|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$21.51
|
|
|
Service Code
|
NDC 00116200106
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.36 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Advantage |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.21
|
| Rate for Payer: Healthscope Commercial |
$19.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.13
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health SBD |
$13.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.13
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$100.04
|
|
|
Service Code
|
NDC 52376002102
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$90.04 |
| Rate for Payer: Aetna American Axle |
$65.03
|
| Rate for Payer: Aetna Commercial |
$85.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.03
|
| Rate for Payer: Cash Price |
$80.03
|
| Rate for Payer: Cofinity Advantage |
$70.03
|
| Rate for Payer: Cofinity Commercial |
$86.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.03
|
| Rate for Payer: Healthscope Commercial |
$90.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.03
|
| Rate for Payer: PHP Commercial |
$85.03
|
| Rate for Payer: Priority Health SBD |
$63.03
|
| Rate for Payer: UMR Bronson Commercial |
$44.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.03
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$44.77
|
|
|
Service Code
|
NDC 60687061616
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Aetna American Axle |
$29.10
|
| Rate for Payer: Aetna Commercial |
$38.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.10
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Advantage |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.58
|
| Rate for Payer: PHP Commercial |
$38.05
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.58
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$19.39
|
|
|
Service Code
|
NDC 00904703587
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna American Axle |
$12.60
|
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Advantage |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: PHP Commercial |
$16.48
|
| Rate for Payer: Priority Health SBD |
$12.22
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
NDC 00121089315
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Aetna American Axle |
$14.66
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.66
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cofinity Advantage |
$15.79
|
| Rate for Payer: Cofinity Commercial |
$19.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.92
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.92
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$21.51
|
|
|
Service Code
|
NDC 00116200105
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.36 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Advantage |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.21
|
| Rate for Payer: Healthscope Commercial |
$19.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.13
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health SBD |
$13.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.13
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$21.51
|
|
|
Service Code
|
NDC 00116200105
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$19.36 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Advantage |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.21
|
| Rate for Payer: Healthscope Commercial |
$19.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.13
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health SBD |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC Core |
$11.21
|
| Rate for Payer: UHC Exchange |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.13
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$25.03
|
|
|
Service Code
|
NDC 00904703588
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna American Axle |
$16.27
|
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Advantage |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.77
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UMR Bronson Commercial |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.77
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna American Axle |
$53.86
|
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna Medicare |
$41.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Advantage |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.15
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health SBD |
$52.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.15
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna American Axle |
$53.86
|
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Advantage |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.15
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health SBD |
$52.20
|
| Rate for Payer: UMR Bronson Commercial |
$36.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.15
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
IP
|
$87.05
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna American Axle |
$56.58
|
| Rate for Payer: Aetna American Axle |
$53.11
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cofinity Advantage |
$60.94
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.29
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: Priority Health SBD |
$54.84
|
| Rate for Payer: UMR Bronson Commercial |
$38.30
|
| Rate for Payer: UMR Bronson Commercial |
$35.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.28
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
OP
|
$81.71
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$73.54 |
| Rate for Payer: Aetna American Axle |
$53.11
|
| Rate for Payer: Aetna American Axle |
$56.58
|
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Medicare |
$40.85
|
| Rate for Payer: Aetna Medicare |
$43.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: BCBS Complete |
$34.82
|
| Rate for Payer: BCBS Complete |
$32.68
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cofinity Advantage |
$60.94
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: Priority Health SBD |
$54.84
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$32.21
|
| Rate for Payer: UMR Bronson Commercial |
$30.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.29
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$668.70
|
|
|
Service Code
|
NDC 65649031112
|
| Hospital Charge Code |
9525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$601.83 |
| Rate for Payer: Aetna American Axle |
$434.65
|
| Rate for Payer: Aetna Commercial |
$568.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.65
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cofinity Advantage |
$468.09
|
| Rate for Payer: Cofinity Commercial |
$575.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.96
|
| Rate for Payer: Healthscope Commercial |
$601.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.52
|
| Rate for Payer: PHP Commercial |
$568.39
|
| Rate for Payer: Priority Health SBD |
$421.28
|
| Rate for Payer: UMR Bronson Commercial |
$294.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.52
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$668.70
|
|
|
Service Code
|
NDC 65649031112
|
| Hospital Charge Code |
9525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.42 |
| Max. Negotiated Rate |
$601.83 |
| Rate for Payer: Aetna American Axle |
$434.65
|
| Rate for Payer: Aetna Commercial |
$568.39
|
| Rate for Payer: Aetna Medicare |
$334.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.65
|
| Rate for Payer: BCBS Complete |
$267.48
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cofinity Advantage |
$468.09
|
| Rate for Payer: Cofinity Commercial |
$575.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.96
|
| Rate for Payer: Healthscope Commercial |
$601.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$534.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.52
|
| Rate for Payer: PHP Commercial |
$568.39
|
| Rate for Payer: Priority Health SBD |
$421.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.65
|
| Rate for Payer: UHC Core |
$348.39
|
| Rate for Payer: UHC Exchange |
$262.80
|
| Rate for Payer: UMR Bronson Commercial |
$247.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.52
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.83
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.41 |
| Max. Negotiated Rate |
$188.47 |
| Rate for Payer: Aetna American Axle |
$85.04
|
| Rate for Payer: Aetna American Axle |
$138.38
|
| Rate for Payer: Aetna American Axle |
$114.34
|
| Rate for Payer: Aetna American Axle |
$114.00
|
| Rate for Payer: Aetna American Axle |
$153.22
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna Commercial |
$149.07
|
| Rate for Payer: Aetna Commercial |
$200.36
|
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna Medicare |
$117.86
|
| Rate for Payer: Aetna Medicare |
$87.69
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna Medicare |
$87.95
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.22
|
| Rate for Payer: BCBS Complete |
$85.16
|
| Rate for Payer: BCBS Complete |
$52.33
|
| Rate for Payer: BCBS Complete |
$70.15
|
| Rate for Payer: BCBS Complete |
$70.36
|
| Rate for Payer: BCBS Complete |
$94.29
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$188.58
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cash Price |
$188.58
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Advantage |
$122.77
|
| Rate for Payer: Cofinity Advantage |
$123.14
|
| Rate for Payer: Cofinity Advantage |
$165.00
|
| Rate for Payer: Cofinity Advantage |
$91.58
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$150.83
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$202.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Healthscope Commercial |
$212.15
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$157.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.79
|
| Rate for Payer: PHP Commercial |
$149.07
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: PHP Commercial |
$200.36
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: Priority Health SBD |
$134.13
|
| Rate for Payer: Priority Health SBD |
$148.50
|
| Rate for Payer: Priority Health SBD |
$110.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.41
|
| Rate for Payer: UMR Bronson Commercial |
$78.77
|
| Rate for Payer: UMR Bronson Commercial |
$65.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.22
|
| Rate for Payer: UMR Bronson Commercial |
$64.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.12
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$235.72
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$212.15 |
| Rate for Payer: Aetna American Axle |
$153.22
|
| Rate for Payer: Aetna American Axle |
$114.34
|
| Rate for Payer: Aetna American Axle |
$85.04
|
| Rate for Payer: Aetna American Axle |
$114.00
|
| Rate for Payer: Aetna American Axle |
$138.38
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna Commercial |
$149.07
|
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna Commercial |
$200.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$188.58
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cofinity Advantage |
$165.00
|
| Rate for Payer: Cofinity Advantage |
$123.14
|
| Rate for Payer: Cofinity Advantage |
$91.58
|
| Rate for Payer: Cofinity Advantage |
$122.77
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$202.72
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$150.83
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Healthscope Commercial |
$157.84
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: Healthscope Commercial |
$212.15
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.79
|
| Rate for Payer: PHP Commercial |
$149.07
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: PHP Commercial |
$200.36
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: Priority Health SBD |
$110.49
|
| Rate for Payer: Priority Health SBD |
$134.13
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: Priority Health SBD |
$148.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.40
|
| Rate for Payer: UMR Bronson Commercial |
$103.72
|
| Rate for Payer: UMR Bronson Commercial |
$93.68
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: UMR Bronson Commercial |
$77.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.68
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
IP
|
$212.90
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.68 |
| Max. Negotiated Rate |
$191.61 |
| Rate for Payer: Aetna American Axle |
$138.38
|
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: Priority Health SBD |
$134.13
|
| Rate for Payer: UMR Bronson Commercial |
$93.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.68
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
OP
|
$212.90
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$191.61 |
| Rate for Payer: Aetna American Axle |
$138.38
|
| Rate for Payer: Aetna Commercial |
$180.97
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.38
|
| Rate for Payer: BCBS Complete |
$85.16
|
| Rate for Payer: BCBS Trust/PPO |
$188.47
|
| Rate for Payer: BCN Commercial |
$188.47
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cofinity Advantage |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$183.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.32
|
| Rate for Payer: Healthscope Commercial |
$191.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.68
|
| Rate for Payer: PHP Commercial |
$180.97
|
| Rate for Payer: Priority Health SBD |
$134.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC Core |
$95.91
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UMR Bronson Commercial |
$78.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.68
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 49483024201
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.08
|
| Rate for Payer: UHC Core |
$25.71
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 00904001261
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 00904001261
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.09
|
| Rate for Payer: UHC Core |
$93.05
|
| Rate for Payer: UHC Exchange |
$70.19
|
| Rate for Payer: UMR Bronson Commercial |
$66.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$28.20
|
|
|
Service Code
|
NDC 00536100601
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna American Axle |
$18.33
|
| Rate for Payer: Aetna Commercial |
$23.97
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.33
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Advantage |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.15
|
| Rate for Payer: PHP Commercial |
$23.97
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.33
|
| Rate for Payer: UHC Core |
$14.69
|
| Rate for Payer: UHC Exchange |
$11.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.15
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$28.20
|
|
|
Service Code
|
NDC 00536100601
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna American Axle |
$18.33
|
| Rate for Payer: Aetna Commercial |
$23.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.33
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Advantage |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.15
|
| Rate for Payer: PHP Commercial |
$23.97
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.15
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 49483024201
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
OP
|
$3,757.99
|
|
|
Service Code
|
NDC 27808008602
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,390.46 |
| Max. Negotiated Rate |
$3,382.19 |
| Rate for Payer: Aetna American Axle |
$2,442.69
|
| Rate for Payer: Aetna Commercial |
$3,194.29
|
| Rate for Payer: Aetna Medicare |
$1,878.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,442.69
|
| Rate for Payer: BCBS Complete |
$1,503.20
|
| Rate for Payer: Cash Price |
$3,006.39
|
| Rate for Payer: Cofinity Advantage |
$2,630.59
|
| Rate for Payer: Cofinity Commercial |
$3,231.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,006.39
|
| Rate for Payer: Healthscope Commercial |
$3,382.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,630.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,818.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,006.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,194.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,818.49
|
| Rate for Payer: PHP Commercial |
$3,194.29
|
| Rate for Payer: Priority Health SBD |
$2,367.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,442.69
|
| Rate for Payer: UHC Core |
$1,957.91
|
| Rate for Payer: UHC Exchange |
$1,476.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,390.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,818.49
|
|
