|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,539.14
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.39 |
| Max. Negotiated Rate |
$1,519.61 |
| Rate for Payer: Aetna American Axle |
$1,000.44
|
| Rate for Payer: Aetna Commercial |
$1,308.27
|
| Rate for Payer: Aetna Medicare |
$313.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.38
|
| Rate for Payer: BCBS Complete |
$169.46
|
| Rate for Payer: BCBS MAPPO |
$301.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,423.66
|
| Rate for Payer: BCN Commercial |
$1,423.66
|
| Rate for Payer: BCN Medicare Advantage |
$301.10
|
| Rate for Payer: Cash Price |
$1,231.31
|
| Rate for Payer: Cash Price |
$1,231.31
|
| Rate for Payer: Cofinity Commercial |
$1,323.66
|
| Rate for Payer: Cofinity Commercial |
$1,077.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,077.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,231.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.10
|
| Rate for Payer: Healthscope Commercial |
$1,385.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,077.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,154.36
|
| Rate for Payer: Mclaren Medicaid |
$161.39
|
| Rate for Payer: Mclaren Medicare |
$301.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.16
|
| Rate for Payer: Meridian Medicaid |
$169.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,308.27
|
| Rate for Payer: Nomi Health Commercial |
$903.30
|
| Rate for Payer: PACE Medicare |
$286.04
|
| Rate for Payer: PACE SWMI |
$301.10
|
| Rate for Payer: PHP Commercial |
$1,308.27
|
| Rate for Payer: PHP Medicare Advantage |
$301.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,519.61
|
| Rate for Payer: Priority Health Medicare |
$301.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,215.69
|
| Rate for Payer: Priority Health SBD |
$969.66
|
| Rate for Payer: Railroad Medicare Medicare |
$301.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.10
|
| Rate for Payer: UHC Exchange |
$575.43
|
| Rate for Payer: UHC Medicare Advantage |
$301.10
|
| Rate for Payer: UHCCP Medicaid |
$161.39
|
| Rate for Payer: UMR Bronson Commercial |
$569.48
|
| Rate for Payer: VA VA |
$301.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,154.36
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$118.44
|
|
|
Service Code
|
NDC 60505252101
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna American Axle |
$76.99
|
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.99
|
| Rate for Payer: Cash Price |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.99
|
| Rate for Payer: Priority Health SBD |
$74.62
|
| Rate for Payer: UMR Bronson Commercial |
$52.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.83
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$168.15
|
|
|
Service Code
|
NDC 00054002821
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$151.34 |
| Rate for Payer: Aetna American Axle |
$109.30
|
| Rate for Payer: Aetna Commercial |
$142.93
|
| Rate for Payer: Aetna Medicare |
$84.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: BCBS Complete |
$67.26
|
| Rate for Payer: Cash Price |
$134.52
|
| Rate for Payer: Cofinity Commercial |
$117.70
|
| Rate for Payer: Cofinity Commercial |
$144.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.52
|
| Rate for Payer: Healthscope Commercial |
$151.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.93
|
| Rate for Payer: PHP Commercial |
$142.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.30
|
| Rate for Payer: Priority Health SBD |
$105.93
|
| Rate for Payer: UMR Bronson Commercial |
$62.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.11
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$149.34
|
|
|
Service Code
|
NDC 70436005006
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.94
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.07
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$149.34
|
|
|
Service Code
|
NDC 70436005006
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna Medicare |
$74.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: BCBS Complete |
$59.74
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.94
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.07
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$55.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
OP
|
$118.44
|
|
|
Service Code
|
NDC 60505252101
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna American Axle |
$76.99
|
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna Medicare |
$59.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.99
|
| Rate for Payer: BCBS Complete |
$47.38
|
| Rate for Payer: Cash Price |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.99
|
| Rate for Payer: Priority Health SBD |
$74.62
|
| Rate for Payer: UMR Bronson Commercial |
$43.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.83
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$168.15
|
|
|
Service Code
|
NDC 00054002821
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$151.34 |
| Rate for Payer: Aetna American Axle |
$109.30
|
| Rate for Payer: Aetna Commercial |
$142.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: Cash Price |
$134.52
|
| Rate for Payer: Cofinity Commercial |
$117.70
|
| Rate for Payer: Cofinity Commercial |
$144.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.52
|
| Rate for Payer: Healthscope Commercial |
$151.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.93
|
| Rate for Payer: PHP Commercial |
$142.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.30
|
| Rate for Payer: Priority Health SBD |
$105.93
|
| Rate for Payer: UMR Bronson Commercial |
$73.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.11
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$1,807.86
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$795.46 |
| Max. Negotiated Rate |
$1,627.07 |
| Rate for Payer: Aetna American Axle |
$1,175.11
|
| Rate for Payer: Aetna American Axle |
$69.28
|
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$61.32
|
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$90.60
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$74.61
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Cofinity Commercial |
$1,265.50
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$91.67
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$95.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,355.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.60
|
| Rate for Payer: PHP Commercial |
$90.60
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.28
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$84.03
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$67.15
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: UMR Bronson Commercial |
$46.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$795.46
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: UMR Bronson Commercial |
$58.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,355.90
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$1,175.11
|
| Rate for Payer: Aetna American Axle |
$61.32
|
| Rate for Payer: Aetna American Axle |
$69.28
|
| Rate for Payer: Aetna American Axle |
$86.70
|
| Rate for Payer: Aetna Commercial |
$90.60
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Commercial |
$1,536.68
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$903.93
|
| Rate for Payer: Aetna Medicare |
$66.26
|
| Rate for Payer: Aetna Medicare |
$47.17
|
| Rate for Payer: Aetna Medicare |
$66.69
|
| Rate for Payer: Aetna Medicare |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.11
|
| Rate for Payer: BCBS Complete |
$37.74
|
| Rate for Payer: BCBS Complete |
$42.64
|
| Rate for Payer: BCBS Complete |
$723.14
|
| Rate for Payer: BCBS Complete |
$53.35
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$1,446.29
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$1,554.76
|
| Rate for Payer: Cofinity Commercial |
$74.61
|
| Rate for Payer: Cofinity Commercial |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Cofinity Commercial |
$1,265.50
|
| Rate for Payer: Cofinity Commercial |
$91.67
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,265.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$95.93
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$1,627.07
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,355.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.19
|
| Rate for Payer: PHP Commercial |
$1,536.68
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: PHP Commercial |
$90.60
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$67.15
|
| Rate for Payer: Priority Health SBD |
$84.03
|
| Rate for Payer: Priority Health SBD |
$1,138.95
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$668.91
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$39.44
|
| Rate for Payer: UMR Bronson Commercial |
$49.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,355.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.04
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna American Axle |
$474.32
|
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna Medicare |
$364.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: BCBS Complete |
$291.89
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UMR Bronson Commercial |
$270.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.99 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna American Axle |
$527.01
|
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna Medicare |
$405.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: BCBS Complete |
$324.32
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$567.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.01
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UMR Bronson Commercial |
$299.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$399.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$359.96 |
| Rate for Payer: Aetna American Axle |
$259.97
|
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.97
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$279.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Healthscope Commercial |
$359.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.96
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.97
|
| Rate for Payer: Priority Health SBD |
$251.97
|
| Rate for Payer: UMR Bronson Commercial |
$175.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.08 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna American Axle |
$474.32
|
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.27
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.32
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UMR Bronson Commercial |
$321.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$399.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$359.96 |
| Rate for Payer: Aetna American Axle |
$259.97
|
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: Aetna Medicare |
$199.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.97
|
| Rate for Payer: BCBS Complete |
$159.98
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$279.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Healthscope Commercial |
$359.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.96
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.97
|
| Rate for Payer: Priority Health SBD |
$251.97
|
| Rate for Payer: UMR Bronson Commercial |
$147.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 00078079975
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.75 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna American Axle |
$527.01
|
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$567.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.17
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.01
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UMR Bronson Commercial |
$356.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$582.24
|
|
|
Service Code
|
NDC 50419077701
|
| Hospital Charge Code |
22987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.19 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.46
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UMR Bronson Commercial |
$256.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$582.24
|
|
|
Service Code
|
NDC 50419077701
|
| Hospital Charge Code |
22987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.43 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna Medicare |
$291.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: BCBS Complete |
$232.90
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.46
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UMR Bronson Commercial |
$215.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687052811
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 63739070010
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$41.47
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna American Axle |
$33.18
|
| Rate for Payer: Aetna American Axle |
$37.32
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$48.81
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$36.17
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$25.26
|
| Rate for Payer: UMR Bronson Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$57.42
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$51.68 |
| Rate for Payer: Aetna American Axle |
$37.32
|
| Rate for Payer: Aetna American Axle |
$33.18
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Aetna Medicare |
$20.74
|
| Rate for Payer: Aetna Medicare |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.94
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.81
|
| Rate for Payer: PHP Commercial |
$48.81
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.32
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: Priority Health SBD |
$36.17
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$21.25
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: UMR Bronson Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.06
|
|
