|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$595.68
|
| Rate for Payer: BCN Commercial |
$563.94
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.56 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna Medicare |
$210.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$253.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$253.37
|
| Rate for Payer: BCBS Complete |
$324.32
|
| Rate for Payer: BCBS MAPPO |
$202.70
|
| Rate for Payer: BCBS Trust/PPO |
$666.55
|
| Rate for Payer: BCN Commercial |
$630.39
|
| Rate for Payer: BCN Medicare Advantage |
$202.70
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.70
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Nomi Health Commercial |
$664.85
|
| Rate for Payer: PACE Senior Care Partners |
$192.56
|
| Rate for Payer: PACE SWMI |
$202.70
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: PHP Medicare Advantage |
$202.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.01
|
| Rate for Payer: Priority Health HMO/PPO |
$705.39
|
| Rate for Payer: Priority Health Medicare |
$204.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.23
|
| Rate for Payer: Railroad Medicare Medicare |
$202.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$713.50
|
| Rate for Payer: UHC Core |
$677.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.70
|
| Rate for Payer: UHC Exchange |
$202.70
|
| Rate for Payer: UHC Medicare Advantage |
$202.70
|
| Rate for Payer: VA VA |
$202.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.31 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna Medicare |
$189.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.04
|
| Rate for Payer: BCBS Complete |
$291.89
|
| Rate for Payer: BCBS MAPPO |
$182.43
|
| Rate for Payer: BCBS Trust/PPO |
$599.91
|
| Rate for Payer: BCN Commercial |
$567.37
|
| Rate for Payer: BCN Medicare Advantage |
$182.43
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.43
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: PACE Senior Care Partners |
$173.31
|
| Rate for Payer: PACE SWMI |
$182.43
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: PHP Medicare Advantage |
$182.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Medicare |
$184.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.92
|
| Rate for Payer: Railroad Medicare Medicare |
$182.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.43
|
| Rate for Payer: UHC Exchange |
$182.43
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$182.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$595.68
|
| Rate for Payer: BCN Commercial |
$563.94
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.16
|
| Rate for Payer: UHC Core |
$609.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: BCBS Trust/PPO |
$295.42
|
| Rate for Payer: BCN Commercial |
$279.68
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$309.11
|
| Rate for Payer: BCN Commercial |
$292.34
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: PACE Senior Care Partners |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health HMO/PPO |
$327.12
|
| Rate for Payer: Priority Health Medicare |
$94.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.92
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.00
|
| Rate for Payer: UHC Exchange |
$94.00
|
| Rate for Payer: UHC Medicare Advantage |
$94.00
|
| Rate for Payer: VA VA |
$94.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$94.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.09
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: BCBS MAPPO |
$90.47
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$281.38
|
| Rate for Payer: BCN Medicare Advantage |
$90.47
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.47
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: PACE Senior Care Partners |
$85.95
|
| Rate for Payer: PACE SWMI |
$90.47
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: PHP Medicare Advantage |
$90.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$91.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.47
|
| Rate for Payer: Railroad Medicare Medicare |
$90.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.47
|
| Rate for Payer: UHC Exchange |
$90.47
|
| Rate for Payer: UHC Medicare Advantage |
$90.47
|
| Rate for Payer: VA VA |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: BCBS Trust/PPO |
$306.93
|
| Rate for Payer: BCN Commercial |
$290.57
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health HMO/PPO |
$327.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$41.96
|
| Rate for Payer: BCN Commercial |
$39.68
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: PACE Senior Care Partners |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health HMO/PPO |
$44.40
|
| Rate for Payer: Priority Health Medicare |
$12.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.92
|
| Rate for Payer: UHC Core |
$42.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Exchange |
$12.76
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: VA VA |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: BCBS Trust/PPO |
$41.66
|
| Rate for Payer: BCN Commercial |
$39.44
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health HMO/PPO |
$44.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.92
|
| Rate for Payer: UHC Core |
$42.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: BCBS Trust/PPO |
$219.46
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 51079018220
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$276.24
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.56
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$374.07
|
| Rate for Payer: BCN Commercial |
$354.14
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 51079018220
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$87.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.75
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$263.11
|
| Rate for Payer: BCN Medicare Advantage |
$84.60
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PACE Senior Care Partners |
$80.37
|
| Rate for Payer: PACE SWMI |
$84.60
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.60
|
| Rate for Payer: UHC Exchange |
$84.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$91.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.42
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: BCBS MAPPO |
$87.54
|
| Rate for Payer: BCBS Trust/PPO |
$287.86
|
| Rate for Payer: BCN Commercial |
$272.24
|
| Rate for Payer: BCN Medicare Advantage |
$87.54
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.54
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: PACE Senior Care Partners |
$83.16
|
| Rate for Payer: PACE SWMI |
$87.54
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: PHP Medicare Advantage |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Medicare |
$88.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$87.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.54
|
| Rate for Payer: UHC Exchange |
$87.54
|
| Rate for Payer: UHC Medicare Advantage |
$87.54
|
| Rate for Payer: VA VA |
$87.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$69.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.02
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS MAPPO |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$221.02
|
| Rate for Payer: BCN Commercial |
$209.03
|
| Rate for Payer: BCN Medicare Advantage |
$67.21
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PACE Senior Care Partners |
$63.85
|
| Rate for Payer: PACE SWMI |
$67.21
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: PHP Medicare Advantage |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Medicare |
$67.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: Railroad Medicare Medicare |
$67.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.21
|
| Rate for Payer: UHC Exchange |
$67.21
|
| Rate for Payer: UHC Medicare Advantage |
$67.21
|
| Rate for Payer: VA VA |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: BCBS Trust/PPO |
$285.83
|
| Rate for Payer: BCN Commercial |
$270.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
OP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.06 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna Commercial |
$834.11
|
| Rate for Payer: Aetna Medicare |
$255.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$306.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$306.66
|
| Rate for Payer: BCBS Complete |
$392.52
|
| Rate for Payer: BCBS MAPPO |
$245.32
|
| Rate for Payer: BCBS Trust/PPO |
$806.73
|
| Rate for Payer: BCN Commercial |
$762.96
|
| Rate for Payer: BCN Medicare Advantage |
$245.32
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cofinity Commercial |
$843.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.32
|
| Rate for Payer: Healthscope Commercial |
$883.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.11
|
| Rate for Payer: Nomi Health Commercial |
$804.67
|
| Rate for Payer: PACE Senior Care Partners |
$233.06
|
| Rate for Payer: PACE SWMI |
$245.32
|
| Rate for Payer: PHP Commercial |
$834.11
|
| Rate for Payer: PHP Medicare Advantage |
$245.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.85
|
| Rate for Payer: Priority Health HMO/PPO |
$853.73
|
| Rate for Payer: Priority Health Medicare |
$247.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.47
|
| Rate for Payer: Railroad Medicare Medicare |
$245.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.54
|
| Rate for Payer: UHC Core |
$819.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.32
|
| Rate for Payer: UHC Exchange |
$245.32
|
| Rate for Payer: UHC Medicare Advantage |
$245.32
|
| Rate for Payer: VA VA |
$245.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
|
