|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 48878062004
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: PHP Commercial |
$21.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$15.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$24.33
|
|
|
Service Code
|
NDC 00904703587
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Aetna American Axle |
$15.81
|
| Rate for Payer: Aetna Commercial |
$20.68
|
| Rate for Payer: Aetna Medicare |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.81
|
| Rate for Payer: BCBS Complete |
$9.73
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| Rate for Payer: Healthscope Commercial |
$21.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.68
|
| Rate for Payer: PHP Commercial |
$20.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health SBD |
$15.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.25
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
IP
|
$66.70
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$60.03 |
| Rate for Payer: Aetna American Axle |
$43.36
|
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.36
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$46.69
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.36
|
| Rate for Payer: Healthscope Commercial |
$60.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.70
|
| Rate for Payer: PHP Commercial |
$56.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.36
|
| Rate for Payer: Priority Health SBD |
$42.02
|
| Rate for Payer: UMR Bronson Commercial |
$29.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
NDC 00904703588
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna American Axle |
$16.27
|
| Rate for Payer: Aetna Commercial |
$21.28
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.27
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cofinity Commercial |
$17.52
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.28
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.27
|
| Rate for Payer: Priority Health SBD |
$15.77
|
| Rate for Payer: UMR Bronson Commercial |
$9.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.77
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna American Axle |
$53.86
|
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Commercial |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.86
|
| Rate for Payer: Priority Health SBD |
$52.20
|
| Rate for Payer: UMR Bronson Commercial |
$36.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.14
|
|
|
CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$82.86
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
150549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna American Axle |
$53.86
|
| Rate for Payer: Aetna Commercial |
$70.43
|
| Rate for Payer: Aetna Medicare |
$41.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.86
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: Cash Price |
$66.29
|
| Rate for Payer: Cofinity Commercial |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.29
|
| Rate for Payer: Healthscope Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.43
|
| Rate for Payer: PHP Commercial |
$70.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.86
|
| Rate for Payer: Priority Health SBD |
$52.20
|
| Rate for Payer: UMR Bronson Commercial |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.14
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
IP
|
$81.71
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$73.54 |
| Rate for Payer: Aetna American Axle |
$53.11
|
| Rate for Payer: Aetna American Axle |
$56.58
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Cofinity Commercial |
$60.94
|
| Rate for Payer: Cofinity Commercial |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.58
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: Priority Health SBD |
$54.84
|
| Rate for Payer: UMR Bronson Commercial |
$35.95
|
| Rate for Payer: UMR Bronson Commercial |
$38.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.29
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION
|
Facility
|
OP
|
$81.71
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
1635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$73.54 |
| Rate for Payer: Aetna American Axle |
$53.11
|
| Rate for Payer: Aetna American Axle |
$56.58
|
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Commercial |
$73.99
|
| Rate for Payer: Aetna Medicare |
$40.86
|
| Rate for Payer: Aetna Medicare |
$43.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: BCBS Complete |
$34.82
|
| Rate for Payer: BCBS Complete |
$32.68
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$69.64
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$60.94
|
| Rate for Payer: Cofinity Commercial |
$74.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.64
|
| Rate for Payer: Healthscope Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.99
|
| Rate for Payer: PHP Commercial |
$73.99
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.58
|
| Rate for Payer: Priority Health SBD |
$54.84
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: UMR Bronson Commercial |
$30.23
|
| Rate for Payer: UMR Bronson Commercial |
$32.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.28
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$610.16
|
|
|
Service Code
|
NDC 65649031112
|
| Hospital Charge Code |
9525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.76 |
| Max. Negotiated Rate |
$549.14 |
| Rate for Payer: Aetna American Axle |
$396.60
|
| Rate for Payer: Aetna Commercial |
$518.64
|
| Rate for Payer: Aetna Medicare |
$305.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.60
|
| Rate for Payer: BCBS Complete |
$244.06
|
| Rate for Payer: Cash Price |
$488.13
|
| Rate for Payer: Cofinity Commercial |
$427.11
|
| Rate for Payer: Cofinity Commercial |
$524.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.13
|
| Rate for Payer: Healthscope Commercial |
$549.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.64
|
| Rate for Payer: PHP Commercial |
$518.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.60
|
| Rate for Payer: Priority Health SBD |
$384.40
|
| Rate for Payer: UMR Bronson Commercial |
$225.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.62
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$610.16
|
|
|
Service Code
|
NDC 65649031112
|
| Hospital Charge Code |
9525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.47 |
| Max. Negotiated Rate |
$549.14 |
| Rate for Payer: Aetna American Axle |
$396.60
|
| Rate for Payer: Aetna Commercial |
$518.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.60
|
| Rate for Payer: Cash Price |
$488.13
|
| Rate for Payer: Cofinity Commercial |
$427.11
|
| Rate for Payer: Cofinity Commercial |
$524.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$427.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.13
|
| Rate for Payer: Healthscope Commercial |
$549.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.64
|
| Rate for Payer: PHP Commercial |
$518.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.60
|
| Rate for Payer: Priority Health SBD |
$384.40
|
| Rate for Payer: UMR Bronson Commercial |
$268.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.62
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175.38
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.89 |
| Max. Negotiated Rate |
$157.84 |
| Rate for Payer: Aetna American Axle |
$114.00
|
| Rate for Payer: Aetna American Axle |
$137.20
|
| Rate for Payer: Aetna American Axle |
$114.34
|
| Rate for Payer: Aetna American Axle |
$85.04
|
| Rate for Payer: Aetna American Axle |
$214.16
|
| Rate for Payer: Aetna Commercial |
$149.07
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna Commercial |
$280.06
|
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Medicare |
$87.96
|
| Rate for Payer: Aetna Medicare |
$105.54
|
| Rate for Payer: Aetna Medicare |
$87.69
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna Medicare |
$164.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: BCBS Complete |
$70.15
|
| Rate for Payer: BCBS Complete |
$52.33
|
| Rate for Payer: BCBS Complete |
$84.43
|
| Rate for Payer: BCBS Complete |
$131.79
|
| Rate for Payer: BCBS Complete |
$70.36
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cofinity Commercial |
$122.77
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$230.64
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Cofinity Commercial |
$147.75
|
| Rate for Payer: Cofinity Commercial |
$150.83
|
| Rate for Payer: Cofinity Commercial |
$91.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$157.84
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Healthscope Commercial |
$296.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: PHP Commercial |
$280.06
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Commercial |
$149.07
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.00
|
| Rate for Payer: Priority Health SBD |
$110.49
|
| Rate for Payer: Priority Health SBD |
$207.57
|
| Rate for Payer: Priority Health SBD |
$132.97
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.41
|
| Rate for Payer: UMR Bronson Commercial |
$65.09
|
| Rate for Payer: UMR Bronson Commercial |
$64.89
|
| Rate for Payer: UMR Bronson Commercial |
$78.10
|
| Rate for Payer: UMR Bronson Commercial |
$121.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.12
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.91
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
9526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$158.32 |
| Rate for Payer: Aetna American Axle |
$114.34
|
| Rate for Payer: Aetna American Axle |
$214.16
|
| Rate for Payer: Aetna American Axle |
$137.20
|
| Rate for Payer: Aetna American Axle |
$114.00
|
| Rate for Payer: Aetna American Axle |
$85.04
|
| Rate for Payer: Aetna Commercial |
$280.06
|
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Aetna Commercial |
$149.07
|
| Rate for Payer: Aetna Commercial |
$111.21
|
| Rate for Payer: Aetna Commercial |
$149.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cash Price |
$104.66
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cash Price |
$168.86
|
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Cofinity Commercial |
$91.58
|
| Rate for Payer: Cofinity Commercial |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$122.77
|
| Rate for Payer: Cofinity Commercial |
$150.83
|
| Rate for Payer: Cofinity Commercial |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$230.64
|
| Rate for Payer: Cofinity Commercial |
$181.52
|
| Rate for Payer: Cofinity Commercial |
$147.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.30
|
| Rate for Payer: Healthscope Commercial |
$157.84
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Healthscope Commercial |
$117.75
|
| Rate for Payer: Healthscope Commercial |
$296.53
|
| Rate for Payer: Healthscope Commercial |
$189.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.07
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: PHP Commercial |
$149.07
|
| Rate for Payer: PHP Commercial |
$280.06
|
| Rate for Payer: PHP Commercial |
$179.41
|
| Rate for Payer: PHP Commercial |
$111.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: Priority Health SBD |
$132.97
|
| Rate for Payer: Priority Health SBD |
$110.49
|
| Rate for Payer: Priority Health SBD |
$82.42
|
| Rate for Payer: Priority Health SBD |
$207.57
|
| Rate for Payer: UMR Bronson Commercial |
$144.97
|
| Rate for Payer: UMR Bronson Commercial |
$92.87
|
| Rate for Payer: UMR Bronson Commercial |
$77.40
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: UMR Bronson Commercial |
$77.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.93
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
OP
|
$329.48
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.55 |
| Max. Negotiated Rate |
$296.53 |
| Rate for Payer: Aetna American Axle |
$214.16
|
| Rate for Payer: Aetna Commercial |
$280.06
|
| Rate for Payer: Aetna Medicare |
$164.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.16
|
| Rate for Payer: BCBS Complete |
$131.79
|
| Rate for Payer: BCBS Trust/PPO |
$107.55
|
| Rate for Payer: BCN Commercial |
$107.55
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cofinity Commercial |
$230.64
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.58
|
| Rate for Payer: Healthscope Commercial |
$296.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.06
|
| Rate for Payer: PHP Commercial |
$280.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.16
|
| Rate for Payer: Priority Health SBD |
$207.57
|
| Rate for Payer: UMR Bronson Commercial |
$121.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.11
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG SOLUTION FOR SOLID FORM MIXTURE CUSTOM
|
Facility
|
IP
|
$329.48
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
301757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.97 |
| Max. Negotiated Rate |
$296.53 |
| Rate for Payer: Aetna American Axle |
$214.16
|
| Rate for Payer: Aetna Commercial |
$280.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.16
|
| Rate for Payer: Cash Price |
$263.58
|
| Rate for Payer: Cofinity Commercial |
$230.64
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.58
|
| Rate for Payer: Healthscope Commercial |
$296.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.06
|
| Rate for Payer: PHP Commercial |
$280.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.16
|
| Rate for Payer: Priority Health SBD |
$207.57
|
| Rate for Payer: UMR Bronson Commercial |
$144.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.11
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$28.20
|
|
|
Service Code
|
NDC 00536100601
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna American Axle |
$18.33
|
| Rate for Payer: Aetna Commercial |
$23.97
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.33
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.97
|
| Rate for Payer: PHP Commercial |
$23.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.33
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.15
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904001261
|
| Hospital Charge Code |
1645
|
|
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 Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| 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: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| 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
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$28.20
|
|
|
Service Code
|
NDC 00536100601
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna American Axle |
$18.33
|
| Rate for Payer: Aetna Commercial |
$23.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.33
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.97
|
| Rate for Payer: PHP Commercial |
$23.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.33
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.15
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904001261
|
| Hospital Charge Code |
1645
|
|
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 |
$69.32
|
| 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 Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| 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: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 49483024201
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
CHLORPHENIRAMINE 4 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 49483024201
|
| Hospital Charge Code |
1645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
OP
|
$43.65
|
|
|
Service Code
|
NDC 09900000025
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$39.28 |
| Rate for Payer: Aetna American Axle |
$28.37
|
| Rate for Payer: Aetna Commercial |
$37.10
|
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.37
|
| Rate for Payer: BCBS Complete |
$17.46
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$37.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$39.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.10
|
| Rate for Payer: PHP Commercial |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.37
|
| Rate for Payer: Priority Health SBD |
$27.50
|
| Rate for Payer: UMR Bronson Commercial |
$16.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.74
|
|
|
CHLORPHENIRAMINE 8 MG HYDROCODONE 10 MG/5 ML ORAL SUSP EXTEND.REL 12HR
|
Facility
|
IP
|
$43.65
|
|
|
Service Code
|
NDC 09900000025
|
| Hospital Charge Code |
9582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$39.28 |
| Rate for Payer: Aetna American Axle |
$28.37
|
| Rate for Payer: Aetna Commercial |
$37.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.37
|
| Rate for Payer: Cash Price |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$37.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$39.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.10
|
| Rate for Payer: PHP Commercial |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.37
|
| Rate for Payer: Priority Health SBD |
$27.50
|
| Rate for Payer: UMR Bronson Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.74
|
|
|
CHLORPROMAZINE 100 MG TABLET
|
Facility
|
IP
|
$637.92
|
|
|
Service Code
|
NDC 00832602000
|
| Hospital Charge Code |
1654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.68 |
| Max. Negotiated Rate |
$574.13 |
| Rate for Payer: Aetna American Axle |
$414.65
|
| Rate for Payer: Aetna Commercial |
$542.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.65
|
| Rate for Payer: Cash Price |
$510.34
|
| Rate for Payer: Cofinity Commercial |
$446.54
|
| Rate for Payer: Cofinity Commercial |
$548.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.34
|
| Rate for Payer: Healthscope Commercial |
$574.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$446.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.23
|
| Rate for Payer: PHP Commercial |
$542.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.65
|
| Rate for Payer: Priority Health SBD |
$401.89
|
| Rate for Payer: UMR Bronson Commercial |
$280.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.44
|
|
|
CHLORPROMAZINE 100 MG TABLET
|
Facility
|
OP
|
$637.92
|
|
|
Service Code
|
NDC 00832602000
|
| Hospital Charge Code |
1654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.03 |
| Max. Negotiated Rate |
$574.13 |
| Rate for Payer: Aetna American Axle |
$414.65
|
| Rate for Payer: Aetna Commercial |
$542.23
|
| Rate for Payer: Aetna Medicare |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.65
|
| Rate for Payer: BCBS Complete |
$255.17
|
| Rate for Payer: Cash Price |
$510.34
|
| Rate for Payer: Cofinity Commercial |
$446.54
|
| Rate for Payer: Cofinity Commercial |
$548.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.34
|
| Rate for Payer: Healthscope Commercial |
$574.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$446.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.23
|
| Rate for Payer: PHP Commercial |
$542.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.65
|
| Rate for Payer: Priority Health SBD |
$401.89
|
| Rate for Payer: UMR Bronson Commercial |
$236.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.44
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$1,152.55
|
|
|
Service Code
|
NDC 00904712961
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.12 |
| Max. Negotiated Rate |
$1,037.30 |
| Rate for Payer: Aetna American Axle |
$749.16
|
| Rate for Payer: Aetna Commercial |
$979.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.16
|
| Rate for Payer: Cash Price |
$922.04
|
| Rate for Payer: Cofinity Commercial |
$806.78
|
| Rate for Payer: Cofinity Commercial |
$991.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$806.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$922.04
|
| Rate for Payer: Healthscope Commercial |
$1,037.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.67
|
| Rate for Payer: PHP Commercial |
$979.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.16
|
| Rate for Payer: Priority Health SBD |
$726.11
|
| Rate for Payer: UMR Bronson Commercial |
$507.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.41
|
|
