|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$190.38
|
|
|
Service Code
|
NDC 70069015110
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna Medicare |
$95.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: BCBS Complete |
$76.15
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Commercial |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.75
|
| Rate for Payer: Priority Health SBD |
$119.94
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.38
|
|
|
Service Code
|
NDC 70069015101
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Commercial |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.75
|
| Rate for Payer: Priority Health SBD |
$119.94
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$618.93 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$392.97 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna Medicare |
$491.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: BCBS Complete |
$392.97
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$307.50
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$276.75 |
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna Commercial |
$253.54
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$207.36
|
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna Medicare |
$149.14
|
| Rate for Payer: Aetna Medicare |
$153.75
|
| Rate for Payer: Aetna Medicare |
$121.88
|
| Rate for Payer: Aetna Medicare |
$295.08
|
| Rate for Payer: Aetna Medicare |
$148.75
|
| Rate for Payer: Aetna Medicare |
$99.69
|
| Rate for Payer: Aetna Medicare |
$121.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Complete |
$119.00
|
| Rate for Payer: BCBS Complete |
$119.31
|
| Rate for Payer: BCBS Complete |
$97.58
|
| Rate for Payer: BCBS Complete |
$79.75
|
| Rate for Payer: BCBS Complete |
$97.50
|
| Rate for Payer: BCBS Complete |
$236.06
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$195.16
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$238.62
|
| Rate for Payer: Cash Price |
$238.62
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$195.16
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Cofinity Commercial |
$209.62
|
| Rate for Payer: Cofinity Commercial |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$413.10
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$170.76
|
| Rate for Payer: Cofinity Commercial |
$209.80
|
| Rate for Payer: Cofinity Commercial |
$208.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.62
|
| Rate for Payer: Healthscope Commercial |
$268.45
|
| Rate for Payer: Healthscope Commercial |
$531.14
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$219.38
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$207.19
|
| Rate for Payer: PHP Commercial |
$207.36
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$253.54
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$261.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.57
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$187.42
|
| Rate for Payer: Priority Health SBD |
$153.69
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$153.56
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: Priority Health SBD |
$187.92
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
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 Commercial |
$646.72
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$526.40
|
| 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: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.80
|
| Rate for Payer: Priority Health SBD |
$473.76
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
NDC 57664050818
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.80 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$376.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: BCBS Complete |
$300.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$526.40
|
| 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: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.80
|
| Rate for Payer: Priority Health SBD |
$473.76
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$721.35
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$649.22 |
| Rate for Payer: Aetna Commercial |
$613.15
|
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna Medicare |
$11.72
|
| Rate for Payer: Aetna Medicare |
$11.72
|
| 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 |
$14.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.09
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.27
|
| Rate for Payer: BCBS MAPPO |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.23
|
| Rate for Payer: BCBS Trust/PPO |
$40.23
|
| Rate for Payer: BCN Commercial |
$40.23
|
| Rate for Payer: BCN Commercial |
$40.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.27
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$577.08
|
| Rate for Payer: Cash Price |
$577.08
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Cofinity Commercial |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$504.94
|
| Rate for Payer: Cofinity Commercial |
$620.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$650.35
|
| 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 |
$11.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.27
|
| Rate for Payer: Healthscope Commercial |
$649.22
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.27
|
| Rate for Payer: Mclaren Medicare |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.83
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.15
|
| Rate for Payer: Nomi Health Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$33.81
|
| Rate for Payer: PACE Medicare |
$10.71
|
| Rate for Payer: PACE Medicare |
$10.71
|
| Rate for Payer: PACE SWMI |
$11.27
|
| Rate for Payer: PACE SWMI |
$11.27
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: PHP Commercial |
$613.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.27
|
| Rate for Payer: PHP Medicare Advantage |
$11.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.01
|
| Rate for Payer: Priority Health Medicare |
$11.27
|
| Rate for Payer: Priority Health Medicare |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$32.81
|
| Rate for Payer: Priority Health Narrow Network |
$32.81
|
| Rate for Payer: Priority Health SBD |
$454.45
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.27
|
| Rate for Payer: UHC Medicare Advantage |
$11.27
|
| Rate for Payer: UHC Medicare Advantage |
$11.27
|
| Rate for Payer: UHCCP Medicaid |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$6.35
|
| Rate for Payer: VA VA |
$11.27
|
| Rate for Payer: VA VA |
$11.27
|
|
|
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 Commercial |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$650.35
|
| 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: PHP Commercial |
$789.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.90
|
| Rate for Payer: Priority Health SBD |
$585.31
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$284.84
|
|
|
Service Code
|
NDC 00904687204
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.45 |
| Max. Negotiated Rate |
$256.36 |
| Rate for Payer: Aetna Commercial |
$242.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.15
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cofinity Commercial |
$199.39
|
| Rate for Payer: Cofinity Commercial |
$244.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$256.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.11
|
| Rate for Payer: PHP Commercial |
$242.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.15
|
| Rate for Payer: Priority Health SBD |
$179.45
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$17.24
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| 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 Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.07
|
| 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: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health SBD |
$10.86
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$278.73
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$250.86 |
| Rate for Payer: Aetna Commercial |
$236.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.17
|
| Rate for Payer: Cash Price |
$222.98
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.98
|
| Rate for Payer: Healthscope Commercial |
$250.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.92
|
| Rate for Payer: PHP Commercial |
$236.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health SBD |
$175.60
|
|
|
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 Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.07
|
| 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: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health SBD |
$10.86
|
|
|
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 Commercial |
$361.85
|
| Rate for Payer: Cofinity Commercial |
$444.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.85
|
| 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: PHP Commercial |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health SBD |
$325.67
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$516.93
|
|
|
Service Code
|
NDC 68084065125
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.77 |
| 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 Commercial |
$361.85
|
| Rate for Payer: Cofinity Commercial |
$444.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.85
|
| 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: PHP Commercial |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health SBD |
$325.67
|
|
