|
CLINDAMYCIN 600 MG (IV PREMIX)
|
Facility
|
IP
|
$106.87
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$96.18 |
| Rate for Payer: Aetna American Axle |
$69.47
|
| Rate for Payer: Aetna Commercial |
$90.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.47
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cofinity Advantage |
$74.81
|
| Rate for Payer: Cofinity Commercial |
$91.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$96.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.15
|
| Rate for Payer: PHP Commercial |
$90.84
|
| Rate for Payer: Priority Health SBD |
$67.33
|
| Rate for Payer: UMR Bronson Commercial |
$47.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.15
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00574012901
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$424.65
|
|
|
Service Code
|
NDC 65162046819
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna Medicare |
$212.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Advantage |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.02
|
| Rate for Payer: UHC Core |
$221.24
|
| Rate for Payer: UHC Exchange |
$166.89
|
| Rate for Payer: UMR Bronson Commercial |
$157.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 65162046819
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Advantage |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$186.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 59762001601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Advantage |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.31
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00574012901
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.51
|
| Rate for Payer: UHC Core |
$200.79
|
| Rate for Payer: UHC Exchange |
$151.46
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
NDC 59762001601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.33 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Advantage |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.31
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.74
|
| Rate for Payer: UHC Core |
$190.56
|
| Rate for Payer: UHC Exchange |
$143.74
|
| Rate for Payer: UMR Bronson Commercial |
$135.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$415.15
|
|
|
Service Code
|
NDC 53746046819
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.85
|
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: Aetna Medicare |
$207.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.85
|
| Rate for Payer: BCBS Complete |
$166.06
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Advantage |
$290.61
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.36
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.85
|
| Rate for Payer: UHC Core |
$216.29
|
| Rate for Payer: UHC Exchange |
$163.15
|
| Rate for Payer: UMR Bronson Commercial |
$153.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$441.80
|
|
|
Service Code
|
NDC 23155060351
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna Medicare |
$220.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: BCBS Complete |
$176.72
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.17
|
| Rate for Payer: UHC Core |
$230.18
|
| Rate for Payer: UHC Exchange |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$163.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 23155060351
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UMR Bronson Commercial |
$194.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$416.10
|
|
|
Service Code
|
NDC 65862059601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$374.49 |
| Rate for Payer: Aetna American Axle |
$270.46
|
| Rate for Payer: Aetna Commercial |
$353.69
|
| Rate for Payer: Aetna Medicare |
$208.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: BCBS Complete |
$166.44
|
| Rate for Payer: Cash Price |
$332.88
|
| Rate for Payer: Cofinity Advantage |
$291.27
|
| Rate for Payer: Cofinity Commercial |
$357.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.88
|
| Rate for Payer: Healthscope Commercial |
$374.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.07
|
| Rate for Payer: PHP Commercial |
$353.69
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.46
|
| Rate for Payer: UHC Core |
$216.79
|
| Rate for Payer: UHC Exchange |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$153.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.07
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$416.10
|
|
|
Service Code
|
NDC 65862059601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.08 |
| Max. Negotiated Rate |
$374.49 |
| Rate for Payer: Aetna American Axle |
$270.46
|
| Rate for Payer: Aetna Commercial |
$353.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: Cash Price |
$332.88
|
| Rate for Payer: Cofinity Advantage |
$291.27
|
| Rate for Payer: Cofinity Commercial |
$357.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.88
|
| Rate for Payer: Healthscope Commercial |
$374.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.07
|
| Rate for Payer: PHP Commercial |
$353.69
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.07
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 53746046819
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.67 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.85
|
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.85
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Advantage |
$290.61
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.36
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$26.48
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
183290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.15
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Exchange |
$3.15
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$26.48
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
183290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$26.48
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna American Axle |
$35.15
|
| Rate for Payer: Aetna American Axle |
$23.58
|
| Rate for Payer: Aetna Commercial |
$30.83
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.58
|
| Rate for Payer: Cash Price |
$29.02
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cofinity Advantage |
$37.85
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Advantage |
$25.39
|
| Rate for Payer: Cofinity Commercial |
$46.50
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PHP Commercial |
$30.83
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$45.96
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: Priority Health SBD |
$22.85
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: UMR Bronson Commercial |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$15.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$26.48
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$26.48
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.21
|
| Rate for Payer: UHC Core |
$13.80
|
| Rate for Payer: UHC Exchange |
$10.41
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$26.48
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna American Axle |
$17.21
|
| Rate for Payer: Aetna American Axle |
$35.15
|
| Rate for Payer: Aetna American Axle |
$23.58
|
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna Commercial |
$30.83
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$27.04
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS Complete |
$14.51
|
| Rate for Payer: BCBS Complete |
$21.63
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cash Price |
$29.02
|
| Rate for Payer: Cash Price |
$29.02
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Advantage |
$18.54
|
| Rate for Payer: Cofinity Advantage |
$25.39
|
| Rate for Payer: Cofinity Advantage |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Commercial |
$46.50
|
| Rate for Payer: Cofinity Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.02
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$30.83
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$45.96
|
| Rate for Payer: Priority Health SBD |
$22.85
|
| Rate for Payer: Priority Health SBD |
$16.68
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.21
|
| Rate for Payer: UHC Core |
$13.80
|
| Rate for Payer: UHC Core |
$18.90
|
| Rate for Payer: UHC Core |
$28.17
|
| Rate for Payer: UHC Exchange |
$21.25
|
| Rate for Payer: UHC Exchange |
$10.41
|
| Rate for Payer: UHC Exchange |
$14.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: UMR Bronson Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.20
|
|
|
CLINDAMYCIN 900 MG (IV PREMIX)
|
Facility
|
OP
|
$94.91
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
500560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna American Axle |
$61.69
|
| Rate for Payer: Aetna Commercial |
$80.67
|
| Rate for Payer: Aetna Medicare |
$47.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.69
|
| Rate for Payer: BCBS Complete |
$37.96
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$75.93
|
| Rate for Payer: Cash Price |
$75.93
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.93
|
| Rate for Payer: Healthscope Commercial |
$85.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.18
|
| Rate for Payer: PHP Commercial |
$80.67
|
| Rate for Payer: Priority Health SBD |
$59.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.88
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: UHC Exchange |
$3.88
|
| Rate for Payer: UMR Bronson Commercial |
$35.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.18
|
|
|
CLINDAMYCIN 900 MG (IV PREMIX)
|
Facility
|
IP
|
$94.91
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
500560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna American Axle |
$61.69
|
| Rate for Payer: Aetna Commercial |
$80.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.69
|
| Rate for Payer: Cash Price |
$75.93
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.93
|
| Rate for Payer: Healthscope Commercial |
$85.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.18
|
| Rate for Payer: PHP Commercial |
$80.67
|
| Rate for Payer: Priority Health SBD |
$59.79
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.18
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna American Axle |
$1.41
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Advantage |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 42571025101
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.56 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna American Axle |
$204.69
|
| Rate for Payer: Aetna Commercial |
$267.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.69
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Advantage |
$220.43
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.18
|
| Rate for Payer: PHP Commercial |
$267.67
|
| Rate for Payer: Priority Health SBD |
$198.39
|
| Rate for Payer: UMR Bronson Commercial |
$138.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna American Axle |
$140.79
|
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Advantage |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$186.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$194.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.45
|
| Rate for Payer: PHP Commercial |
$184.11
|
| Rate for Payer: Priority Health SBD |
$136.46
|
| Rate for Payer: UMR Bronson Commercial |
$95.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.45
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 42292001801
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna American Axle |
$2.95
|
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Advantage |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health SBD |
$2.86
|
| Rate for Payer: UMR Bronson Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
