|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 60687086001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.10 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: BCBS Trust/PPO |
$224.40
|
| Rate for Payer: BCN Commercial |
$224.40
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$236.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.10
|
| Rate for Payer: UHC Core |
$226.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 60687086011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$91.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.42
|
| Rate for Payer: BCBS Complete |
$64.81
|
| Rate for Payer: BCBS MAPPO |
$87.54
|
| Rate for Payer: BCBS Trust/PPO |
$287.86
|
| Rate for Payer: BCN Commercial |
$287.86
|
| Rate for Payer: BCN Medicare Advantage |
$87.54
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.54
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Mclaren Medicaid |
$61.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.91
|
| Rate for Payer: Meridian Medicaid |
$64.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| 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 Choice Medicaid |
$61.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Medicare |
$88.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.70
|
| 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 Exchange |
$87.54
|
| Rate for Payer: UHC Medicaid |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$87.54
|
| Rate for Payer: UHCCP Medicaid |
$61.73
|
| Rate for Payer: VA VA |
$87.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
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 500 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 51079018220
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.66 |
| 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 |
$62.64
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$278.20
|
| 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: Mclaren Medicaid |
$59.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: Meridian Medicaid |
$62.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| 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 Choice Medicaid |
$59.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.53
|
| 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 Exchange |
$84.60
|
| Rate for Payer: UHC Medicaid |
$59.66
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: UHCCP Medicaid |
$59.66
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: BCBS Trust/PPO |
$222.04
|
| Rate for Payer: BCN Commercial |
$222.04
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.64
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.12
|
| 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
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| 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 |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| 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: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.02
|
| 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 Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| 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 Exchange |
$0.67
|
| Rate for Payer: UHC Medicaid |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| 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 |
$80.79 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$84.82
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$376.73
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Mclaren Medicaid |
$80.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: Meridian Medicaid |
$84.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| 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 Choice Medicaid |
$80.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| 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 Exchange |
$114.56
|
| Rate for Payer: UHC Medicaid |
$80.79
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: UHCCP Medicaid |
$80.79
|
| 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 |
$1.87 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| 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: Opus (Opus Packaging Group) HMA |
$2.02
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| 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
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$69.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.02
|
| Rate for Payer: BCBS Complete |
$49.76
|
| Rate for Payer: BCBS MAPPO |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$221.02
|
| Rate for Payer: BCN Commercial |
$221.02
|
| Rate for Payer: BCN Medicare Advantage |
$67.21
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Mclaren Medicaid |
$47.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.57
|
| Rate for Payer: Meridian Medicaid |
$49.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.64
|
| Rate for Payer: PACE Senior Care Partners |
$63.85
|
| Rate for Payer: PACE SWMI |
$67.21
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: PHP Medicare Advantage |
$67.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Medicare |
$67.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.12
|
| Rate for Payer: Railroad Medicare Medicare |
$67.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: UHC Exchange |
$67.21
|
| Rate for Payer: UHC Medicaid |
$47.40
|
| Rate for Payer: UHC Medicare Advantage |
$67.21
|
| Rate for Payer: UHCCP Medicaid |
$47.40
|
| Rate for Payer: VA VA |
$67.21
|
| 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 |
$318.94 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$378.47
|
| Rate for Payer: BCN Commercial |
$378.47
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 51079018220
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.53 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$279.48
|
| Rate for Payer: BCN Commercial |
$279.48
|
| 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: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| 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 500 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 60687086001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$70.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.91
|
| Rate for Payer: BCBS Complete |
$50.29
|
| Rate for Payer: BCBS MAPPO |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$223.36
|
| Rate for Payer: BCN Commercial |
$223.36
|
| Rate for Payer: BCN Medicare Advantage |
$67.92
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.92
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Mclaren Medicaid |
$47.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.32
|
| Rate for Payer: Meridian Medicaid |
$50.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PACE Senior Care Partners |
$64.53
|
| Rate for Payer: PACE SWMI |
$67.92
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: PHP Medicare Advantage |
$67.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$236.38
|
| Rate for Payer: Priority Health Medicare |
$68.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: Railroad Medicare Medicare |
$67.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.10
|
| Rate for Payer: UHC Core |
$226.87
|
| Rate for Payer: UHC Exchange |
$67.92
|
| Rate for Payer: UHC Medicaid |
$47.90
|
| Rate for Payer: UHC Medicare Advantage |
$67.92
|
| Rate for Payer: UHCCP Medicaid |
$47.90
|
| Rate for Payer: VA VA |
$67.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 60687086011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Nomi Health Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.70 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: BCBS Trust/PPO |
$289.19
|
| Rate for Payer: BCN Commercial |
$289.19
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Nomi Health Commercial |
$287.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$114.51
|
| Rate for Payer: BCN Commercial |
$114.51
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$25.66
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$113.98
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Mclaren Medicaid |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: Meridian Medicaid |
$25.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicaid |
$24.44
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: UHCCP Medicaid |
$24.44
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.84
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Commercial |
$11.79
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Mclaren Medicaid |
$2.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$2.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PACE Senior Care Partners |
$3.41
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Medicare |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicaid |
$2.53
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$2.53
|
| Rate for Payer: VA VA |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$20,704.95
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$19,719.00 |
| Max. Negotiated Rate |
$20,704.95 |
| Rate for Payer: BCBS Complete |
$20,704.95
|
| Rate for Payer: Mclaren Medicaid |
$19,719.00
|
| Rate for Payer: Meridian Medicaid |
$20,704.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,719.00
|
| Rate for Payer: UHC Medicaid |
$19,719.00
|
| Rate for Payer: UHCCP Medicaid |
$19,719.00
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$7,435.38
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$7,081.31 |
| Max. Negotiated Rate |
$7,435.38 |
| Rate for Payer: BCBS Complete |
$7,435.38
|
| Rate for Payer: Mclaren Medicaid |
$7,081.31
|
| Rate for Payer: Meridian Medicaid |
$7,435.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,081.31
|
| Rate for Payer: UHC Medicaid |
$7,081.31
|
| Rate for Payer: UHCCP Medicaid |
$7,081.31
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$11,825.62
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$11,262.49 |
| Max. Negotiated Rate |
$11,825.62 |
| Rate for Payer: BCBS Complete |
$11,825.62
|
| Rate for Payer: Mclaren Medicaid |
$11,262.49
|
| Rate for Payer: Meridian Medicaid |
$11,825.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,262.49
|
| Rate for Payer: UHC Medicaid |
$11,262.49
|
| Rate for Payer: UHCCP Medicaid |
$11,262.49
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$9,982.02
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$9,506.69 |
| Max. Negotiated Rate |
$9,982.02 |
| Rate for Payer: BCBS Complete |
$9,982.02
|
| Rate for Payer: Mclaren Medicaid |
$9,506.69
|
| Rate for Payer: Meridian Medicaid |
$9,982.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,506.69
|
| Rate for Payer: UHC Medicaid |
$9,506.69
|
| Rate for Payer: UHCCP Medicaid |
$9,506.69
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.28
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: Aetna Medicare |
$3.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.34
|
| Rate for Payer: BCBS Complete |
$2.83
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$5.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.69
|
| Rate for Payer: BCN Commercial |
$16.69
|
| Rate for Payer: BCN Commercial |
$12.56
|
| Rate for Payer: BCN Medicare Advantage |
$5.08
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cofinity Commercial |
$13.14
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.75
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.22
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicaid |
$2.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.01
|
| Rate for Payer: Meridian Medicaid |
$2.83
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.99
|
| Rate for Payer: Nomi Health Commercial |
$16.65
|
| Rate for Payer: Nomi Health Commercial |
$12.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$5.08
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$12.99
|
| Rate for Payer: PHP Commercial |
$17.25
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.29
|
| Rate for Payer: Priority Health Medicare |
$5.13
|
| Rate for Payer: Priority Health Medicare |
$3.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.86
|
| Rate for Payer: UHC Core |
$16.95
|
| Rate for Payer: UHC Core |
$12.76
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Exchange |
$3.82
|
| Rate for Payer: UHC Medicaid |
$3.58
|
| Rate for Payer: UHC Medicaid |
$2.69
|
| Rate for Payer: UHC Medicare Advantage |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$2.69
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: VA VA |
$5.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.46
|
|
