|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$671.52
|
|
|
Service Code
|
NDC 00781602346
|
| Hospital Charge Code |
12886
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$604.37 |
| Rate for Payer: Aetna American Axle |
$436.49
|
| Rate for Payer: Aetna Commercial |
$570.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.49
|
| Rate for Payer: Cash Price |
$537.22
|
| Rate for Payer: Cofinity Commercial |
$470.06
|
| Rate for Payer: Cofinity Commercial |
$577.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.22
|
| Rate for Payer: Healthscope Commercial |
$604.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.79
|
| Rate for Payer: PHP Commercial |
$570.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.49
|
| Rate for Payer: Priority Health SBD |
$423.06
|
| Rate for Payer: UMR Bronson Commercial |
$295.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.64
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$251.14
|
|
|
Service Code
|
NDC 00527193206
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$226.03 |
| Rate for Payer: Aetna American Axle |
$163.24
|
| Rate for Payer: Aetna Commercial |
$213.47
|
| Rate for Payer: Aetna Medicare |
$125.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.24
|
| Rate for Payer: BCBS Complete |
$100.46
|
| Rate for Payer: Cash Price |
$200.91
|
| Rate for Payer: Cofinity Commercial |
$175.80
|
| Rate for Payer: Cofinity Commercial |
$215.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.91
|
| Rate for Payer: Healthscope Commercial |
$226.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: PHP Commercial |
$213.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.24
|
| Rate for Payer: Priority Health SBD |
$158.22
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.36
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$278.73
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$250.86 |
| Rate for Payer: Aetna American Axle |
$181.17
|
| Rate for Payer: Aetna Commercial |
$236.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.17
|
| Rate for Payer: Cash Price |
$222.98
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.98
|
| Rate for Payer: Healthscope Commercial |
$250.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.92
|
| Rate for Payer: PHP Commercial |
$236.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health SBD |
$175.60
|
| Rate for Payer: UMR Bronson Commercial |
$122.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.05
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$278.73
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.13 |
| Max. Negotiated Rate |
$250.86 |
| Rate for Payer: Aetna American Axle |
$181.17
|
| Rate for Payer: Aetna Commercial |
$236.92
|
| Rate for Payer: Aetna Medicare |
$139.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.17
|
| Rate for Payer: BCBS Complete |
$111.49
|
| Rate for Payer: Cash Price |
$222.98
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.98
|
| Rate for Payer: Healthscope Commercial |
$250.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.92
|
| Rate for Payer: PHP Commercial |
$236.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health SBD |
$175.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.05
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$251.14
|
|
|
Service Code
|
NDC 00527193206
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$226.03 |
| Rate for Payer: Aetna American Axle |
$163.24
|
| Rate for Payer: Aetna Commercial |
$213.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.24
|
| Rate for Payer: Cash Price |
$200.91
|
| Rate for Payer: Cofinity Commercial |
$175.80
|
| Rate for Payer: Cofinity Commercial |
$215.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.91
|
| Rate for Payer: Healthscope Commercial |
$226.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.47
|
| Rate for Payer: PHP Commercial |
$213.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.24
|
| Rate for Payer: Priority Health SBD |
$158.22
|
| Rate for Payer: UMR Bronson Commercial |
$110.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.36
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.43 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$571.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CLINDAMYCIN 100 MG/ML CUSTOM INJECTION
|
Facility
|
OP
|
$550.50
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$495.45 |
| Rate for Payer: Aetna American Axle |
$357.82
|
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Commercial |
$467.92
|
| Rate for Payer: Aetna Medicare |
$275.25
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Complete |
$220.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Commercial |
$385.35
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$473.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.40
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$495.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$385.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$467.92
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: Priority Health SBD |
$346.82
|
| Rate for Payer: UMR Bronson Commercial |
$203.68
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.88
|
|
|
CLINDAMYCIN 100 MG/ML CUSTOM INJECTION
|
Facility
|
IP
|
$550.50
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.22 |
| Max. Negotiated Rate |
$495.45 |
| Rate for Payer: Aetna American Axle |
$357.82
|
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$467.92
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$385.35
|
| Rate for Payer: Cofinity Commercial |
$473.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$495.45
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$385.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.92
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$467.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$346.82
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$242.22
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.96
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Aetna American Axle |
$12.32
|
| Rate for Payer: Aetna American Axle |
$61.96
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$12.21
|
| Rate for Payer: Aetna American Axle |
$63.69
|
| Rate for Payer: Aetna Commercial |
$16.12
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$83.29
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Aetna Medicare |
$9.48
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$38.13
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$68.59
|
| Rate for Payer: Cofinity Commercial |
$81.98
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.26
|
| Rate for Payer: Healthscope Commercial |
$85.79
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$88.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$83.29
|
| Rate for Payer: PHP Commercial |
$81.02
|
| Rate for Payer: PHP Commercial |
$16.12
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.32
|
| Rate for Payer: Priority Health SBD |
$11.94
|
| Rate for Payer: Priority Health SBD |
$61.73
|
| Rate for Payer: Priority Health SBD |
$60.05
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$7.02
|
| Rate for Payer: UMR Bronson Commercial |
$35.27
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$95.32
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.94 |
| Max. Negotiated Rate |
$85.79 |
| Rate for Payer: Aetna American Axle |
$61.96
|
| Rate for Payer: Aetna American Axle |
$12.21
|
| Rate for Payer: Aetna American Axle |
$12.32
|
| Rate for Payer: Aetna American Axle |
$63.69
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Commercial |
$16.12
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$83.29
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.32
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$68.59
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$81.98
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$85.79
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$88.19
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$83.29
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$81.02
|
| Rate for Payer: PHP Commercial |
$16.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.21
|
| Rate for Payer: Priority Health SBD |
$61.73
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$11.94
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$60.05
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.34
|
| Rate for Payer: UMR Bronson Commercial |
$41.94
|
| Rate for Payer: UMR Bronson Commercial |
$43.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.49
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION (BMH OSC)
|
Facility
|
OP
|
$97.99
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
169407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$88.19 |
| Rate for Payer: Aetna American Axle |
$63.69
|
| Rate for Payer: Aetna Commercial |
$83.29
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.69
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cofinity Commercial |
$68.59
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.39
|
| Rate for Payer: Healthscope Commercial |
$88.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.29
|
| Rate for Payer: PHP Commercial |
$83.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.69
|
| Rate for Payer: Priority Health SBD |
$61.73
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.49
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION (BMH OSC)
|
Facility
|
IP
|
$97.99
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
169407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$88.19 |
| Rate for Payer: Aetna American Axle |
$63.69
|
| Rate for Payer: Aetna Commercial |
$83.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.69
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cofinity Commercial |
$68.59
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.39
|
| Rate for Payer: Healthscope Commercial |
$88.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.29
|
| Rate for Payer: PHP Commercial |
$83.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.69
|
| Rate for Payer: Priority Health SBD |
$61.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.49
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
IP
|
$279.72
|
|
|
Service Code
|
NDC 59762500901
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna American Axle |
$181.82
|
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.82
|
| Rate for Payer: Cash Price |
$223.78
|
| Rate for Payer: Cofinity Commercial |
$195.80
|
| Rate for Payer: Cofinity Commercial |
$240.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.78
|
| Rate for Payer: Healthscope Commercial |
$251.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.76
|
| Rate for Payer: PHP Commercial |
$237.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.82
|
| Rate for Payer: Priority Health SBD |
$176.22
|
| Rate for Payer: UMR Bronson Commercial |
$123.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.79
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
IP
|
$259.70
|
|
|
Service Code
|
NDC 00168027740
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$233.73 |
| Rate for Payer: Aetna American Axle |
$168.80
|
| Rate for Payer: Aetna Commercial |
$220.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.80
|
| Rate for Payer: Cash Price |
$207.76
|
| Rate for Payer: Cofinity Commercial |
$181.79
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.76
|
| Rate for Payer: Healthscope Commercial |
$233.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.74
|
| Rate for Payer: PHP Commercial |
$220.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.80
|
| Rate for Payer: Priority Health SBD |
$163.61
|
| Rate for Payer: UMR Bronson Commercial |
$114.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.78
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
OP
|
$279.72
|
|
|
Service Code
|
NDC 59762500901
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna American Axle |
$181.82
|
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: Aetna Medicare |
$139.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.82
|
| Rate for Payer: BCBS Complete |
$111.89
|
| Rate for Payer: Cash Price |
$223.78
|
| Rate for Payer: Cofinity Commercial |
$195.80
|
| Rate for Payer: Cofinity Commercial |
$240.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.78
|
| Rate for Payer: Healthscope Commercial |
$251.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.76
|
| Rate for Payer: PHP Commercial |
$237.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.82
|
| Rate for Payer: Priority Health SBD |
$176.22
|
| Rate for Payer: UMR Bronson Commercial |
$103.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.79
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
OP
|
$259.70
|
|
|
Service Code
|
NDC 00168027740
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.09 |
| Max. Negotiated Rate |
$233.73 |
| Rate for Payer: Aetna American Axle |
$168.80
|
| Rate for Payer: Aetna Commercial |
$220.74
|
| Rate for Payer: Aetna Medicare |
$129.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.80
|
| Rate for Payer: BCBS Complete |
$103.88
|
| Rate for Payer: Cash Price |
$207.76
|
| Rate for Payer: Cofinity Commercial |
$181.79
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.76
|
| Rate for Payer: Healthscope Commercial |
$233.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.74
|
| Rate for Payer: PHP Commercial |
$220.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.80
|
| Rate for Payer: Priority Health SBD |
$163.61
|
| Rate for Payer: UMR Bronson Commercial |
$96.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.78
|
|
|
CLINDAMYCIN 300 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$25.16
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$22.64 |
| Rate for Payer: Aetna American Axle |
$16.35
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.35
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Cofinity Commercial |
$21.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health SBD |
$15.85
|
| Rate for Payer: UMR Bronson Commercial |
$11.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.87
|
|
|
CLINDAMYCIN 300 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$25.16
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$22.64 |
| Rate for Payer: Aetna American Axle |
$16.35
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.35
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$7.57
|
| Rate for Payer: BCN Commercial |
$7.57
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Cofinity Commercial |
$21.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health SBD |
$15.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.87
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna American Axle |
$13.88
|
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.88
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$14.95
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health SBD |
$13.46
|
| Rate for Payer: UMR Bronson Commercial |
$9.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna American Axle |
$13.88
|
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.88
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.57
|
| Rate for Payer: BCN Commercial |
$7.57
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$14.95
|
| Rate for Payer: Cofinity Commercial |
$18.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.16
|
| Rate for Payer: PHP Commercial |
$18.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health SBD |
$13.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$32.04
|
|
|
Service Code
|
NDC 00781328991
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Aetna American Axle |
$20.83
|
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: Aetna Medicare |
$16.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.83
|
| Rate for Payer: BCBS Complete |
$12.82
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.23
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.83
|
| Rate for Payer: Priority Health SBD |
$20.19
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.03
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$44.28
|
|
|
Service Code
|
NDC 43066099324
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna American Axle |
$28.78
|
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.78
|
| Rate for Payer: BCBS Complete |
$17.71
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$31.00
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.78
|
| Rate for Payer: Priority Health SBD |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.21
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$32.04
|
|
|
Service Code
|
NDC 00781328991
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.43
|
| Rate for Payer: Aetna American Axle |
$20.83
|
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.83
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.23
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.83
|
| Rate for Payer: Priority Health SBD |
$20.19
|
| Rate for Payer: UMR Bronson Commercial |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.03
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
NDC 43066099324
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna American Axle |
$28.78
|
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.78
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$31.00
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.78
|
| Rate for Payer: Priority Health SBD |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$19.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.21
|
|
|
CLINDAMYCIN 600 MG (IV PREMIX)
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna American Axle |
$42.96
|
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.18
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.96
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: UMR Bronson Commercial |
$29.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
|
