|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$248.10
|
|
|
Service Code
|
NDC 0409-4093-09
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna American Axle |
$161.26
|
| Rate for Payer: Aetna Commercial |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Cash Price |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$173.67
|
| Rate for Payer: Cofinity Commercial |
$213.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.48
|
| Rate for Payer: Healthscope Commercial |
$223.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.88
|
| Rate for Payer: PHP Commercial |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.67
|
| Rate for Payer: Priority Health SBD |
$156.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.08
|
|
|
CHROMIUM CHLORIDE SD 0.5 MCG/ML IV
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 0990-0000-57
|
| Hospital Charge Code |
150942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,462.39
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$94.30
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$16,647.96
|
|
|
Service Code
|
MS-DRG 191
|
| Min. Negotiated Rate |
$6,702.05 |
| Max. Negotiated Rate |
$16,647.96 |
| Rate for Payer: Aetna Medicare |
$7,336.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,818.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,818.49
|
| Rate for Payer: BCBS MAPPO |
$7,054.79
|
| Rate for Payer: BCBS Trust/PPO |
$16,647.96
|
| Rate for Payer: BCN Medicare Advantage |
$7,054.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,054.79
|
| Rate for Payer: Mclaren Medicare |
$7,054.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,407.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,113.01
|
| Rate for Payer: PACE Medicare |
$6,702.05
|
| Rate for Payer: PACE SWMI |
$7,054.79
|
| Rate for Payer: PHP Medicare Advantage |
$7,054.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,183.08
|
| Rate for Payer: Priority Health Medicare |
$7,054.79
|
| Rate for Payer: Priority Health Narrow Network |
$9,746.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7,054.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,950.65
|
| Rate for Payer: UHC Core |
$10,619.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,054.79
|
| Rate for Payer: UHC Exchange |
$8,442.46
|
| Rate for Payer: UHC Medicare Advantage |
$7,266.43
|
| Rate for Payer: VA VA |
$7,054.79
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$18,708.54
|
|
|
Service Code
|
MS-DRG 190
|
| Min. Negotiated Rate |
$8,554.18 |
| Max. Negotiated Rate |
$18,708.54 |
| Rate for Payer: Aetna Medicare |
$9,364.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,255.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,255.50
|
| Rate for Payer: BCBS MAPPO |
$9,004.40
|
| Rate for Payer: BCBS Trust/PPO |
$18,708.54
|
| Rate for Payer: BCN Medicare Advantage |
$9,004.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,004.40
|
| Rate for Payer: Mclaren Medicare |
$9,004.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,454.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,355.06
|
| Rate for Payer: PACE Medicare |
$8,554.18
|
| Rate for Payer: PACE SWMI |
$9,004.40
|
| Rate for Payer: PHP Medicare Advantage |
$9,004.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,813.61
|
| Rate for Payer: Priority Health Medicare |
$9,004.40
|
| Rate for Payer: Priority Health Narrow Network |
$12,650.89
|
| Rate for Payer: Railroad Medicare Medicare |
$9,004.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,809.91
|
| Rate for Payer: UHC Core |
$13,783.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,004.40
|
| Rate for Payer: UHC Exchange |
$10,958.29
|
| Rate for Payer: UHC Medicare Advantage |
$9,274.53
|
| Rate for Payer: VA VA |
$9,004.40
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$12,215.21
|
|
|
Service Code
|
MS-DRG 192
|
| Min. Negotiated Rate |
$5,185.20 |
| Max. Negotiated Rate |
$12,215.21 |
| Rate for Payer: Aetna Medicare |
$5,676.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,822.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,822.62
|
| Rate for Payer: BCBS MAPPO |
$5,458.10
|
| Rate for Payer: BCBS Trust/PPO |
$12,215.21
|
| Rate for Payer: BCN Medicare Advantage |
$5,458.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,458.10
|
| Rate for Payer: Mclaren Medicare |
$5,458.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,731.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,276.82
|
| Rate for Payer: PACE Medicare |
$5,185.20
|
| Rate for Payer: PACE SWMI |
$5,458.10
|
| Rate for Payer: PHP Medicare Advantage |
$5,458.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,209.78
|
| Rate for Payer: Priority Health Medicare |
$5,458.10
|
| Rate for Payer: Priority Health Narrow Network |
$7,367.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5,458.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,790.02
|
| Rate for Payer: UHC Core |
$8,027.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,458.10
|
| Rate for Payer: UHC Exchange |
$6,382.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,621.84
|
| Rate for Payer: VA VA |
$5,458.10
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,202.24
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.99 |
| Max. Negotiated Rate |
$1,982.02 |
| Rate for Payer: Aetna American Axle |
$1,431.46
|
| Rate for Payer: Aetna Commercial |
$1,871.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,431.46
|
| Rate for Payer: Cash Price |
$1,761.79
|
| Rate for Payer: Cofinity Commercial |
$1,541.57
|
| Rate for Payer: Cofinity Commercial |
$1,893.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.79
|
| Rate for Payer: Healthscope Commercial |
$1,982.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,541.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,651.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,871.90
|
| Rate for Payer: PHP Commercial |
$1,871.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.57
|
| Rate for Payer: Priority Health SBD |
$1,387.41
|
| Rate for Payer: UMR Bronson Commercial |
$968.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,651.68
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,202.24
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
17378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.14 |
| Max. Negotiated Rate |
$1,982.02 |
| Rate for Payer: Aetna American Axle |
$1,431.46
|
| Rate for Payer: Aetna Commercial |
$1,871.90
|
| Rate for Payer: Aetna Medicare |
$576.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,431.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$692.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$692.74
|
| Rate for Payer: BCBS Complete |
$318.33
|
| Rate for Payer: BCBS MAPPO |
$554.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,790.87
|
| Rate for Payer: BCN Medicare Advantage |
$554.19
|
| Rate for Payer: Cash Price |
$1,761.79
|
| Rate for Payer: Cash Price |
$1,761.79
|
| Rate for Payer: Cofinity Commercial |
$1,893.93
|
| Rate for Payer: Cofinity Commercial |
$1,541.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.19
|
| Rate for Payer: Healthscope Commercial |
$1,982.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,541.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,651.68
|
| Rate for Payer: Mclaren Medicaid |
$303.14
|
| Rate for Payer: Mclaren Medicare |
$554.19
|
| Rate for Payer: Meridian Medicaid |
$318.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$581.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$637.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,871.90
|
| Rate for Payer: PACE Medicare |
$526.48
|
| Rate for Payer: PACE SWMI |
$554.19
|
| Rate for Payer: PHP Commercial |
$1,871.90
|
| Rate for Payer: PHP Medicare Advantage |
$554.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,616.38
|
| Rate for Payer: Priority Health Medicare |
$554.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,293.10
|
| Rate for Payer: Priority Health SBD |
$1,387.41
|
| Rate for Payer: Railroad Medicare Medicare |
$554.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.19
|
| Rate for Payer: UHC Medicare Advantage |
$570.82
|
| Rate for Payer: UMR Bronson Commercial |
$814.83
|
| Rate for Payer: VA VA |
$554.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,651.68
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$100.11
|
|
|
Service Code
|
NDC 60505-2521-1
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna American Axle |
$65.07
|
| Rate for Payer: Aetna Commercial |
$85.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.07
|
| Rate for Payer: Cash Price |
$80.09
|
| Rate for Payer: Cofinity Commercial |
$70.08
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.09
|
| Rate for Payer: Healthscope Commercial |
$90.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.09
|
| Rate for Payer: PHP Commercial |
$85.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.08
|
| Rate for Payer: Priority Health SBD |
$63.07
|
| Rate for Payer: UMR Bronson Commercial |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.08
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$168.15
|
|
|
Service Code
|
NDC 0054-0028-21
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$151.34 |
| Rate for Payer: Aetna American Axle |
$109.30
|
| Rate for Payer: Aetna Commercial |
$142.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: Cash Price |
$134.52
|
| Rate for Payer: Cofinity Commercial |
$117.70
|
| Rate for Payer: Cofinity Commercial |
$144.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.52
|
| Rate for Payer: Healthscope Commercial |
$151.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.93
|
| Rate for Payer: PHP Commercial |
$142.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.70
|
| Rate for Payer: Priority Health SBD |
$105.93
|
| Rate for Payer: UMR Bronson Commercial |
$73.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.11
|
|
|
CILOSTAZOL 50 MG TABLET
|
Facility
|
IP
|
$149.34
|
|
|
Service Code
|
NDC 70436-050-06
|
| Hospital Charge Code |
24473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.94
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.54
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
CINACALCET 30 MG TABLET
|
Facility
|
IP
|
$1,804.31
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$793.90 |
| Max. Negotiated Rate |
$1,623.88 |
| Rate for Payer: Aetna American Axle |
$1,172.80
|
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$61.32
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$80.19
|
| Rate for Payer: Aetna Commercial |
$1,533.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$1,443.45
|
| Rate for Payer: Cash Price |
$75.47
|
| Rate for Payer: Cofinity Commercial |
$1,263.02
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$81.13
|
| Rate for Payer: Cofinity Commercial |
$1,551.71
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$1,623.88
|
| Rate for Payer: Healthscope Commercial |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,353.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,533.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.19
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$1,533.66
|
| Rate for Payer: PHP Commercial |
$80.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.04
|
| Rate for Payer: Priority Health SBD |
$1,136.72
|
| Rate for Payer: Priority Health SBD |
$59.43
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: UMR Bronson Commercial |
$793.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,353.23
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$810.79
|
|
|
Service Code
|
NDC 0078-0799-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.75 |
| Max. Negotiated Rate |
$729.71 |
| Rate for Payer: Aetna American Axle |
$527.01
|
| Rate for Payer: Aetna Commercial |
$689.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.01
|
| Rate for Payer: Cash Price |
$648.63
|
| Rate for Payer: Cofinity Commercial |
$567.55
|
| Rate for Payer: Cofinity Commercial |
$697.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.63
|
| Rate for Payer: Healthscope Commercial |
$729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$689.17
|
| Rate for Payer: PHP Commercial |
$689.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.55
|
| Rate for Payer: Priority Health SBD |
$510.80
|
| Rate for Payer: UMR Bronson Commercial |
$356.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.09
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$729.73
|
|
|
Service Code
|
NDC 0781-6186-67
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.08 |
| Max. Negotiated Rate |
$656.76 |
| Rate for Payer: Aetna American Axle |
$474.32
|
| Rate for Payer: Aetna Commercial |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.32
|
| Rate for Payer: Cash Price |
$583.78
|
| Rate for Payer: Cofinity Commercial |
$510.81
|
| Rate for Payer: Cofinity Commercial |
$627.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.78
|
| Rate for Payer: Healthscope Commercial |
$656.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$620.27
|
| Rate for Payer: PHP Commercial |
$620.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.81
|
| Rate for Payer: Priority Health SBD |
$459.73
|
| Rate for Payer: UMR Bronson Commercial |
$321.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.30
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
IP
|
$394.15
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$354.74 |
| Rate for Payer: Aetna American Axle |
$256.20
|
| Rate for Payer: Aetna Commercial |
$335.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.20
|
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Cofinity Commercial |
$275.90
|
| Rate for Payer: Cofinity Commercial |
$338.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.32
|
| Rate for Payer: Healthscope Commercial |
$354.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.03
|
| Rate for Payer: PHP Commercial |
$335.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.90
|
| Rate for Payer: Priority Health SBD |
$248.31
|
| Rate for Payer: UMR Bronson Commercial |
$173.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.61
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$582.24
|
|
|
Service Code
|
NDC 50419-777-01
|
| Hospital Charge Code |
22987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.19 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$494.90
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.57
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UMR Bronson Commercial |
$256.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687-528-11
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 60687-528-01
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 63739-700-10
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.20
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
CIPROFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 65862-076-01
|
| Hospital Charge Code |
25118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.40
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
9611
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Aetna American Axle |
$33.18
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.73
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.28
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 0904-6378-61
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$1,183.63
|
|
|
Service Code
|
NDC 62135-309-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,065.27 |
| Rate for Payer: Aetna American Axle |
$769.36
|
| Rate for Payer: Aetna Commercial |
$1,006.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.36
|
| Rate for Payer: Cash Price |
$946.90
|
| Rate for Payer: Cofinity Commercial |
$1,017.92
|
| Rate for Payer: Cofinity Commercial |
$828.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.90
|
| Rate for Payer: Healthscope Commercial |
$1,065.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$828.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.09
|
| Rate for Payer: PHP Commercial |
$1,006.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.54
|
| Rate for Payer: Priority Health SBD |
$745.69
|
| Rate for Payer: UMR Bronson Commercial |
$520.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.72
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 0904-7083-61
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UMR Bronson Commercial |
$149.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-070-01
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
