|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
NDC 57664050818
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Advantage |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.60
|
| Rate for Payer: Healthscope Commercial |
$676.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health SBD |
$473.76
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Advantage |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.32
|
| Rate for Payer: UHC Core |
$7.47
|
| Rate for Payer: UHC Exchange |
$5.64
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.09
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$929.07
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.31 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cofinity Advantage |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.80
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: Priority Health SBD |
$585.31
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$929.07
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna Commercial |
$613.15
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.91
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.59
|
| Rate for Payer: BCN Commercial |
$18.59
|
| Rate for Payer: BCN Commercial |
$18.59
|
| Rate for Payer: BCN Medicare Advantage |
$8.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.73
|
| Rate for Payer: Cash Price |
$577.08
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$577.08
|
| Rate for Payer: Cofinity Advantage |
$504.94
|
| Rate for Payer: Cofinity Advantage |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Cofinity Commercial |
$620.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Healthscope Commercial |
$649.22
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Mclaren Medicare |
$8.73
|
| Rate for Payer: Mclaren Medicare |
$8.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.71
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$541.01
|
| Rate for Payer: PACE Medicare |
$8.29
|
| Rate for Payer: PACE Medicare |
$8.29
|
| Rate for Payer: PACE SWMI |
$8.73
|
| Rate for Payer: PACE SWMI |
$8.73
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: PHP Commercial |
$613.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.73
|
| Rate for Payer: PHP Medicare Advantage |
$8.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.68
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health SBD |
$454.45
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: Priority Health Tiered Network |
$26.94
|
| Rate for Payer: Priority Health Tiered Network |
$26.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8.73
|
| Rate for Payer: Railroad Medicare Medicare |
$8.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.73
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$8.73
|
| Rate for Payer: VA VA |
$8.73
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$17.24
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cofinity Advantage |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health SBD |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.21
|
| Rate for Payer: UHC Core |
$8.98
|
| Rate for Payer: UHC Exchange |
$6.78
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$226.44
|
|
|
Service Code
|
NDC 00904687204
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.66 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.19
|
| Rate for Payer: Cash Price |
$181.15
|
| Rate for Payer: Cofinity Advantage |
$158.51
|
| Rate for Payer: Cofinity Commercial |
$194.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.15
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.83
|
| Rate for Payer: PHP Commercial |
$192.47
|
| Rate for Payer: Priority Health SBD |
$142.66
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$516.93
|
|
|
Service Code
|
NDC 68084065125
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.67 |
| Max. Negotiated Rate |
$465.24 |
| Rate for Payer: Aetna Commercial |
$439.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.00
|
| Rate for Payer: Cash Price |
$413.54
|
| Rate for Payer: Cofinity Advantage |
$361.85
|
| Rate for Payer: Cofinity Commercial |
$444.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.54
|
| Rate for Payer: Healthscope Commercial |
$465.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.70
|
| Rate for Payer: PHP Commercial |
$439.39
|
| Rate for Payer: Priority Health SBD |
$325.67
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$17.24
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cofinity Advantage |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health SBD |
$10.86
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$516.93
|
|
|
Service Code
|
NDC 68084065125
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.15 |
| Max. Negotiated Rate |
$465.24 |
| Rate for Payer: Aetna Commercial |
$439.39
|
| Rate for Payer: Aetna Medicare |
$258.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.00
|
| Rate for Payer: BCBS Complete |
$206.77
|
| Rate for Payer: Cash Price |
$413.54
|
| Rate for Payer: Cofinity Advantage |
$361.85
|
| Rate for Payer: Cofinity Commercial |
$444.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.54
|
| Rate for Payer: Healthscope Commercial |
$465.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.70
|
| Rate for Payer: PHP Commercial |
$439.39
|
| Rate for Payer: Priority Health SBD |
$325.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.00
|
| Rate for Payer: UHC Core |
$269.32
|
| Rate for Payer: UHC Exchange |
$203.15
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$261.80
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.89 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Aetna Medicare |
$130.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: BCBS Complete |
$104.72
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cofinity Advantage |
$183.26
|
| Rate for Payer: Cofinity Commercial |
$225.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.44
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.35
|
| Rate for Payer: PHP Commercial |
$222.53
|
| Rate for Payer: Priority Health SBD |
$164.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.17
|
| Rate for Payer: UHC Core |
$136.40
|
| Rate for Payer: UHC Exchange |
$102.89
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$261.80
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.93 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cofinity Advantage |
$183.26
|
| Rate for Payer: Cofinity Commercial |
$225.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.44
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.35
|
| Rate for Payer: PHP Commercial |
$222.53
|
| Rate for Payer: Priority Health SBD |
$164.93
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$226.44
|
|
|
Service Code
|
NDC 00904687204
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.99 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna Medicare |
$113.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.19
|
| Rate for Payer: BCBS Complete |
$90.58
|
| Rate for Payer: Cash Price |
$181.15
|
| Rate for Payer: Cofinity Advantage |
$158.51
|
| Rate for Payer: Cofinity Commercial |
$194.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.15
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.83
|
| Rate for Payer: PHP Commercial |
$192.47
|
| Rate for Payer: Priority Health SBD |
$142.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.19
|
| Rate for Payer: UHC Core |
$117.98
|
| Rate for Payer: UHC Exchange |
$88.99
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$22,573.69
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$21,498.75 |
| Max. Negotiated Rate |
$22,573.69 |
| Rate for Payer: BCBS Complete |
$22,573.69
|
| Rate for Payer: Mclaren Medicaid |
$21,498.75
|
| Rate for Payer: Meridian Medicaid |
$22,573.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,498.75
|
| Rate for Payer: UHC Medicaid |
$21,498.75
|
| Rate for Payer: UHCCP Medicaid |
$21,498.75
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$10,882.95
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$10,364.72 |
| Max. Negotiated Rate |
$10,882.95 |
| Rate for Payer: BCBS Complete |
$10,882.95
|
| Rate for Payer: Mclaren Medicaid |
$10,364.72
|
| Rate for Payer: Meridian Medicaid |
$10,882.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,364.72
|
| Rate for Payer: UHC Medicaid |
$10,364.72
|
| Rate for Payer: UHCCP Medicaid |
$10,364.72
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$8,106.46
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$7,720.44 |
| Max. Negotiated Rate |
$8,106.46 |
| Rate for Payer: BCBS Complete |
$8,106.46
|
| Rate for Payer: Mclaren Medicaid |
$7,720.44
|
| Rate for Payer: Meridian Medicaid |
$8,106.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,720.44
|
| Rate for Payer: UHC Medicaid |
$7,720.44
|
| Rate for Payer: UHCCP Medicaid |
$7,720.44
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$12,892.94
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$12,278.99 |
| Max. Negotiated Rate |
$12,892.94 |
| Rate for Payer: BCBS Complete |
$12,892.94
|
| Rate for Payer: Mclaren Medicaid |
$12,278.99
|
| Rate for Payer: Meridian Medicaid |
$12,892.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,278.99
|
| Rate for Payer: UHC Medicaid |
$12,278.99
|
| Rate for Payer: UHCCP Medicaid |
$12,278.99
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna Commercial |
$17.87
|
| Rate for Payer: Aetna Medicare |
$10.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.66
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Advantage |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$18.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: PHP Commercial |
$17.87
|
| Rate for Payer: Priority Health SBD |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.15
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Exchange |
$3.15
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna Commercial |
$17.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.66
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Advantage |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$18.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: PHP Commercial |
$17.87
|
| Rate for Payer: Priority Health SBD |
$13.24
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
IP
|
$245.42
|
|
|
Service Code
|
NDC 00168027740
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.61 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$208.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.52
|
| Rate for Payer: Cash Price |
$196.34
|
| Rate for Payer: Cofinity Advantage |
$171.79
|
| Rate for Payer: Cofinity Commercial |
$211.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.34
|
| Rate for Payer: Healthscope Commercial |
$220.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.06
|
| Rate for Payer: PHP Commercial |
$208.61
|
| Rate for Payer: Priority Health SBD |
$154.61
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
OP
|
$245.42
|
|
|
Service Code
|
NDC 00168027740
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.45 |
| Max. Negotiated Rate |
$220.88 |
| Rate for Payer: Aetna Commercial |
$208.61
|
| Rate for Payer: Aetna Medicare |
$122.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.52
|
| Rate for Payer: BCBS Complete |
$98.17
|
| Rate for Payer: Cash Price |
$196.34
|
| Rate for Payer: Cofinity Advantage |
$171.79
|
| Rate for Payer: Cofinity Commercial |
$211.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.34
|
| Rate for Payer: Healthscope Commercial |
$220.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.06
|
| Rate for Payer: PHP Commercial |
$208.61
|
| Rate for Payer: Priority Health SBD |
$154.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.52
|
| Rate for Payer: UHC Core |
$127.86
|
| Rate for Payer: UHC Exchange |
$96.45
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.88
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Advantage |
$14.95
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.02
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health SBD |
$13.46
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.88
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Advantage |
$14.95
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.02
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health SBD |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.88
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: UHC Exchange |
$3.88
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Advantage |
$14.95
|
| Rate for Payer: Cofinity Advantage |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.36
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health SBD |
$13.46
|
| Rate for Payer: Priority Health SBD |
$18.79
|
|
