Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLARITHROMYCIN 500 MG TABLET

Facility

$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

CLARITHROMYCIN 500 MG TABLET

Facility

$278.73

Service Code	NDC 00781196260
Hospital Charge Code	9617
Hospital Revenue Code	637
Min. Negotiated Rate	$111.49
Max. Negotiated Rate	$250.86
Rate for Payer: Aetna Commercial	$236.92
Rate for Payer: Aetna Medicare	$139.37
Rate for Payer: Aetna New Business (MI Preferred)	$181.17
Rate for Payer: BCBS Complete	$111.49
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

$284.84

Service Code	NDC 00904687204
Hospital Charge Code	9617
Hospital Revenue Code	637
Min. Negotiated Rate	$113.94
Max. Negotiated Rate	$256.36
Rate for Payer: Aetna Commercial	$242.11
Rate for Payer: Aetna Medicare	$142.42
Rate for Payer: Aetna New Business (MI Preferred)	$185.15
Rate for Payer: BCBS Complete	$113.94
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

$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

$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

$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

CLAVICULECTOMY; PARTIAL

Facility

$8,907.47

Service Code	CPT 23120
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION

Facility

$23.40

Service Code	HCPCS J0736
Hospital Charge Code	1743
Hospital Revenue Code	636
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$21.06
Rate for Payer: Aetna Commercial	$19.89
Rate for Payer: Aetna Medicare	$11.70
Rate for Payer: Aetna New Business (MI Preferred)	$15.21
Rate for Payer: BCBS Complete	$9.36
Rate for Payer: Cash Price	$18.72
Rate for Payer: Cofinity Commercial	$16.38
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.38
Rate for Payer: Encore Health Key Benefits Commercial	$18.72
Rate for Payer: Healthscope Commercial	$21.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.89
Rate for Payer: PHP Commercial	$19.89
Rate for Payer: Priority Health Cigna Priority Health	$15.21
Rate for Payer: Priority Health SBD	$14.74

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION

Facility

$23.40

Service Code	HCPCS J0736
Hospital Charge Code	1743
Hospital Revenue Code	636
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$21.06
Rate for Payer: Aetna Commercial	$19.89
Rate for Payer: Aetna New Business (MI Preferred)	$15.21
Rate for Payer: Cash Price	$18.72
Rate for Payer: Cofinity Commercial	$16.38
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.38
Rate for Payer: Encore Health Key Benefits Commercial	$18.72
Rate for Payer: Healthscope Commercial	$21.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.89
Rate for Payer: PHP Commercial	$19.89
Rate for Payer: Priority Health Cigna Priority Health	$15.21
Rate for Payer: Priority Health SBD	$14.74

CLINDAMYCIN 2 % VAGINAL CREAM

Facility

$259.70

Service Code	NDC 00168027740
Hospital Charge Code	9624
Hospital Revenue Code	637
Min. Negotiated Rate	$103.88
Max. Negotiated Rate	$233.73
Rate for Payer: Aetna Commercial	$220.75
Rate for Payer: Aetna Medicare	$129.85
Rate for Payer: Aetna New Business (MI Preferred)	$168.81
Rate for Payer: BCBS Complete	$103.88
Rate for Payer: Cash Price	$207.76
Rate for Payer: Cofinity Commercial	$181.79
Rate for Payer: Cofinity Commercial	$223.34
Rate for Payer: Cofinity Medicare Advantage	$181.79
Rate for Payer: Encore Health Key Benefits Commercial	$207.76
Rate for Payer: Healthscope Commercial	$233.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.75
Rate for Payer: PHP Commercial	$220.75
Rate for Payer: Priority Health Cigna Priority Health	$168.81
Rate for Payer: Priority Health SBD	$163.61

CLINDAMYCIN 2 % VAGINAL CREAM

Facility

$259.70

Service Code	NDC 00168027740
Hospital Charge Code	9624
Hospital Revenue Code	637
Min. Negotiated Rate	$163.61
Max. Negotiated Rate	$233.73
Rate for Payer: Aetna Commercial	$220.75
Rate for Payer: Aetna New Business (MI Preferred)	$168.81
Rate for Payer: Cash Price	$207.76
Rate for Payer: Cofinity Commercial	$181.79
Rate for Payer: Cofinity Commercial	$223.34
Rate for Payer: Cofinity Medicare Advantage	$181.79
Rate for Payer: Encore Health Key Benefits Commercial	$207.76
Rate for Payer: Healthscope Commercial	$233.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.75
Rate for Payer: PHP Commercial	$220.75
Rate for Payer: Priority Health Cigna Priority Health	$168.81
Rate for Payer: Priority Health SBD	$163.61

CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK

Facility

$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 Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK

Facility

$21.36

Service Code	HCPCS J0737
Hospital Charge Code	183289
Hospital Revenue Code	636
Min. Negotiated Rate	$8.54
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: Cash Price	$17.09
Rate for Payer: Cofinity Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK

Facility

$32.04

Service Code	HCPCS J0736
Hospital Charge Code	183289
Hospital Revenue Code	636
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Commercial	$18.16
Rate for Payer: Aetna New Business (MI Preferred)	$13.88
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: Cash Price	$17.09
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$14.95
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Cofinity Medicare Advantage	$14.95
Rate for Payer: Encore Health Key Benefits Commercial	$17.09
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$19.22
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$18.16
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$20.19
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK

Facility

$32.04

Service Code	HCPCS J0736
Hospital Charge Code	183289
Hospital Revenue Code	636
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Commercial	$18.16
Rate for Payer: Aetna Medicare	$10.68
Rate for Payer: Aetna Medicare	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$13.88
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: BCBS Complete	$12.82
Rate for Payer: BCBS Complete	$8.54
Rate for Payer: Cash Price	$17.09
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$14.95
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Cofinity Medicare Advantage	$14.95
Rate for Payer: Encore Health Key Benefits Commercial	$17.09
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$19.22
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$21.36

Service Code	HCPCS J0736
Hospital Charge Code	9626
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 Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$32.04

Service Code	HCPCS J7036
Hospital Charge Code	9626
Hospital Revenue Code	636
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Medicare	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: BCBS Complete	$12.82
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$21.36

Service Code	HCPCS J0736
Hospital Charge Code	9626
Hospital Revenue Code	636
Min. Negotiated Rate	$8.54
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: Cash Price	$17.09
Rate for Payer: Cofinity Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$32.04

Service Code	HCPCS J7036
Hospital Charge Code	9626
Hospital Revenue Code	636
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$32.04

Service Code	NDC 00781328909
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$21.36

Service Code	HCPCS J0736
Hospital Charge Code	300021
Hospital Revenue Code	250
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 Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$32.04

Service Code	NDC 00781328991
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Medicare	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: BCBS Complete	$12.82
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$32.04

Service Code	NDC 00781328909
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Medicare	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: BCBS Complete	$12.82
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$32.04

Service Code	NDC 00781328991
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$21.36

Service Code	HCPCS J0736
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$8.54
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: Cash Price	$17.09
Rate for Payer: Cofinity Commercial	$14.95
Rate for Payer: Cofinity Commercial	$18.37
Rate for Payer: Cofinity Medicare Advantage	$14.95
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: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$13.88
Rate for Payer: Priority Health SBD	$13.46

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