|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$233.88
|
|
|
Service Code
|
NDC 00409110311
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$102.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna Medicare |
$491.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: BCBS Complete |
$392.97
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$363.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.88
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.54 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna Medicare |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: BCBS Complete |
$93.55
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$86.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.16 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna Medicare |
$106.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: BCBS Complete |
$85.51
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.96
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Commercial |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.58
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$432.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.96
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$94.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.16 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna Medicare |
$96.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.01
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$297.50
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna American Axle |
$193.38
|
| Rate for Payer: Aetna American Axle |
$383.60
|
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna American Axle |
$193.88
|
| Rate for Payer: Aetna American Axle |
$212.54
|
| Rate for Payer: Aetna American Axle |
$194.19
|
| Rate for Payer: Aetna American Axle |
$93.28
|
| Rate for Payer: Aetna American Axle |
$129.60
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Commercial |
$253.94
|
| Rate for Payer: Aetna Commercial |
$253.54
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$277.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.88
|
| Rate for Payer: Cash Price |
$261.58
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.62
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Cofinity Commercial |
$208.25
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$256.93
|
| Rate for Payer: Cofinity Commercial |
$123.41
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$413.11
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Healthscope Commercial |
$294.28
|
| Rate for Payer: Healthscope Commercial |
$531.13
|
| Rate for Payer: Healthscope Commercial |
$129.15
|
| Rate for Payer: Healthscope Commercial |
$268.88
|
| Rate for Payer: Healthscope Commercial |
$268.45
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.94
|
| Rate for Payer: PHP Commercial |
$253.54
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$253.94
|
| Rate for Payer: PHP Commercial |
$277.93
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$121.97
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health SBD |
$90.41
|
| Rate for Payer: Priority Health SBD |
$187.92
|
| Rate for Payer: Priority Health SBD |
$187.43
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$206.00
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$131.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: UMR Bronson Commercial |
$259.67
|
| Rate for Payer: UMR Bronson Commercial |
$87.73
|
| Rate for Payer: UMR Bronson Commercial |
$129.89
|
| Rate for Payer: UMR Bronson Commercial |
$63.14
|
| Rate for Payer: UMR Bronson Commercial |
$143.87
|
| Rate for Payer: UMR Bronson Commercial |
$130.90
|
| Rate for Payer: UMR Bronson Commercial |
$131.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.24
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$297.50
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna American Axle |
$193.38
|
| Rate for Payer: Aetna American Axle |
$194.19
|
| Rate for Payer: Aetna American Axle |
$129.60
|
| Rate for Payer: Aetna American Axle |
$193.88
|
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna American Axle |
$93.28
|
| Rate for Payer: Aetna American Axle |
$383.60
|
| Rate for Payer: Aetna American Axle |
$189.88
|
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna American Axle |
$212.54
|
| Rate for Payer: Aetna American Axle |
$199.88
|
| Rate for Payer: Aetna Commercial |
$253.94
|
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Aetna Commercial |
$253.54
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna Commercial |
$252.88
|
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna Commercial |
$248.31
|
| Rate for Payer: Aetna Commercial |
$277.93
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$147.60
|
| Rate for Payer: Aetna Medicare |
$146.06
|
| Rate for Payer: Aetna Medicare |
$153.75
|
| Rate for Payer: Aetna Medicare |
$295.07
|
| Rate for Payer: Aetna Medicare |
$149.14
|
| Rate for Payer: Aetna Medicare |
$71.75
|
| Rate for Payer: Aetna Medicare |
$149.38
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna Medicare |
$148.75
|
| Rate for Payer: Aetna Medicare |
$163.49
|
| Rate for Payer: Aetna Medicare |
$99.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.19
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Complete |
$130.79
|
| Rate for Payer: BCBS Complete |
$236.06
|
| Rate for Payer: BCBS Complete |
$118.08
|
| Rate for Payer: BCBS Complete |
$119.31
|
| Rate for Payer: BCBS Complete |
$119.50
|
| Rate for Payer: BCBS Complete |
$57.40
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Complete |
$116.85
|
| Rate for Payer: BCBS Complete |
$119.00
|
| Rate for Payer: BCBS Complete |
$79.75
|
| Rate for Payer: Cash Price |
$233.70
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cash Price |
$261.58
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: Cash Price |
$238.62
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Cofinity Commercial |
$208.25
|
| Rate for Payer: Cofinity Commercial |
$255.85
|
| Rate for Payer: Cofinity Commercial |
$256.93
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$204.49
|
| Rate for Payer: Cofinity Commercial |
$251.23
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$123.41
|
| Rate for Payer: Cofinity Commercial |
$413.11
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.12
|
| Rate for Payer: Healthscope Commercial |
$262.92
|
| Rate for Payer: Healthscope Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: Healthscope Commercial |
$268.88
|
| Rate for Payer: Healthscope Commercial |
$268.45
|
| Rate for Payer: Healthscope Commercial |
$294.28
|
| Rate for Payer: Healthscope Commercial |
$129.15
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Healthscope Commercial |
$531.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.94
|
| Rate for Payer: PHP Commercial |
$277.93
|
| Rate for Payer: PHP Commercial |
$248.31
|
| Rate for Payer: PHP Commercial |
$261.38
|
| Rate for Payer: PHP Commercial |
$252.88
|
| Rate for Payer: PHP Commercial |
$253.54
|
| Rate for Payer: PHP Commercial |
$121.97
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: PHP Commercial |
$253.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: Priority Health SBD |
$187.43
|
| Rate for Payer: Priority Health SBD |
$187.92
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: Priority Health SBD |
$206.00
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$184.04
|
| Rate for Payer: Priority Health SBD |
$90.41
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: UMR Bronson Commercial |
$113.78
|
| Rate for Payer: UMR Bronson Commercial |
$108.09
|
| Rate for Payer: UMR Bronson Commercial |
$53.09
|
| Rate for Payer: UMR Bronson Commercial |
$110.54
|
| Rate for Payer: UMR Bronson Commercial |
$158.53
|
| Rate for Payer: UMR Bronson Commercial |
$218.36
|
| Rate for Payer: UMR Bronson Commercial |
$110.08
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: UMR Bronson Commercial |
$109.22
|
| Rate for Payer: UMR Bronson Commercial |
$110.36
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.71
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 65862000601
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.96
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$112.80
|
|
|
Service Code
|
NDC 13668001001
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Medicare |
$56.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: BCBS Complete |
$45.12
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.32
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 68084074411
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna American Axle |
$1.56
|
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.56
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health SBD |
$1.51
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.80
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 68084074411
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna American Axle |
$1.56
|
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.56
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health SBD |
$1.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.80
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna American Axle |
$8.55
|
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 68084074401
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.81
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$88.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna American Axle |
$8.55
|
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 65862000601
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.96
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$54.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 68084074401
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.81
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$105.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
