|
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
|
$453.55
|
|
|
Service Code
|
NDC 42292001820
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 42292001801
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna American Axle |
$2.95
|
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.82
|
| 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: MI Amish Medical Board Commercial |
$3.63
|
| 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: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.37
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna American Axle |
$140.79
|
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna Medicare |
$108.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: BCBS Complete |
$86.64
|
| 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: MI Amish Medical Board Commercial |
$173.28
|
| 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: UHC All Payor (Choice/PPO) |
$140.79
|
| Rate for Payer: UHC Core |
$112.85
|
| Rate for Payer: UHC Exchange |
$85.12
|
| Rate for Payer: UMR Bronson Commercial |
$80.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.45
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 65862018501
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$171.55
|
|
|
Service Code
|
NDC 63304069201
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Aetna American Axle |
$111.51
|
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Advantage |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.66
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 65862018501
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.64 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$210.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.42
|
| Rate for Payer: UHC Core |
$219.16
|
| Rate for Payer: UHC Exchange |
$165.32
|
| Rate for Payer: UMR Bronson Commercial |
$155.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
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
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 59762332801
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
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
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna American Axle |
$1.41
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.87
|
| 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: MI Amish Medical Board Commercial |
$1.74
|
| 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: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$171.55
|
|
|
Service Code
|
NDC 63304069201
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Aetna American Axle |
$111.51
|
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna Medicare |
$85.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: BCBS Complete |
$68.62
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Advantage |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.51
|
| Rate for Payer: UHC Core |
$89.38
|
| Rate for Payer: UHC Exchange |
$67.42
|
| Rate for Payer: UMR Bronson Commercial |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.66
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
OP
|
$477.12
|
|
|
Service Code
|
NDC 68084024401
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.53 |
| Max. Negotiated Rate |
$429.41 |
| Rate for Payer: Aetna American Axle |
$310.13
|
| Rate for Payer: Aetna Commercial |
$405.55
|
| Rate for Payer: Aetna Medicare |
$238.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.13
|
| Rate for Payer: BCBS Complete |
$190.85
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cofinity Advantage |
$333.98
|
| Rate for Payer: Cofinity Commercial |
$410.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.70
|
| Rate for Payer: Healthscope Commercial |
$429.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.84
|
| Rate for Payer: PHP Commercial |
$405.55
|
| Rate for Payer: Priority Health SBD |
$300.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.13
|
| Rate for Payer: UHC Core |
$248.58
|
| Rate for Payer: UHC Exchange |
$187.51
|
| Rate for Payer: UMR Bronson Commercial |
$176.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.84
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
OP
|
$433.92
|
|
|
Service Code
|
NDC 00904719461
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna Medicare |
$216.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: BCBS Complete |
$173.57
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Advantage |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.44
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.05
|
| Rate for Payer: UHC Core |
$226.07
|
| Rate for Payer: UHC Exchange |
$170.53
|
| Rate for Payer: UMR Bronson Commercial |
$160.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
NDC 42571025201
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna American Axle |
$247.00
|
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Advantage |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health SBD |
$239.40
|
| Rate for Payer: UMR Bronson Commercial |
$167.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$477.12
|
|
|
Service Code
|
NDC 68084024411
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.93 |
| Max. Negotiated Rate |
$429.41 |
| Rate for Payer: Aetna American Axle |
$310.13
|
| Rate for Payer: Aetna Commercial |
$405.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.13
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cofinity Advantage |
$333.98
|
| Rate for Payer: Cofinity Commercial |
$410.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.70
|
| Rate for Payer: Healthscope Commercial |
$429.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.84
|
| Rate for Payer: PHP Commercial |
$405.55
|
| Rate for Payer: Priority Health SBD |
$300.59
|
| Rate for Payer: UMR Bronson Commercial |
$209.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.84
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$477.12
|
|
|
Service Code
|
NDC 68084024401
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.93 |
| Max. Negotiated Rate |
$429.41 |
| Rate for Payer: Aetna American Axle |
$310.13
|
| Rate for Payer: Aetna Commercial |
$405.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.13
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cofinity Advantage |
$333.98
|
| Rate for Payer: Cofinity Commercial |
$410.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.70
|
| Rate for Payer: Healthscope Commercial |
$429.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.84
|
| Rate for Payer: PHP Commercial |
$405.55
|
| Rate for Payer: Priority Health SBD |
$300.59
|
| Rate for Payer: UMR Bronson Commercial |
$209.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.84
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
NDC 42571025201
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna American Axle |
$247.00
|
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare |
$190.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.00
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Advantage |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health SBD |
$239.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.00
|
| Rate for Payer: UHC Core |
$197.98
|
| Rate for Payer: UHC Exchange |
$149.34
|
| Rate for Payer: UMR Bronson Commercial |
$140.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
OP
|
$477.12
|
|
|
Service Code
|
NDC 68084024411
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.53 |
| Max. Negotiated Rate |
$429.41 |
| Rate for Payer: Aetna American Axle |
$310.13
|
| Rate for Payer: Aetna Commercial |
$405.55
|
| Rate for Payer: Aetna Medicare |
$238.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.13
|
| Rate for Payer: BCBS Complete |
$190.85
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cofinity Advantage |
$333.98
|
| Rate for Payer: Cofinity Commercial |
$410.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.70
|
| Rate for Payer: Healthscope Commercial |
$429.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.84
|
| Rate for Payer: PHP Commercial |
$405.55
|
| Rate for Payer: Priority Health SBD |
$300.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.13
|
| Rate for Payer: UHC Core |
$248.58
|
| Rate for Payer: UHC Exchange |
$187.51
|
| Rate for Payer: UMR Bronson Commercial |
$176.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.84
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$433.92
|
|
|
Service Code
|
NDC 00904719461
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Advantage |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.44
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$190.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
CLINDAMYCIN IN NS 30 MG/0.5 ML FOR DISCOGRAM
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
NDC 09900000390
|
| Hospital Charge Code |
163511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna American Axle |
$6.47
|
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
| Rate for Payer: UMR Bronson Commercial |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
CLINDAMYCIN IN NS 30 MG/0.5 ML FOR DISCOGRAM
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
NDC 09900000390
|
| Hospital Charge Code |
163511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna American Axle |
$6.47
|
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.47
|
| Rate for Payer: BCBS Complete |
$3.98
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$6.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health SBD |
$6.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.47
|
| Rate for Payer: UHC Core |
$5.19
|
| Rate for Payer: UHC Exchange |
$3.91
|
| Rate for Payer: UMR Bronson Commercial |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
OP
|
$976.50
|
|
|
Service Code
|
NDC 51991090001
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna American Axle |
$634.73
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna Medicare |
$488.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.73
|
| Rate for Payer: BCBS Complete |
$390.60
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cofinity Advantage |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.38
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.73
|
| Rate for Payer: UHC Core |
$508.76
|
| Rate for Payer: UHC Exchange |
$383.76
|
| Rate for Payer: UMR Bronson Commercial |
$361.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$976.50
|
|
|
Service Code
|
NDC 51991090001
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.66 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna American Axle |
$634.73
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.73
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cofinity Advantage |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.38
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UMR Bronson Commercial |
$429.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
OP
|
$561.75
|
|
|
Service Code
|
NDC 00832058011
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.85 |
| Max. Negotiated Rate |
$505.57 |
| Rate for Payer: Aetna American Axle |
$365.14
|
| Rate for Payer: Aetna Commercial |
$477.49
|
| Rate for Payer: Aetna Medicare |
$280.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.14
|
| Rate for Payer: BCBS Complete |
$224.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cofinity Advantage |
$393.23
|
| Rate for Payer: Cofinity Commercial |
$483.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.40
|
| Rate for Payer: Healthscope Commercial |
$505.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.31
|
| Rate for Payer: PHP Commercial |
$477.49
|
| Rate for Payer: Priority Health SBD |
$353.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.14
|
| Rate for Payer: UHC Core |
$292.67
|
| Rate for Payer: UHC Exchange |
$220.77
|
| Rate for Payer: UMR Bronson Commercial |
$207.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.31
|
|
