|
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
|
$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
|
$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
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.42 |
| 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 |
$412.42
|
| 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
|
$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
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$315.14 |
| 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 |
$315.14
|
| 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
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$241.96 |
| 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 |
$241.96
|
| 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
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$412.42 |
| 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 |
$412.42
|
| 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 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
IP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$637.84 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna Commercial |
$834.10
|
| Rate for Payer: BCBS Trust/PPO |
$801.04
|
| Rate for Payer: BCN Commercial |
$758.35
|
| 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: Healthscope Commercial |
$883.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.10
|
| Rate for Payer: Nomi Health Commercial |
$804.67
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.84
|
| Rate for Payer: Priority Health HMO/PPO |
$853.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.54
|
| Rate for Payer: UHC Core |
$819.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
|
|
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 |
$834.10
|
| 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 |
$834.10
|
| 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 |
$834.10
|
| Rate for Payer: PHP Medicare Advantage |
$245.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.84
|
| 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
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.19
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$100.46
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: Railroad Medicare Medicare |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Exchange |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.55
|
| Rate for Payer: VA VA |
$30.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$99.75
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCN Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health HMO/PPO |
$11.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$3.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.11
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS MAPPO |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.82
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: BCN Medicare Advantage |
$3.29
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: PACE Senior Care Partners |
$3.13
|
| Rate for Payer: PACE SWMI |
$3.29
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health HMO/PPO |
$11.45
|
| Rate for Payer: Priority Health Medicare |
$3.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.29
|
| Rate for Payer: UHC Exchange |
$3.29
|
| Rate for Payer: UHC Medicare Advantage |
$3.29
|
| Rate for Payer: VA VA |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
CITALOPRAM 5 MG CUSTOM TAB
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 09900000320
|
| Hospital Charge Code |
155135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna Commercial |
$0.40
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.15
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.40
|
| Rate for Payer: Nomi Health Commercial |
$0.39
|
| Rate for Payer: PACE Senior Care Partners |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.31
|
| Rate for Payer: Priority Health HMO/PPO |
$0.41
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.31
|
| Rate for Payer: Railroad Medicare Medicare |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: VA VA |
$0.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
CITALOPRAM 5 MG CUSTOM TAB
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 09900000320
|
| Hospital Charge Code |
155135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna Commercial |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCN Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$0.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.40
|
| Rate for Payer: Nomi Health Commercial |
$0.39
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.31
|
| Rate for Payer: Priority Health HMO/PPO |
$0.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.73
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.70
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE Senior Care Partners |
$4.46
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PACE SWMI |
$4.70
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Medicare Advantage |
$4.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.21
|
| Rate for Payer: Priority Health HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.59
|
| Rate for Payer: Railroad Medicare Medicare |
$4.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.70
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.70
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$4.70
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$14.52
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.21
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$16.51
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Nomi Health Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO |
$18.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Core |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.68
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS MAPPO |
$5.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.34
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Nomi Health Commercial |
$17.52
|
| Rate for Payer: PACE Senior Care Partners |
$5.07
|
| Rate for Payer: PACE SWMI |
$5.34
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO |
$18.58
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Core |
$17.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.34
|
| Rate for Payer: UHC Exchange |
$5.34
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$16.51
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Nomi Health Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO |
$18.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Core |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.68
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS MAPPO |
$5.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.34
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: Nomi Health Commercial |
$17.52
|
| Rate for Payer: PACE Senior Care Partners |
$5.07
|
| Rate for Payer: PACE SWMI |
$5.34
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO |
$18.58
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Core |
$17.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.34
|
| Rate for Payer: UHC Exchange |
$5.34
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$39.16
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$30.45
|
| Rate for Payer: BCN Commercial |
$20.59
|
| Rate for Payer: BCN Medicare Advantage |
$9.79
|
| Rate for Payer: BCN Medicare Advantage |
$6.62
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Commercial |
$33.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Healthscope Commercial |
$35.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$32.11
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: PACE Senior Care Partners |
$9.30
|
| Rate for Payer: PACE Senior Care Partners |
$6.29
|
| Rate for Payer: PACE SWMI |
$9.79
|
| Rate for Payer: PACE SWMI |
$6.62
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Medicare Advantage |
$6.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO |
$23.04
|
| Rate for Payer: Priority Health HMO/PPO |
$34.07
|
| Rate for Payer: Priority Health Medicare |
$9.89
|
| Rate for Payer: Priority Health Medicare |
$6.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.62
|
| Rate for Payer: Railroad Medicare Medicare |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.46
|
| Rate for Payer: UHC Core |
$32.70
|
| Rate for Payer: UHC Core |
$22.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.62
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Exchange |
$9.79
|
| Rate for Payer: UHC Medicare Advantage |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.79
|
| Rate for Payer: VA VA |
$6.62
|
| Rate for Payer: VA VA |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$26.48
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.97
|
| Rate for Payer: BCN Commercial |
$20.46
|
| Rate for Payer: BCN Commercial |
$30.26
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cofinity Commercial |
$33.68
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Healthscope Commercial |
$35.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: Nomi Health Commercial |
$32.11
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO |
$34.07
|
| Rate for Payer: Priority Health HMO/PPO |
$23.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.46
|
| Rate for Payer: UHC Core |
$22.11
|
| Rate for Payer: UHC Core |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.37
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$39.16
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$30.45
|
| Rate for Payer: BCN Commercial |
$20.59
|
| Rate for Payer: BCN Medicare Advantage |
$9.79
|
| Rate for Payer: BCN Medicare Advantage |
$6.62
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Commercial |
$33.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Healthscope Commercial |
$35.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$32.11
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: PACE Senior Care Partners |
$9.30
|
| Rate for Payer: PACE Senior Care Partners |
$6.29
|
| Rate for Payer: PACE SWMI |
$9.79
|
| Rate for Payer: PACE SWMI |
$6.62
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Medicare Advantage |
$6.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO |
$23.04
|
| Rate for Payer: Priority Health HMO/PPO |
$34.07
|
| Rate for Payer: Priority Health Medicare |
$9.89
|
| Rate for Payer: Priority Health Medicare |
$6.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.62
|
| Rate for Payer: Railroad Medicare Medicare |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.46
|
| Rate for Payer: UHC Core |
$32.70
|
| Rate for Payer: UHC Core |
$22.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.62
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Exchange |
$9.79
|
| Rate for Payer: UHC Medicare Advantage |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.79
|
| Rate for Payer: VA VA |
$6.62
|
| Rate for Payer: VA VA |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
