
Rate for Payer: BCN Commercial	$280.22
Rate for Payer: Cash Price	$289.15
Rate for Payer: Cofinity Commercial	$339.75
Rate for Payer: Encore Health Key Benefits Commercial	$289.15
Rate for Payer: Healthscope Commercial	$361.44
Rate for Payer: Healthscope Whirlpool	$350.60
Rate for Payer: Mclaren Commercial	$325.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$307.22
Rate for Payer: Priority Health Cigna Priority Health	$253.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$318.07

FLUDROCORTISONE 0.1 MG TABLET

Facility

$3.62

Service Code	NDC 68084-288-11
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: ASR ASR	$3.51
Rate for Payer: BCBS Trust/PPO	$2.81
Rate for Payer: BCN Commercial	$2.81
Rate for Payer: Cash Price	$2.89
Rate for Payer: Cofinity Commercial	$3.40
Rate for Payer: Encore Health Key Benefits Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.62
Rate for Payer: Healthscope Whirlpool	$3.51
Rate for Payer: Mclaren Commercial	$3.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.08
Rate for Payer: Priority Health Cigna Priority Health	$2.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.19

FLUDROCORTISONE 0.1 MG TABLET

Facility

$2.40

Service Code	NDC 50268-330-11
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna Commercial	$2.16
Rate for Payer: ASR ASR	$2.33
Rate for Payer: BCBS Trust/PPO	$1.86
Rate for Payer: BCN Commercial	$1.86
Rate for Payer: Cash Price	$1.92
Rate for Payer: Cofinity Commercial	$2.26
Rate for Payer: Encore Health Key Benefits Commercial	$1.92
Rate for Payer: Healthscope Commercial	$2.40
Rate for Payer: Healthscope Whirlpool	$2.33
Rate for Payer: Mclaren Commercial	$2.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.04
Rate for Payer: Priority Health Cigna Priority Health	$1.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.11

FLUDROCORTISONE 0.1 MG TABLET

Facility

$120.24

Service Code	NDC 50268-330-15
Hospital Charge Code	10054
Hospital Revenue Code	637
Min. Negotiated Rate	$84.17
Max. Negotiated Rate	$120.24
Rate for Payer: Aetna Commercial	$108.22
Rate for Payer: ASR ASR	$116.63
Rate for Payer: BCBS Trust/PPO	$93.22
Rate for Payer: BCN Commercial	$93.22
Rate for Payer: Cash Price	$96.19
Rate for Payer: Cofinity Commercial	$113.03
Rate for Payer: Encore Health Key Benefits Commercial	$96.19
Rate for Payer: Healthscope Commercial	$120.24
Rate for Payer: Healthscope Whirlpool	$116.63
Rate for Payer: Mclaren Commercial	$108.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.20
Rate for Payer: Priority Health Cigna Priority Health	$84.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$105.81

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 0143-9784-10
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: BCBS Trust/PPO	$14.63
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 Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 0143-9684-10
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: BCBS Trust/PPO	$14.63
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 Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 0143-9784-01
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: BCBS Trust/PPO	$14.63
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 Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION

Facility

$18.87

Service Code	NDC 0143-9684-01
Hospital Charge Code	10055
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: BCBS Trust/PPO	$14.63
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 Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUMAZENIL 0.1 MG/ML IV (CODE)

Facility

$18.87

Service Code	NDC 0143-9784-10
Hospital Charge Code	163712
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$18.87
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: ASR ASR	$18.30
Rate for Payer: BCBS Trust/PPO	$14.63
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 Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61

FLUORESCEIN 0.6 MG EYE STRIPS

Facility

$571.05

Service Code	NDC 17478-403-03
Hospital Charge Code	27662
Hospital Revenue Code	250
Min. Negotiated Rate	$399.74
Max. Negotiated Rate	$571.05
Rate for Payer: Aetna Commercial	$513.94
Rate for Payer: ASR ASR	$553.92
Rate for Payer: BCBS Trust/PPO	$442.74
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 Multiplan/Beech St/PHCS	$485.39
Rate for Payer: Priority Health Cigna Priority Health	$399.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$502.52

FLUORESCEIN 1 MG EYE STRIPS

Facility

$458.25

Service Code	NDC 17238-900-11
Hospital Charge Code	27663
Hospital Revenue Code	250
Min. Negotiated Rate	$320.78
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$412.42
Rate for Payer: ASR ASR	$444.50
Rate for Payer: BCBS Trust/PPO	$355.28
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 Multiplan/Beech St/PHCS	$389.51
Rate for Payer: Priority Health Cigna Priority Health	$320.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.26

Know your out-of-pocket cost for care.

All Charges