|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$9,737.26
|
|
|
Service Code
|
APR-DRG 1404
|
| Min. Negotiated Rate |
$9,273.58 |
| Max. Negotiated Rate |
$9,737.26 |
| Rate for Payer: BCBS Complete |
$9,737.26
|
| Rate for Payer: Mclaren Medicaid |
$9,273.58
|
| Rate for Payer: Meridian Medicaid |
$9,737.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,273.58
|
| Rate for Payer: UHC Medicaid |
$9,273.58
|
| Rate for Payer: UHCCP Medicaid |
$9,273.58
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$6,082.91
|
|
|
Service Code
|
APR-DRG 1403
|
| Min. Negotiated Rate |
$5,793.25 |
| Max. Negotiated Rate |
$6,082.91 |
| Rate for Payer: BCBS Complete |
$6,082.91
|
| Rate for Payer: Mclaren Medicaid |
$5,793.25
|
| Rate for Payer: Meridian Medicaid |
$6,082.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,793.25
|
| Rate for Payer: UHC Medicaid |
$5,793.25
|
| Rate for Payer: UHCCP Medicaid |
$5,793.25
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$4,614.39
|
|
|
Service Code
|
APR-DRG 1402
|
| Min. Negotiated Rate |
$4,394.66 |
| Max. Negotiated Rate |
$4,614.39 |
| Rate for Payer: BCBS Complete |
$4,614.39
|
| Rate for Payer: Mclaren Medicaid |
$4,394.66
|
| Rate for Payer: Meridian Medicaid |
$4,614.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,394.66
|
| Rate for Payer: UHC Medicaid |
$4,394.66
|
| Rate for Payer: UHCCP Medicaid |
$4,394.66
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$18,186.29
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$7,260.59 |
| Max. Negotiated Rate |
$18,186.29 |
| Rate for Payer: Aetna Medicare |
$7,948.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,553.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,553.41
|
| Rate for Payer: BCBS MAPPO |
$7,642.73
|
| Rate for Payer: BCBS Trust/PPO |
$18,186.29
|
| Rate for Payer: BCN Commercial |
$18,186.29
|
| Rate for Payer: BCN Medicare Advantage |
$7,642.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,642.73
|
| Rate for Payer: Mclaren Medicare |
$7,642.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,024.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,789.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,407.00
|
| Rate for Payer: Nomi Health Commercial |
$10,874.70
|
| Rate for Payer: PACE Medicare |
$7,260.59
|
| Rate for Payer: PACE SWMI |
$7,642.73
|
| Rate for Payer: PHP Medicare Advantage |
$7,642.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,590.96
|
| Rate for Payer: Priority Health Medicare |
$7,642.73
|
| Rate for Payer: Priority Health Tiered Network |
$10,872.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7,642.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,740.90
|
| Rate for Payer: UHC Core |
$11,495.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,642.73
|
| Rate for Payer: UHC Exchange |
$9,388.49
|
| Rate for Payer: VA VA |
$7,642.73
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$20,437.27
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$9,363.50 |
| Max. Negotiated Rate |
$20,437.27 |
| Rate for Payer: Aetna Medicare |
$10,250.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,320.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,320.40
|
| Rate for Payer: BCBS MAPPO |
$9,856.32
|
| Rate for Payer: BCBS Trust/PPO |
$20,437.27
|
| Rate for Payer: BCN Commercial |
$20,437.27
|
| Rate for Payer: BCN Medicare Advantage |
$9,856.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,856.32
|
| Rate for Payer: Mclaren Medicare |
$9,856.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,349.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,334.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,841.95
|
| Rate for Payer: Nomi Health Commercial |
$14,289.33
|
| Rate for Payer: PACE Medicare |
$9,363.50
|
| Rate for Payer: PACE SWMI |
$9,856.32
|
| Rate for Payer: PHP Medicare Advantage |
$9,856.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,858.49
|
| Rate for Payer: Priority Health Medicare |
$9,856.32
|
| Rate for Payer: Priority Health Tiered Network |
$14,286.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,856.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,055.51
|
| Rate for Payer: UHC Core |
$15,105.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,856.32
|
| Rate for Payer: UHC Exchange |
$12,336.45
|
| Rate for Payer: VA VA |
$9,856.32
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$13,343.93
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,663.72 |
| Max. Negotiated Rate |
$13,343.93 |
| Rate for Payer: Aetna Medicare |
$6,200.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,452.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,452.26
|
| Rate for Payer: BCBS MAPPO |
$5,961.81
|
| Rate for Payer: BCBS Trust/PPO |
$13,343.93
|
| Rate for Payer: BCN Commercial |
$13,343.93
|
| Rate for Payer: BCN Medicare Advantage |
$5,961.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,961.81
|
| Rate for Payer: Mclaren Medicare |
$5,961.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,259.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,856.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,557.99
|
| Rate for Payer: Nomi Health Commercial |
$8,281.80
|
| Rate for Payer: PACE Medicare |
$5,663.72
|
| Rate for Payer: PACE SWMI |
$5,961.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,961.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,350.41
|
| Rate for Payer: Priority Health Medicare |
$5,961.81
|
| Rate for Payer: Priority Health Tiered Network |
$8,280.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5,961.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,464.60
|
| Rate for Payer: UHC Core |
$8,754.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,961.81
|
| Rate for Payer: UHC Exchange |
$7,149.95
|
| Rate for Payer: VA VA |
$5,961.81
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,831.43
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.29 |
| Max. Negotiated Rate |
$1,723.00 |
| Rate for Payer: Aetna American Axle |
$1,190.43
|
| Rate for Payer: Aetna Commercial |
$1,556.72
|
| Rate for Payer: Aetna Medicare |
$583.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$700.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$700.99
|
| Rate for Payer: BCBS Complete |
$307.99
|
| Rate for Payer: BCBS MAPPO |
$560.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.69
|
| Rate for Payer: BCN Commercial |
$1,700.69
|
| Rate for Payer: BCN Medicare Advantage |
$560.79
|
| Rate for Payer: Cash Price |
$1,465.14
|
| Rate for Payer: Cash Price |
$1,465.14
|
| Rate for Payer: Cofinity Advantage |
$1,282.00
|
| Rate for Payer: Cofinity Commercial |
$1,575.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.79
|
| Rate for Payer: Healthscope Commercial |
$1,648.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.57
|
| Rate for Payer: Mclaren Medicaid |
$560.79
|
| Rate for Payer: Mclaren Medicare |
$560.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.83
|
| Rate for Payer: Meridian Medicaid |
$588.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$616.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.72
|
| Rate for Payer: Nomi Health Commercial |
$1,682.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.57
|
| Rate for Payer: PACE Medicare |
$532.75
|
| Rate for Payer: PACE SWMI |
$560.79
|
| Rate for Payer: PHP Commercial |
$1,556.72
|
| Rate for Payer: PHP Medicare Advantage |
$560.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,723.00
|
| Rate for Payer: Priority Health Medicare |
$560.79
|
| Rate for Payer: Priority Health SBD |
$1,153.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,378.40
|
| Rate for Payer: Railroad Medicare Medicare |
$560.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$865.39
|
| Rate for Payer: UHC Core |
$865.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$560.79
|
| Rate for Payer: UHC Exchange |
$865.39
|
| Rate for Payer: UHC Medicaid |
$293.29
|
| Rate for Payer: UHCCP Medicaid |
$293.29
|
| Rate for Payer: UMR Bronson Commercial |
$677.63
|
| Rate for Payer: VA VA |
$560.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.57
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,831.43
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$805.83 |
| Max. Negotiated Rate |
$1,648.29 |
| Rate for Payer: Aetna American Axle |
$1,190.43
|
| Rate for Payer: Aetna Commercial |
$1,556.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.43
|
| Rate for Payer: Cash Price |
$1,465.14
|
| Rate for Payer: Cofinity Advantage |
$1,282.00
|
| Rate for Payer: Cofinity Commercial |
$1,575.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.14
|
| Rate for Payer: Healthscope Commercial |
$1,648.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.57
|
| Rate for Payer: PHP Commercial |
$1,556.72
|
| Rate for Payer: Priority Health SBD |
$1,153.80
|
| Rate for Payer: UMR Bronson Commercial |
$805.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.57
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 60505252101
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$149.34
|
|
|
Service Code
|
NDC 70436005006
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna Medicare |
$74.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: BCBS Complete |
$59.74
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Advantage |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.00
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.07
|
| Rate for Payer: UHC Core |
$77.81
|
| Rate for Payer: UHC Exchange |
$58.69
|
| Rate for Payer: UMR Bronson Commercial |
$55.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$149.34
|
|
|
Service Code
|
NDC 70436005006
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Advantage |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.00
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 60505252101
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$84.91 |
| Rate for Payer: Aetna American Axle |
$61.32
|
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna American Axle |
$1,175.11
|
| Rate for Payer: Aetna American Axle |
$77.81
|
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$903.93
|
| Rate for Payer: Aetna Medicare |
$47.17
|
| Rate for Payer: Aetna Medicare |
$66.69
|
| Rate for Payer: Aetna Medicare |
$59.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: BCBS Complete |
$53.35
|
| Rate for Payer: BCBS Complete |
$723.14
|
| Rate for Payer: BCBS Complete |
$37.74
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS Complete |
$47.88
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Advantage |
$93.37
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Advantage |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,355.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,446.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,355.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.75
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$84.03
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.81
|
| Rate for Payer: UHC Core |
$49.15
|
| Rate for Payer: UHC Core |
$941.90
|
| Rate for Payer: UHC Core |
$62.36
|
| Rate for Payer: UHC Core |
$69.49
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Exchange |
$47.04
|
| Rate for Payer: UHC Exchange |
$37.08
|
| Rate for Payer: UHC Exchange |
$710.49
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Exchange |
$52.42
|
| Rate for Payer: UMR Bronson Commercial |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$49.35
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$668.91
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,355.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$1,807.86
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$795.46 |
| Max. Negotiated Rate |
$1,627.07 |
| Rate for Payer: Aetna American Axle |
$1,175.11
|
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna American Axle |
$61.32
|
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$77.81
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Advantage |
$66.04
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Advantage |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,355.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,355.89
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: Priority Health SBD |
$84.03
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: UMR Bronson Commercial |
$58.69
|
| Rate for Payer: UMR Bronson Commercial |
$52.67
|
| Rate for Payer: UMR Bronson Commercial |
$795.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,355.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna American Axle |
$474.32
|
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna Medicare |
$364.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: BCBS Complete |
$291.89
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Advantage |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$583.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.32
|
| Rate for Payer: UHC Core |
$380.19
|
| Rate for Payer: UHC Exchange |
$286.78
|
| Rate for Payer: UMR Bronson Commercial |
$270.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.75 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna American Axle |
$527.01
|
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Advantage |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UMR Bronson Commercial |
$356.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.08 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna American Axle |
$474.32
|
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Advantage |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.30
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UMR Bronson Commercial |
$321.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.93 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna American Axle |
$244.06
|
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: Aetna Medicare |
$187.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.06
|
| Rate for Payer: BCBS Complete |
$150.19
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Advantage |
$262.84
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: Priority Health SBD |
$236.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.06
|
| Rate for Payer: UHC Core |
$195.63
|
| Rate for Payer: UHC Exchange |
$147.56
|
| Rate for Payer: UMR Bronson Commercial |
$138.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.61
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$337.93 |
| Rate for Payer: Aetna American Axle |
$244.06
|
| Rate for Payer: Aetna Commercial |
$319.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.06
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Advantage |
$262.84
|
| Rate for Payer: Cofinity Commercial |
$322.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$337.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: PHP Commercial |
$319.16
|
| Rate for Payer: Priority Health SBD |
$236.55
|
| Rate for Payer: UMR Bronson Commercial |
$165.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.61
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.99 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna American Axle |
$527.01
|
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna Medicare |
$405.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: BCBS Complete |
$324.32
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Advantage |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.09
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.01
|
| Rate for Payer: UHC Core |
$422.42
|
| Rate for Payer: UHC Exchange |
$318.64
|
| Rate for Payer: UMR Bronson Commercial |
$299.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$582.24
|
|
|
Service Code
|
NDC 50419077701
|
| Hospital Charge Code |
22987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.19 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Advantage |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UMR Bronson Commercial |
$256.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$582.24
|
|
|
Service Code
|
NDC 50419077701
|
| Hospital Charge Code |
22987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.43 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna Medicare |
$291.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: BCBS Complete |
$232.90
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Advantage |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.46
|
| Rate for Payer: UHC Core |
$303.35
|
| Rate for Payer: UHC Exchange |
$228.82
|
| Rate for Payer: UMR Bronson Commercial |
$215.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.24
|
| Rate for Payer: UHC Core |
$188.55
|
| Rate for Payer: UHC Exchange |
$142.23
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
