|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Advantage |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.82
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$432.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.16 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.01
|
| Rate for Payer: UHC Core |
$100.20
|
| Rate for Payer: UHC Exchange |
$75.59
|
| Rate for Payer: UMR Bronson Commercial |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Advantage |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.34
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$94.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$621.60
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$559.44 |
| Rate for Payer: Aetna American Axle |
$404.04
|
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna American Axle |
$98.61
|
| Rate for Payer: Aetna American Axle |
$223.86
|
| Rate for Payer: Aetna American Axle |
$197.21
|
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna American Axle |
$193.38
|
| Rate for Payer: Aetna American Axle |
$190.55
|
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Commercial |
$257.89
|
| Rate for Payer: Aetna Commercial |
$292.74
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Commercial |
$128.94
|
| Rate for Payer: Aetna Commercial |
$528.36
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.04
|
| Rate for Payer: Cash Price |
$275.52
|
| Rate for Payer: Cash Price |
$242.72
|
| Rate for Payer: Cash Price |
$497.28
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$121.36
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$208.25
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Advantage |
$435.12
|
| Rate for Payer: Cofinity Advantage |
$241.08
|
| Rate for Payer: Cofinity Advantage |
$212.38
|
| Rate for Payer: Cofinity Advantage |
$299.92
|
| Rate for Payer: Cofinity Advantage |
$106.19
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$130.46
|
| Rate for Payer: Cofinity Commercial |
$534.58
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.72
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$309.96
|
| Rate for Payer: Healthscope Commercial |
$273.06
|
| Rate for Payer: Healthscope Commercial |
$136.53
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$559.44
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.30
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$257.89
|
| Rate for Payer: PHP Commercial |
$292.74
|
| Rate for Payer: PHP Commercial |
$528.36
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$128.94
|
| Rate for Payer: Priority Health SBD |
$191.14
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: Priority Health SBD |
$391.61
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: Priority Health SBD |
$95.57
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$187.43
|
| Rate for Payer: UMR Bronson Commercial |
$66.75
|
| Rate for Payer: UMR Bronson Commercial |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$133.50
|
| Rate for Payer: UMR Bronson Commercial |
$130.90
|
| Rate for Payer: UMR Bronson Commercial |
$151.54
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: UMR Bronson Commercial |
$273.50
|
| Rate for Payer: UMR Bronson Commercial |
$92.40
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.20
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna American Axle |
$197.21
|
| Rate for Payer: Aetna American Axle |
$193.38
|
| Rate for Payer: Aetna American Axle |
$199.88
|
| Rate for Payer: Aetna American Axle |
$190.55
|
| Rate for Payer: Aetna American Axle |
$223.86
|
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna American Axle |
$98.61
|
| Rate for Payer: Aetna American Axle |
$404.04
|
| Rate for Payer: Aetna American Axle |
$187.22
|
| Rate for Payer: Aetna Commercial |
$128.94
|
| Rate for Payer: Aetna Commercial |
$528.36
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Commercial |
$292.74
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$244.83
|
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Commercial |
$257.89
|
| Rate for Payer: Aetna Medicare |
$310.80
|
| Rate for Payer: Aetna Medicare |
$144.01
|
| Rate for Payer: Aetna Medicare |
$75.85
|
| Rate for Payer: Aetna Medicare |
$146.57
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna Medicare |
$172.20
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna Medicare |
$153.75
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna Medicare |
$151.70
|
| Rate for Payer: Aetna Medicare |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.04
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Complete |
$117.26
|
| Rate for Payer: BCBS Complete |
$60.68
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Complete |
$248.64
|
| Rate for Payer: BCBS Complete |
$121.36
|
| Rate for Payer: BCBS Complete |
$119.00
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS Complete |
$137.76
|
| Rate for Payer: BCBS Complete |
$115.21
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: Cash Price |
$121.36
|
| Rate for Payer: Cash Price |
$230.42
|
| Rate for Payer: Cash Price |
$230.42
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$497.28
|
| Rate for Payer: Cash Price |
$497.28
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$242.72
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$275.52
|
| Rate for Payer: Cash Price |
$275.52
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$242.72
|
| Rate for Payer: Cash Price |
$121.36
|
| Rate for Payer: Cofinity Advantage |
$241.08
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Advantage |
$208.25
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$201.62
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Advantage |
$212.38
|
| Rate for Payer: Cofinity Advantage |
$106.19
|
| Rate for Payer: Cofinity Advantage |
$215.25
|
| Rate for Payer: Cofinity Advantage |
$435.12
|
| Rate for Payer: Cofinity Advantage |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$130.46
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$534.58
|
| Rate for Payer: Cofinity Commercial |
$247.71
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.00
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$136.53
|
| Rate for Payer: Healthscope Commercial |
$259.23
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$273.06
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: Healthscope Commercial |
$309.96
|
| Rate for Payer: Healthscope Commercial |
$559.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.02
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$261.38
|
| Rate for Payer: PHP Commercial |
$257.89
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Commercial |
$292.74
|
| Rate for Payer: PHP Commercial |
$528.36
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$128.94
|
| Rate for Payer: PHP Commercial |
$244.83
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Priority Health SBD |
$95.57
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$391.61
|
| Rate for Payer: Priority Health SBD |
$181.46
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: Priority Health SBD |
$191.14
|
| Rate for Payer: Priority Health SBD |
$187.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UMR Bronson Commercial |
$56.13
|
| Rate for Payer: UMR Bronson Commercial |
$127.43
|
| Rate for Payer: UMR Bronson Commercial |
$229.99
|
| Rate for Payer: UMR Bronson Commercial |
$112.26
|
| Rate for Payer: UMR Bronson Commercial |
$158.53
|
| Rate for Payer: UMR Bronson Commercial |
$106.57
|
| Rate for Payer: UMR Bronson Commercial |
$113.78
|
| Rate for Payer: UMR Bronson Commercial |
$110.08
|
| Rate for Payer: UMR Bronson Commercial |
$108.47
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: UMR Bronson Commercial |
$77.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.12
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Advantage |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.55
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: UHC Exchange |
$18.47
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Advantage |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 65862000601
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$64.89
|
| Rate for Payer: UHC Exchange |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 13668001001
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Advantage |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 65862000601
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$54.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 13668001001
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Advantage |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.32
|
| Rate for Payer: UHC Core |
$7.47
|
| Rate for Payer: UHC Exchange |
$5.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
CITALOPRAM 40 MG TABLET
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
CITRIC ACID (BULK) POWDER
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
NDC 38779006809
|
| Hospital Charge Code |
1703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna American Axle |
$124.80
|
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna Medicare |
$96.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.80
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Advantage |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health SBD |
$120.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.80
|
| Rate for Payer: UHC Core |
$100.03
|
| Rate for Payer: UHC Exchange |
$75.46
|
| Rate for Payer: UMR Bronson Commercial |
$71.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
CITRIC ACID (BULK) POWDER
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
NDC 38779006809
|
| Hospital Charge Code |
1703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna American Axle |
$124.80
|
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Advantage |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health SBD |
$120.96
|
| Rate for Payer: UMR Bronson Commercial |
$84.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$929.07
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.79 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna American Axle |
$603.90
|
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cofinity Advantage |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.80
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: UMR Bronson Commercial |
$408.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.80
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$597.92
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$538.13 |
| Rate for Payer: Aetna American Axle |
$388.65
|
| Rate for Payer: Aetna American Axle |
$447.33
|
| Rate for Payer: Aetna American Axle |
$603.90
|
| Rate for Payer: Aetna Commercial |
$508.23
|
| Rate for Payer: Aetna Commercial |
$584.97
|
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.91
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: BCN Medicare Advantage |
$8.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.73
|
| Rate for Payer: Cash Price |
$550.56
|
| Rate for Payer: Cash Price |
$550.56
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$478.34
|
| Rate for Payer: Cash Price |
$478.34
|
| Rate for Payer: Cofinity Advantage |
$418.54
|
| Rate for Payer: Cofinity Advantage |
$481.74
|
| Rate for Payer: Cofinity Advantage |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$514.21
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Cofinity Commercial |
$591.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$538.13
|
| Rate for Payer: Healthscope Commercial |
$619.38
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.80
|
| Rate for Payer: Mclaren Medicaid |
$8.73
|
| Rate for Payer: Mclaren Medicaid |
$8.73
|
| Rate for Payer: Mclaren Medicaid |
$8.73
|
| Rate for Payer: Mclaren Medicare |
$8.73
|
| Rate for Payer: Mclaren Medicare |
$8.73
|
| Rate for Payer: Mclaren Medicare |
$8.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.71
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.44
|
| Rate for Payer: PACE Medicare |
$8.29
|
| Rate for Payer: PACE Medicare |
$8.29
|
| Rate for Payer: PACE Medicare |
$8.29
|
| Rate for Payer: PACE SWMI |
$8.73
|
| Rate for Payer: PACE SWMI |
$8.73
|
| Rate for Payer: PACE SWMI |
$8.73
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: PHP Commercial |
$584.97
|
| Rate for Payer: PHP Commercial |
$508.23
|
| Rate for Payer: PHP Medicare Advantage |
$8.73
|
| Rate for Payer: PHP Medicare Advantage |
$8.73
|
| Rate for Payer: PHP Medicare Advantage |
$8.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.68
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health SBD |
$376.69
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: Priority Health SBD |
$433.57
|
| Rate for Payer: Priority Health Tiered Network |
$26.94
|
| Rate for Payer: Priority Health Tiered Network |
$26.94
|
| Rate for Payer: Priority Health Tiered Network |
$26.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8.73
|
| Rate for Payer: Railroad Medicare Medicare |
$8.73
|
| Rate for Payer: Railroad Medicare Medicare |
$8.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.73
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: UMR Bronson Commercial |
$221.23
|
| Rate for Payer: UMR Bronson Commercial |
$254.63
|
| Rate for Payer: UMR Bronson Commercial |
$343.76
|
| Rate for Payer: VA VA |
$8.73
|
| Rate for Payer: VA VA |
$8.73
|
| Rate for Payer: VA VA |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.80
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$867.36
|
|
|
Service Code
|
NDC 00781602346
|
| Hospital Charge Code |
12886
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.64 |
| Max. Negotiated Rate |
$780.62 |
| Rate for Payer: Aetna American Axle |
$563.78
|
| Rate for Payer: Aetna Commercial |
$737.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.78
|
| Rate for Payer: Cash Price |
$693.89
|
| Rate for Payer: Cofinity Advantage |
$607.15
|
| Rate for Payer: Cofinity Commercial |
$745.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.89
|
| Rate for Payer: Healthscope Commercial |
$780.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.52
|
| Rate for Payer: PHP Commercial |
$737.26
|
| Rate for Payer: Priority Health SBD |
$546.44
|
| Rate for Payer: UMR Bronson Commercial |
$381.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.52
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$867.36
|
|
|
Service Code
|
NDC 00781602346
|
| Hospital Charge Code |
12886
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.92 |
| Max. Negotiated Rate |
$780.62 |
| Rate for Payer: Aetna American Axle |
$563.78
|
| Rate for Payer: Aetna Commercial |
$737.26
|
| Rate for Payer: Aetna Medicare |
$433.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.78
|
| Rate for Payer: BCBS Complete |
$346.94
|
| Rate for Payer: Cash Price |
$693.89
|
| Rate for Payer: Cofinity Advantage |
$607.15
|
| Rate for Payer: Cofinity Commercial |
$745.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.89
|
| Rate for Payer: Healthscope Commercial |
$780.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.52
|
| Rate for Payer: PHP Commercial |
$737.26
|
| Rate for Payer: Priority Health SBD |
$546.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.78
|
| Rate for Payer: UHC Core |
$451.89
|
| Rate for Payer: UHC Exchange |
$340.87
|
| Rate for Payer: UMR Bronson Commercial |
$320.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.52
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$261.80
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Aetna American Axle |
$170.17
|
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: Cash Price |
$209.44
|
| Rate for Payer: Cofinity Advantage |
$183.26
|
| Rate for Payer: Cofinity Commercial |
$225.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.44
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.35
|
| Rate for Payer: PHP Commercial |
$222.53
|
| Rate for Payer: Priority Health SBD |
$164.93
|
| Rate for Payer: UMR Bronson Commercial |
$115.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.35
|
|
