|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$37.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.94
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$35.95
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$118.23
|
| Rate for Payer: BCN Medicare Advantage |
$35.95
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.95
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Mclaren Medicaid |
$25.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.75
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Nomi Health Commercial |
$117.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PACE Senior Care Partners |
$34.16
|
| Rate for Payer: PACE SWMI |
$35.95
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: PHP Medicare Advantage |
$35.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.12
|
| Rate for Payer: Priority Health Medicare |
$36.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.10
|
| Rate for Payer: Railroad Medicare Medicare |
$35.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.56
|
| Rate for Payer: UHC Core |
$120.09
|
| Rate for Payer: UHC Exchange |
$35.95
|
| Rate for Payer: UHC Medicaid |
$25.36
|
| Rate for Payer: UHC Medicare Advantage |
$35.95
|
| Rate for Payer: UHCCP Medicaid |
$25.36
|
| Rate for Payer: VA VA |
$35.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.11
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.93
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.10
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.13
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicaid |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: UHCCP Medicaid |
$0.63
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$177.60
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna Commercial |
$150.96
|
| Rate for Payer: Aetna Medicare |
$46.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.50
|
| Rate for Payer: BCBS Complete |
$32.87
|
| Rate for Payer: BCBS MAPPO |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$146.00
|
| Rate for Payer: BCN Commercial |
$146.00
|
| Rate for Payer: BCN Medicare Advantage |
$44.40
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$152.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.40
|
| Rate for Payer: Healthscope Commercial |
$159.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.20
|
| Rate for Payer: Mclaren Medicaid |
$31.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.62
|
| Rate for Payer: Meridian Medicaid |
$32.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.96
|
| Rate for Payer: Nomi Health Commercial |
$145.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.20
|
| Rate for Payer: PACE Senior Care Partners |
$42.18
|
| Rate for Payer: PACE SWMI |
$44.40
|
| Rate for Payer: PHP Commercial |
$150.96
|
| Rate for Payer: PHP Medicare Advantage |
$44.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.51
|
| Rate for Payer: Priority Health Medicare |
$44.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.61
|
| Rate for Payer: Railroad Medicare Medicare |
$44.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.29
|
| Rate for Payer: UHC Core |
$148.30
|
| Rate for Payer: UHC Exchange |
$44.40
|
| Rate for Payer: UHC Medicaid |
$31.31
|
| Rate for Payer: UHC Medicare Advantage |
$44.40
|
| Rate for Payer: UHCCP Medicaid |
$31.31
|
| Rate for Payer: VA VA |
$44.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.20
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 60505252201
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: BCBS Trust/PPO |
$118.78
|
| Rate for Payer: BCN Commercial |
$118.78
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Nomi Health Commercial |
$117.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.56
|
| Rate for Payer: UHC Core |
$120.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
NDC 50268017711
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.94
|
| Rate for Payer: BCN Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.13
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
NDC 70436005106
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.97
|
| Rate for Payer: BCBS Complete |
$31.97
|
| Rate for Payer: BCBS MAPPO |
$43.18
|
| Rate for Payer: BCBS Trust/PPO |
$141.98
|
| Rate for Payer: BCN Commercial |
$141.98
|
| Rate for Payer: BCN Medicare Advantage |
$43.18
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.18
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Mclaren Medicaid |
$30.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.34
|
| Rate for Payer: Meridian Medicaid |
$31.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PACE Senior Care Partners |
$41.02
|
| Rate for Payer: PACE SWMI |
$43.18
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: PHP Medicare Advantage |
$43.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Medicare |
$43.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.21
|
| Rate for Payer: Railroad Medicare Medicare |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: UHC Exchange |
$43.18
|
| Rate for Payer: UHC Medicaid |
$30.45
|
| Rate for Payer: UHC Medicare Advantage |
$43.18
|
| Rate for Payer: UHCCP Medicaid |
$30.45
|
| Rate for Payer: VA VA |
$43.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
CILOSTAZOL 100 MG TABLET
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
NDC 70436005106
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: BCBS Trust/PPO |
$142.64
|
| Rate for Payer: BCN Commercial |
$142.64
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
OP
|
$2,496.62
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.15 |
| Max. Negotiated Rate |
$2,246.96 |
| Rate for Payer: Aetna Commercial |
$2,122.13
|
| Rate for Payer: Aetna Medicare |
$649.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$780.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$780.19
|
| Rate for Payer: BCBS Complete |
$462.12
|
| Rate for Payer: BCBS MAPPO |
$624.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.47
|
| Rate for Payer: BCN Commercial |
$2,052.47
|
| Rate for Payer: BCN Medicare Advantage |
$624.15
|
| Rate for Payer: Cash Price |
$1,997.30
|
| Rate for Payer: Cofinity Commercial |
$2,147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,997.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.15
|
| Rate for Payer: Healthscope Commercial |
$2,246.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,872.46
|
| Rate for Payer: Mclaren Medicaid |
$440.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.36
|
| Rate for Payer: Meridian Medicaid |
$462.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$717.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$686.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,122.13
|
| Rate for Payer: Nomi Health Commercial |
$2,047.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,872.46
|
| Rate for Payer: PACE Senior Care Partners |
$592.95
|
| Rate for Payer: PACE SWMI |
$624.15
|
| Rate for Payer: PHP Commercial |
$2,122.13
|
| Rate for Payer: PHP Medicare Advantage |
$624.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,172.06
|
| Rate for Payer: Priority Health Medicare |
$630.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,737.65
|
| Rate for Payer: Railroad Medicare Medicare |
$624.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,197.03
|
| Rate for Payer: UHC Core |
$2,084.68
|
| Rate for Payer: UHC Exchange |
$624.15
|
| Rate for Payer: UHC Medicaid |
$440.15
|
| Rate for Payer: UHC Medicare Advantage |
$624.15
|
| Rate for Payer: UHCCP Medicaid |
$440.15
|
| Rate for Payer: VA VA |
$624.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,872.46
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$2,496.62
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,737.65 |
| Max. Negotiated Rate |
$2,246.96 |
| Rate for Payer: Aetna Commercial |
$2,122.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,061.96
|
| Rate for Payer: BCN Commercial |
$2,061.96
|
| Rate for Payer: Cash Price |
$1,997.30
|
| Rate for Payer: Cofinity Commercial |
$2,147.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,997.30
|
| Rate for Payer: Healthscope Commercial |
$2,246.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,872.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,122.13
|
| Rate for Payer: Nomi Health Commercial |
$2,047.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,872.46
|
| Rate for Payer: PHP Commercial |
$2,122.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,172.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,737.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,197.03
|
| Rate for Payer: UHC Core |
$2,084.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,872.46
|
|
|
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 |
$128.65 |
| 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 |
$135.07
|
| Rate for Payer: BCBS MAPPO |
$182.43
|
| Rate for Payer: BCBS Trust/PPO |
$599.91
|
| Rate for Payer: BCN Commercial |
$599.91
|
| 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: Mclaren Medicaid |
$128.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.55
|
| Rate for Payer: Meridian Medicaid |
$135.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| 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 Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Medicare |
$184.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.89
|
| 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 Exchange |
$182.43
|
| Rate for Payer: UHC Medicaid |
$128.65
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
| 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 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.89 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$602.68
|
| Rate for Payer: BCN Commercial |
$602.68
|
| 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: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.89
|
| 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
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: Aetna Medicare |
$97.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.34
|
| Rate for Payer: BCBS Complete |
$69.50
|
| Rate for Payer: BCBS MAPPO |
$93.87
|
| Rate for Payer: BCBS Trust/PPO |
$308.68
|
| Rate for Payer: BCN Commercial |
$308.68
|
| Rate for Payer: BCN Medicare Advantage |
$93.87
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.87
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.61
|
| Rate for Payer: Mclaren Medicaid |
$66.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.56
|
| Rate for Payer: Meridian Medicaid |
$69.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Nomi Health Commercial |
$307.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PACE Senior Care Partners |
$89.18
|
| Rate for Payer: PACE SWMI |
$93.87
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: PHP Medicare Advantage |
$93.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.67
|
| Rate for Payer: Priority Health Medicare |
$94.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.33
|
| Rate for Payer: Railroad Medicare Medicare |
$93.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.42
|
| Rate for Payer: UHC Core |
$313.53
|
| Rate for Payer: UHC Exchange |
$93.87
|
| Rate for Payer: UHC Medicaid |
$66.20
|
| Rate for Payer: UHC Medicare Advantage |
$93.87
|
| Rate for Payer: UHCCP Medicaid |
$66.20
|
| Rate for Payer: VA VA |
$93.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.61
|
|
|
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 |
$507.89 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: BCBS Trust/PPO |
$602.68
|
| Rate for Payer: BCN Commercial |
$602.68
|
| 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: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.89
|
| 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
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$564.31 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: BCBS Trust/PPO |
$669.63
|
| Rate for Payer: BCN Commercial |
$669.63
|
| 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: Healthscope Commercial |
$729.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Nomi Health Commercial |
$664.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$705.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$713.50
|
| Rate for Payer: UHC Core |
$677.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
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 |
$142.94 |
| 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 |
$150.08
|
| Rate for Payer: BCBS MAPPO |
$202.70
|
| Rate for Payer: BCBS Trust/PPO |
$666.55
|
| Rate for Payer: BCN Commercial |
$666.55
|
| 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: Mclaren Medicaid |
$142.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.83
|
| Rate for Payer: Meridian Medicaid |
$150.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Nomi Health Commercial |
$664.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| 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 Choice Medicaid |
$142.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$705.39
|
| Rate for Payer: Priority Health Medicare |
$204.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.31
|
| 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 Exchange |
$202.70
|
| Rate for Payer: UHC Medicaid |
$142.94
|
| Rate for Payer: UHC Medicare Advantage |
$202.70
|
| Rate for Payer: UHCCP Medicaid |
$142.94
|
| 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 62756042790
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.65 |
| 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 |
$135.07
|
| Rate for Payer: BCBS MAPPO |
$182.43
|
| Rate for Payer: BCBS Trust/PPO |
$599.91
|
| Rate for Payer: BCN Commercial |
$599.91
|
| 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: Mclaren Medicaid |
$128.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.55
|
| Rate for Payer: Meridian Medicaid |
$135.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Nomi Health Commercial |
$598.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| 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 Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.87
|
| Rate for Payer: Priority Health Medicare |
$184.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.89
|
| 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 Exchange |
$182.43
|
| Rate for Payer: UHC Medicaid |
$128.65
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
| 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
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.33 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: BCBS Trust/PPO |
$310.11
|
| Rate for Payer: BCN Commercial |
$310.11
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Nomi Health Commercial |
$307.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.42
|
| Rate for Payer: UHC Core |
$313.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.61
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$261.56
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.05 |
| Max. Negotiated Rate |
$235.40 |
| Rate for Payer: Aetna Commercial |
$222.33
|
| Rate for Payer: BCBS Trust/PPO |
$216.02
|
| Rate for Payer: BCN Commercial |
$216.02
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$235.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.33
|
| Rate for Payer: Nomi Health Commercial |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.17
|
| Rate for Payer: PHP Commercial |
$222.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.17
|
| Rate for Payer: UHC Core |
$218.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.17
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$261.56
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$235.40 |
| Rate for Payer: Aetna Commercial |
$222.33
|
| Rate for Payer: Aetna Medicare |
$68.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.74
|
| Rate for Payer: BCBS Complete |
$48.41
|
| Rate for Payer: BCBS MAPPO |
$65.39
|
| Rate for Payer: BCBS Trust/PPO |
$215.03
|
| Rate for Payer: BCN Commercial |
$215.03
|
| Rate for Payer: BCN Medicare Advantage |
$65.39
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cofinity Commercial |
$224.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.39
|
| Rate for Payer: Healthscope Commercial |
$235.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.17
|
| Rate for Payer: Mclaren Medicaid |
$46.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.66
|
| Rate for Payer: Meridian Medicaid |
$48.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.33
|
| Rate for Payer: Nomi Health Commercial |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.17
|
| Rate for Payer: PACE Senior Care Partners |
$62.12
|
| Rate for Payer: PACE SWMI |
$65.39
|
| Rate for Payer: PHP Commercial |
$222.33
|
| Rate for Payer: PHP Medicare Advantage |
$65.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.56
|
| Rate for Payer: Priority Health Medicare |
$66.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.05
|
| Rate for Payer: Railroad Medicare Medicare |
$65.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.17
|
| Rate for Payer: UHC Core |
$218.40
|
| Rate for Payer: UHC Exchange |
$65.39
|
| Rate for Payer: UHC Medicaid |
$46.11
|
| Rate for Payer: UHC Medicare Advantage |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$46.11
|
| Rate for Payer: VA VA |
$65.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.17
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| 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: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| 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
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.88 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: BCBS Trust/PPO |
$298.89
|
| Rate for Payer: BCN Commercial |
$298.89
|
| 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: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| 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
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| 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 |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| 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: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| 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 Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| 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 Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.80 |
| 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 |
$66.99
|
| Rate for Payer: BCBS MAPPO |
$90.47
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$297.52
|
| 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: Mclaren Medicaid |
$63.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.00
|
| Rate for Payer: Meridian Medicaid |
$66.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| 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 Choice Medicaid |
$63.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$91.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| 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 Exchange |
$90.47
|
| Rate for Payer: UHC Medicaid |
$63.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.47
|
| Rate for Payer: UHCCP Medicaid |
$63.80
|
| Rate for Payer: VA VA |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
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 |
$9.00 |
| 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 |
$9.45
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$41.96
|
| Rate for Payer: BCN Commercial |
$41.96
|
| 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: Mclaren Medicaid |
$9.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Meridian Medicaid |
$9.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.28
|
| 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 Choice Medicaid |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.40
|
| Rate for Payer: Priority Health Medicare |
$12.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.52
|
| 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 Exchange |
$12.76
|
| Rate for Payer: UHC Medicaid |
$9.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: UHCCP Medicaid |
$9.00
|
| 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 |
$35.52 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: BCBS Trust/PPO |
$42.15
|
| Rate for Payer: BCN Commercial |
$42.15
|
| 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: Opus (Opus Packaging Group) HMA |
$38.28
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.52
|
| 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
|
|
