|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
IP
|
$3,757.99
|
|
|
Service Code
|
NDC 27808008602
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,653.52 |
| 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 New Business (MI Preferred) |
$2,442.69
|
| 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: 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: UMR Bronson Commercial |
$1,653.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,818.49
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
IP
|
$43.65
|
|
|
Service Code
|
NDC 09900000025
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$39.28 |
| Rate for Payer: Aetna American Axle |
$28.37
|
| Rate for Payer: Aetna Commercial |
$37.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.37
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cofinity Advantage |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$37.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$39.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.74
|
| Rate for Payer: PHP Commercial |
$37.10
|
| Rate for Payer: Priority Health SBD |
$27.50
|
| Rate for Payer: UMR Bronson Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.74
|
|
|
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
|
|
|
CHLORPROMAZINE 100 MG TABLET
|
Facility
|
OP
|
$363.36
|
|
|
Service Code
|
NDC 00832602000
|
| Hospital Charge Code |
1654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.44 |
| Max. Negotiated Rate |
$327.02 |
| Rate for Payer: Aetna American Axle |
$236.18
|
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Aetna Medicare |
$181.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.18
|
| Rate for Payer: BCBS Complete |
$145.34
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Advantage |
$254.35
|
| Rate for Payer: Cofinity Commercial |
$312.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$327.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.52
|
| Rate for Payer: PHP Commercial |
$308.86
|
| Rate for Payer: Priority Health SBD |
$228.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.18
|
| Rate for Payer: UHC Core |
$189.31
|
| Rate for Payer: UHC Exchange |
$142.80
|
| Rate for Payer: UMR Bronson Commercial |
$134.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.52
|
|
|
CHLORPROMAZINE 100 MG TABLET
|
Facility
|
IP
|
$363.36
|
|
|
Service Code
|
NDC 00832602000
|
| Hospital Charge Code |
1654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$327.02 |
| Rate for Payer: Aetna American Axle |
$236.18
|
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.18
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Advantage |
$254.35
|
| Rate for Payer: Cofinity Commercial |
$312.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$327.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.52
|
| Rate for Payer: PHP Commercial |
$308.86
|
| Rate for Payer: Priority Health SBD |
$228.92
|
| Rate for Payer: UMR Bronson Commercial |
$159.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.52
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$304.95
|
|
|
Service Code
|
NDC 00527296137
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$274.45 |
| Rate for Payer: Aetna American Axle |
$198.22
|
| Rate for Payer: Aetna Commercial |
$259.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.22
|
| Rate for Payer: Cash Price |
$243.96
|
| Rate for Payer: Cofinity Advantage |
$213.47
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.71
|
| Rate for Payer: PHP Commercial |
$259.21
|
| Rate for Payer: Priority Health SBD |
$192.12
|
| Rate for Payer: UMR Bronson Commercial |
$134.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.71
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.63 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna American Axle |
$593.31
|
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Advantage |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.59
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health SBD |
$575.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.59
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 00832601700
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Advantage |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$1,152.55
|
|
|
Service Code
|
NDC 00904712961
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.12 |
| Max. Negotiated Rate |
$1,037.30 |
| Rate for Payer: Aetna American Axle |
$749.16
|
| Rate for Payer: Aetna Commercial |
$979.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.16
|
| Rate for Payer: Cash Price |
$922.04
|
| Rate for Payer: Cofinity Advantage |
$806.78
|
| Rate for Payer: Cofinity Commercial |
$991.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$922.04
|
| Rate for Payer: Healthscope Commercial |
$1,037.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$864.41
|
| Rate for Payer: PHP Commercial |
$979.67
|
| Rate for Payer: Priority Health SBD |
$726.11
|
| Rate for Payer: UMR Bronson Commercial |
$507.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.41
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.73 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna American Axle |
$593.31
|
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna Medicare |
$456.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: BCBS Complete |
$365.12
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Advantage |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$730.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.59
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health SBD |
$575.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.31
|
| Rate for Payer: UHC Core |
$475.56
|
| Rate for Payer: UHC Exchange |
$358.73
|
| Rate for Payer: UMR Bronson Commercial |
$337.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.59
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$304.95
|
|
|
Service Code
|
NDC 00527296137
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.83 |
| Max. Negotiated Rate |
$274.45 |
| Rate for Payer: Aetna American Axle |
$198.22
|
| Rate for Payer: Aetna Commercial |
$259.21
|
| Rate for Payer: Aetna Medicare |
$152.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.22
|
| Rate for Payer: BCBS Complete |
$121.98
|
| Rate for Payer: Cash Price |
$243.96
|
| Rate for Payer: Cofinity Advantage |
$213.47
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.71
|
| Rate for Payer: PHP Commercial |
$259.21
|
| Rate for Payer: Priority Health SBD |
$192.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.22
|
| Rate for Payer: UHC Core |
$158.88
|
| Rate for Payer: UHC Exchange |
$119.85
|
| Rate for Payer: UMR Bronson Commercial |
$112.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.71
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 00832601700
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Advantage |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.94
|
| Rate for Payer: UHC Core |
$185.11
|
| Rate for Payer: UHC Exchange |
$139.63
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$1,152.55
|
|
|
Service Code
|
NDC 00904712961
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$1,037.30 |
| Rate for Payer: Aetna American Axle |
$749.16
|
| Rate for Payer: Aetna Commercial |
$979.67
|
| Rate for Payer: Aetna Medicare |
$576.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.16
|
| Rate for Payer: BCBS Complete |
$461.02
|
| Rate for Payer: Cash Price |
$922.04
|
| Rate for Payer: Cofinity Advantage |
$806.78
|
| Rate for Payer: Cofinity Commercial |
$991.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$922.04
|
| Rate for Payer: Healthscope Commercial |
$1,037.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$922.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$864.41
|
| Rate for Payer: PHP Commercial |
$979.67
|
| Rate for Payer: Priority Health SBD |
$726.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.16
|
| Rate for Payer: UHC Core |
$600.48
|
| Rate for Payer: UHC Exchange |
$452.95
|
| Rate for Payer: UMR Bronson Commercial |
$426.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.41
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$94.04
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna American Axle |
$46.87
|
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: BCBS Complete |
$37.62
|
| Rate for Payer: BCBS Trust/PPO |
$77.05
|
| Rate for Payer: BCBS Trust/PPO |
$77.05
|
| Rate for Payer: BCN Commercial |
$77.05
|
| Rate for Payer: BCN Commercial |
$77.05
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Advantage |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health SBD |
$45.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Core |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
| Rate for Payer: UHC Exchange |
$39.22
|
| Rate for Payer: UMR Bronson Commercial |
$34.79
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$94.04
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: UMR Bronson Commercial |
$41.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 62332073631
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 62332073631
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.50 |
| Max. Negotiated Rate |
$1,177.15 |
| Rate for Payer: Aetna American Axle |
$850.17
|
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.17
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Advantage |
$915.57
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$980.96
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health SBD |
$824.01
|
| Rate for Payer: UMR Bronson Commercial |
$575.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$249.12
|
|
|
Service Code
|
NDC 00832601800
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna Medicare |
$124.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: BCBS Complete |
$99.65
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Advantage |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.84
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.93
|
| Rate for Payer: UHC Core |
$129.79
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.94 |
| Max. Negotiated Rate |
$1,177.15 |
| Rate for Payer: Aetna American Axle |
$850.17
|
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna Medicare |
$653.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.17
|
| Rate for Payer: BCBS Complete |
$523.18
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Advantage |
$915.57
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,046.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$980.96
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health SBD |
$824.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.17
|
| Rate for Payer: UHC Core |
$681.44
|
| Rate for Payer: UHC Exchange |
$514.02
|
| Rate for Payer: UMR Bronson Commercial |
$483.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 00832601800
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Advantage |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.84
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$109.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$380.64
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Advantage |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.48
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UMR Bronson Commercial |
$167.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$447.84
|
|
|
Service Code
|
NDC 70710113001
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.70 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna Medicare |
$223.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Advantage |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.88
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health SBD |
$282.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.10
|
| Rate for Payer: UHC Core |
$233.32
|
| Rate for Payer: UHC Exchange |
$176.00
|
| Rate for Payer: UMR Bronson Commercial |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$380.64
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna Medicare |
$190.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: BCBS Complete |
$152.26
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Advantage |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.48
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.42
|
| Rate for Payer: UHC Core |
$198.31
|
| Rate for Payer: UHC Exchange |
$149.59
|
| Rate for Payer: UMR Bronson Commercial |
$140.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 70710113001
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Advantage |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.88
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health SBD |
$282.14
|
| Rate for Payer: UMR Bronson Commercial |
$197.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
