|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.63 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna American Axle |
$593.31
|
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Commercial |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.31
|
| Rate for Payer: Priority Health SBD |
$575.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.59
|
|
|
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
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 00832601700
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UMR Bronson Commercial |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$1,152.55
|
|
|
Service Code
|
NDC 00904712961
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.44 |
| 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 Medicare |
$576.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.16
|
| Rate for Payer: BCBS Complete |
$461.02
|
| 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 |
$426.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.41
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$912.79
|
|
|
Service Code
|
NDC 00832030000
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.73 |
| Max. Negotiated Rate |
$821.51 |
| Rate for Payer: Aetna American Axle |
$593.31
|
| Rate for Payer: Aetna Commercial |
$775.87
|
| Rate for Payer: Aetna Medicare |
$456.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.31
|
| Rate for Payer: BCBS Complete |
$365.12
|
| Rate for Payer: Cash Price |
$730.23
|
| Rate for Payer: Cofinity Commercial |
$638.95
|
| Rate for Payer: Cofinity Commercial |
$785.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.23
|
| Rate for Payer: Healthscope Commercial |
$821.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.87
|
| Rate for Payer: PHP Commercial |
$775.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.31
|
| Rate for Payer: Priority Health SBD |
$575.06
|
| Rate for Payer: UMR Bronson Commercial |
$337.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.59
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$94.04
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Commercial |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: UMR Bronson Commercial |
$41.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$94.04
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
1649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna American Axle |
$46.86
|
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: BCBS Complete |
$37.62
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$74.71
|
| Rate for Payer: BCBS Trust/PPO |
$74.71
|
| Rate for Payer: BCN Commercial |
$74.71
|
| Rate for Payer: BCN Commercial |
$74.71
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Commercial |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Cofinity Commercial |
$65.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health SBD |
$45.42
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
| Rate for Payer: UMR Bronson Commercial |
$34.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$306.24
|
|
|
Service Code
|
NDC 00832601800
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: Cash Price |
$244.99
|
| Rate for Payer: Cofinity Commercial |
$214.37
|
| Rate for Payer: Cofinity Commercial |
$263.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.99
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.93
|
| Rate for Payer: UMR Bronson Commercial |
$134.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.68
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$306.24
|
|
|
Service Code
|
NDC 00832601800
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.31 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare |
$153.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: BCBS Complete |
$122.50
|
| Rate for Payer: Cash Price |
$244.99
|
| Rate for Payer: Cofinity Commercial |
$214.37
|
| Rate for Payer: Cofinity Commercial |
$263.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.99
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.93
|
| Rate for Payer: UMR Bronson Commercial |
$113.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.68
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.94 |
| Max. Negotiated Rate |
$1,177.16 |
| Rate for Payer: Aetna American Axle |
$850.17
|
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna Medicare |
$653.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.17
|
| Rate for Payer: BCBS Complete |
$523.18
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Cofinity Commercial |
$915.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health SBD |
$824.01
|
| Rate for Payer: UMR Bronson Commercial |
$483.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$447.84
|
|
|
Service Code
|
NDC 70710113001
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.70 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna Medicare |
$223.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.10
|
| Rate for Payer: Priority Health SBD |
$282.14
|
| Rate for Payer: UMR Bronson Commercial |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$380.64
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Commercial |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.42
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UMR Bronson Commercial |
$167.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 70710113001
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.10
|
| Rate for Payer: Priority Health SBD |
$282.14
|
| Rate for Payer: UMR Bronson Commercial |
$197.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$380.64
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna Medicare |
$190.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: BCBS Complete |
$152.26
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Commercial |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.42
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UMR Bronson Commercial |
$140.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.50 |
| Max. Negotiated Rate |
$1,177.16 |
| Rate for Payer: Aetna American Axle |
$850.17
|
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.17
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Cofinity Commercial |
$915.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health SBD |
$824.01
|
| Rate for Payer: UMR Bronson Commercial |
$575.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$772.32
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.76 |
| Max. Negotiated Rate |
$695.09 |
| Rate for Payer: Aetna American Axle |
$502.01
|
| Rate for Payer: Aetna Commercial |
$656.47
|
| Rate for Payer: Aetna Medicare |
$386.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.01
|
| Rate for Payer: BCBS Complete |
$308.93
|
| Rate for Payer: Cash Price |
$617.86
|
| Rate for Payer: Cofinity Commercial |
$540.62
|
| Rate for Payer: Cofinity Commercial |
$664.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.86
|
| Rate for Payer: Healthscope Commercial |
$695.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$540.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.47
|
| Rate for Payer: PHP Commercial |
$656.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.01
|
| Rate for Payer: Priority Health SBD |
$486.56
|
| Rate for Payer: UMR Bronson Commercial |
$285.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.24
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$868.80
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$781.92 |
| Rate for Payer: Aetna American Axle |
$564.72
|
| Rate for Payer: Aetna Commercial |
$738.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: Cash Price |
$695.04
|
| Rate for Payer: Cofinity Commercial |
$608.16
|
| Rate for Payer: Cofinity Commercial |
$747.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.04
|
| Rate for Payer: Healthscope Commercial |
$781.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.48
|
| Rate for Payer: PHP Commercial |
$738.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.72
|
| Rate for Payer: Priority Health SBD |
$547.34
|
| Rate for Payer: UMR Bronson Commercial |
$382.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.60
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$772.32
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$695.09 |
| Rate for Payer: Aetna American Axle |
$502.01
|
| Rate for Payer: Aetna Commercial |
$656.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.01
|
| Rate for Payer: Cash Price |
$617.86
|
| Rate for Payer: Cofinity Commercial |
$540.62
|
| Rate for Payer: Cofinity Commercial |
$664.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.86
|
| Rate for Payer: Healthscope Commercial |
$695.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$540.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.47
|
| Rate for Payer: PHP Commercial |
$656.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.01
|
| Rate for Payer: Priority Health SBD |
$486.56
|
| Rate for Payer: UMR Bronson Commercial |
$339.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.24
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
NDC 51079005801
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$868.80
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$781.92 |
| Rate for Payer: Aetna American Axle |
$564.72
|
| Rate for Payer: Aetna Commercial |
$738.48
|
| Rate for Payer: Aetna Medicare |
$434.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: BCBS Complete |
$347.52
|
| Rate for Payer: Cash Price |
$695.04
|
| Rate for Payer: Cofinity Commercial |
$608.16
|
| Rate for Payer: Cofinity Commercial |
$747.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.04
|
| Rate for Payer: Healthscope Commercial |
$781.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.48
|
| Rate for Payer: PHP Commercial |
$738.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.72
|
| Rate for Payer: Priority Health SBD |
$547.34
|
| Rate for Payer: UMR Bronson Commercial |
$321.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.60
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
NDC 51079005801
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$30.55
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: BCBS Complete |
$12.22
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$331.35
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$298.22 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna Medicare |
$165.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: BCBS Complete |
$132.54
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$122.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.22 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
