|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$226.99
|
|
|
Service Code
|
NDC 0409-1103-01
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$204.29 |
| Rate for Payer: Aetna American Axle |
$147.54
|
| Rate for Payer: Aetna Commercial |
$192.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.54
|
| Rate for Payer: Cash Price |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$158.89
|
| Rate for Payer: Cofinity Commercial |
$195.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.59
|
| Rate for Payer: Healthscope Commercial |
$204.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.94
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: Priority Health SBD |
$143.00
|
| Rate for Payer: UMR Bronson Commercial |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.24
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$980.51
|
|
|
Service Code
|
NDC 0074-4382-20
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$431.42 |
| Max. Negotiated Rate |
$882.46 |
| Rate for Payer: Aetna American Axle |
$637.33
|
| Rate for Payer: Aetna Commercial |
$833.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.33
|
| Rate for Payer: Cash Price |
$784.41
|
| Rate for Payer: Cofinity Commercial |
$686.36
|
| Rate for Payer: Cofinity Commercial |
$843.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.41
|
| Rate for Payer: Healthscope Commercial |
$882.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$833.43
|
| Rate for Payer: PHP Commercial |
$833.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.36
|
| Rate for Payer: Priority Health SBD |
$617.72
|
| Rate for Payer: UMR Bronson Commercial |
$431.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.38
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$291.25
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$262.12 |
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$129.60
|
| Rate for Payer: Aetna American Axle |
$136.10
|
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna American Axle |
$615.68
|
| Rate for Payer: Aetna American Axle |
$178.56
|
| Rate for Payer: Aetna American Axle |
$194.54
|
| Rate for Payer: Aetna American Axle |
$383.60
|
| Rate for Payer: Aetna American Axle |
$212.54
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Commercial |
$233.50
|
| Rate for Payer: Aetna Commercial |
$805.12
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$177.97
|
| Rate for Payer: Aetna Commercial |
$277.93
|
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$254.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.60
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$239.44
|
| Rate for Payer: Cash Price |
$261.58
|
| Rate for Payer: Cash Price |
$757.76
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$219.76
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Commercial |
$209.51
|
| Rate for Payer: Cofinity Commercial |
$257.40
|
| Rate for Payer: Cofinity Commercial |
$192.29
|
| Rate for Payer: Cofinity Commercial |
$413.10
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$180.07
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$250.48
|
| Rate for Payer: Cofinity Commercial |
$203.88
|
| Rate for Payer: Cofinity Commercial |
$146.57
|
| Rate for Payer: Cofinity Commercial |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$663.04
|
| Rate for Payer: Cofinity Commercial |
$814.59
|
| Rate for Payer: Cofinity Commercial |
$236.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.50
|
| Rate for Payer: Healthscope Commercial |
$247.23
|
| Rate for Payer: Healthscope Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Healthscope Commercial |
$294.28
|
| Rate for Payer: Healthscope Commercial |
$852.48
|
| Rate for Payer: Healthscope Commercial |
$269.37
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Healthscope Commercial |
$531.14
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.47
|
| Rate for Payer: PHP Commercial |
$233.50
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$177.97
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$247.56
|
| Rate for Payer: PHP Commercial |
$254.40
|
| Rate for Payer: PHP Commercial |
$277.93
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$805.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.10
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: Priority Health SBD |
$596.74
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: Priority Health SBD |
$173.06
|
| Rate for Payer: Priority Health SBD |
$131.91
|
| Rate for Payer: Priority Health SBD |
$206.00
|
| Rate for Payer: Priority Health SBD |
$188.56
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: UMR Bronson Commercial |
$259.67
|
| Rate for Payer: UMR Bronson Commercial |
$143.87
|
| Rate for Payer: UMR Bronson Commercial |
$128.15
|
| Rate for Payer: UMR Bronson Commercial |
$120.87
|
| Rate for Payer: UMR Bronson Commercial |
$131.69
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: UMR Bronson Commercial |
$92.13
|
| Rate for Payer: UMR Bronson Commercial |
$87.73
|
| Rate for Payer: UMR Bronson Commercial |
$416.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.61
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$274.70
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
9612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$247.23 |
| Rate for Payer: Aetna American Axle |
$178.56
|
| Rate for Payer: Aetna American Axle |
$189.88
|
| Rate for Payer: Aetna American Axle |
$129.60
|
| Rate for Payer: Aetna American Axle |
$615.68
|
| Rate for Payer: Aetna American Axle |
$383.60
|
| Rate for Payer: Aetna American Axle |
$189.31
|
| Rate for Payer: Aetna American Axle |
$212.54
|
| Rate for Payer: Aetna American Axle |
$199.88
|
| Rate for Payer: Aetna Commercial |
$277.93
|
| Rate for Payer: Aetna Commercial |
$169.47
|
| Rate for Payer: Aetna Commercial |
$261.38
|
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Commercial |
$501.63
|
| Rate for Payer: Aetna Commercial |
$248.31
|
| Rate for Payer: Aetna Commercial |
$233.50
|
| Rate for Payer: Aetna Commercial |
$805.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.31
|
| 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) |
$383.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.60
|
| Rate for Payer: BCBS Complete |
$378.88
|
| Rate for Payer: BCBS Complete |
$116.85
|
| Rate for Payer: BCBS Complete |
$236.06
|
| Rate for Payer: BCBS Complete |
$130.79
|
| Rate for Payer: BCBS Complete |
$116.50
|
| Rate for Payer: BCBS Complete |
$109.88
|
| Rate for Payer: BCBS Complete |
$123.00
|
| Rate for Payer: BCBS Complete |
$79.75
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$219.76
|
| Rate for Payer: Cash Price |
$219.76
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$233.70
|
| Rate for Payer: Cash Price |
$233.70
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$261.58
|
| Rate for Payer: Cash Price |
$261.58
|
| Rate for Payer: Cash Price |
$472.12
|
| Rate for Payer: Cash Price |
$757.76
|
| Rate for Payer: Cash Price |
$757.76
|
| Rate for Payer: Cofinity Commercial |
$171.47
|
| Rate for Payer: Cofinity Commercial |
$192.29
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Commercial |
$139.57
|
| Rate for Payer: Cofinity Commercial |
$236.24
|
| Rate for Payer: Cofinity Commercial |
$203.88
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$814.59
|
| Rate for Payer: Cofinity Commercial |
$204.49
|
| Rate for Payer: Cofinity Commercial |
$251.23
|
| Rate for Payer: Cofinity Commercial |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$413.10
|
| Rate for Payer: Cofinity Commercial |
$507.53
|
| Rate for Payer: Cofinity Commercial |
$264.45
|
| Rate for Payer: Cofinity Commercial |
$663.04
|
| Rate for Payer: Cofinity Commercial |
$250.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.76
|
| Rate for Payer: Healthscope Commercial |
$247.23
|
| Rate for Payer: Healthscope Commercial |
$262.12
|
| Rate for Payer: Healthscope Commercial |
$531.14
|
| Rate for Payer: Healthscope Commercial |
$294.28
|
| Rate for Payer: Healthscope Commercial |
$852.48
|
| Rate for Payer: Healthscope Commercial |
$262.92
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| 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 |
$192.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.10
|
| 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 |
$204.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.12
|
| Rate for Payer: PHP Commercial |
$501.63
|
| Rate for Payer: PHP Commercial |
$169.47
|
| Rate for Payer: PHP Commercial |
$805.12
|
| 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 |
$247.56
|
| Rate for Payer: PHP Commercial |
$233.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.25
|
| Rate for Payer: Priority Health SBD |
$173.06
|
| Rate for Payer: Priority Health SBD |
$184.04
|
| Rate for Payer: Priority Health SBD |
$183.49
|
| Rate for Payer: Priority Health SBD |
$596.74
|
| Rate for Payer: Priority Health SBD |
$206.00
|
| Rate for Payer: Priority Health SBD |
$193.72
|
| Rate for Payer: Priority Health SBD |
$371.79
|
| Rate for Payer: Priority Health SBD |
$125.61
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: UMR Bronson Commercial |
$113.78
|
| Rate for Payer: UMR Bronson Commercial |
$218.36
|
| Rate for Payer: UMR Bronson Commercial |
$108.09
|
| Rate for Payer: UMR Bronson Commercial |
$101.64
|
| Rate for Payer: UMR Bronson Commercial |
$107.76
|
| Rate for Payer: UMR Bronson Commercial |
$350.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.40
|
|
|
CITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 0904-6084-61
|
| 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: 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 Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 0378-6231-01
|
| Hospital Charge Code |
30264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna American Axle |
$24.44
|
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$32.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$33.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.96
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$23.69
|
| Rate for Payer: UMR Bronson Commercial |
$16.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.20
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 68084-744-01
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.80
|
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| 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 Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| 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
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 68084-744-11
|
| 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: 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 Multiplan/Beech St/PHCS |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| 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 0904-6085-61
|
| 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: 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 Multiplan/Beech St/PHCS |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.21
|
| 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 40 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 0378-6233-01
|
| Hospital Charge Code |
23490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna American Axle |
$48.88
|
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
CITRIC ACID (BULK) POWDER
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 3877900689
|
| Hospital Charge Code |
1703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UMR Bronson Commercial |
$73.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$929.07
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.79 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna American Axle |
$603.90
|
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cofinity Commercial |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$789.71
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.35
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: UMR Bronson Commercial |
$408.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.80
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$756.56
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
9615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$680.90 |
| Rate for Payer: Aetna American Axle |
$491.76
|
| Rate for Payer: Aetna American Axle |
$603.90
|
| Rate for Payer: Aetna American Axle |
$528.94
|
| Rate for Payer: Aetna Commercial |
$691.69
|
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna Commercial |
$643.08
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$50.97
|
| Rate for Payer: BCBS Trust/PPO |
$50.97
|
| Rate for Payer: BCBS Trust/PPO |
$50.97
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$743.26
|
| Rate for Payer: Cofinity Commercial |
$529.59
|
| Rate for Payer: Cofinity Commercial |
$650.64
|
| Rate for Payer: Cofinity Commercial |
$569.62
|
| Rate for Payer: Cofinity Commercial |
$699.82
|
| Rate for Payer: Cofinity Commercial |
$650.35
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$836.16
|
| Rate for Payer: Healthscope Commercial |
$732.38
|
| Rate for Payer: Healthscope Commercial |
$680.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$529.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$610.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.80
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicare |
$15.77
|
| Rate for Payer: Mclaren Medicare |
$15.77
|
| Rate for Payer: Mclaren Medicare |
$15.77
|
| Rate for Payer: Meridian Medicaid |
$9.06
|
| Rate for Payer: Meridian Medicaid |
$9.06
|
| Rate for Payer: Meridian Medicaid |
$9.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$691.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.08
|
| Rate for Payer: PACE Medicare |
$14.98
|
| Rate for Payer: PACE Medicare |
$14.98
|
| Rate for Payer: PACE Medicare |
$14.98
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PHP Commercial |
$691.69
|
| Rate for Payer: PHP Commercial |
$643.08
|
| Rate for Payer: PHP Commercial |
$789.71
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.22
|
| Rate for Payer: Priority Health Medicare |
$15.77
|
| Rate for Payer: Priority Health Medicare |
$15.77
|
| Rate for Payer: Priority Health Medicare |
$15.77
|
| Rate for Payer: Priority Health Narrow Network |
$39.38
|
| Rate for Payer: Priority Health Narrow Network |
$39.38
|
| Rate for Payer: Priority Health Narrow Network |
$39.38
|
| Rate for Payer: Priority Health SBD |
$585.31
|
| Rate for Payer: Priority Health SBD |
$476.63
|
| Rate for Payer: Priority Health SBD |
$512.66
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UMR Bronson Commercial |
$279.93
|
| Rate for Payer: UMR Bronson Commercial |
$301.09
|
| Rate for Payer: UMR Bronson Commercial |
$343.76
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$610.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.80
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$708.96
|
|
|
Service Code
|
NDC 0781-6023-46
|
| Hospital Charge Code |
12886
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.94 |
| Max. Negotiated Rate |
$638.06 |
| Rate for Payer: Aetna American Axle |
$460.82
|
| Rate for Payer: Aetna Commercial |
$602.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.82
|
| Rate for Payer: Cash Price |
$567.17
|
| Rate for Payer: Cofinity Commercial |
$496.27
|
| Rate for Payer: Cofinity Commercial |
$609.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.17
|
| Rate for Payer: Healthscope Commercial |
$638.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.62
|
| Rate for Payer: PHP Commercial |
$602.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.27
|
| Rate for Payer: Priority Health SBD |
$446.64
|
| Rate for Payer: UMR Bronson Commercial |
$311.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.72
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$271.89
|
|
|
Service Code
|
NDC 0781-1962-60
|
| Hospital Charge Code |
9617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.63 |
| Max. Negotiated Rate |
$244.70 |
| Rate for Payer: Aetna American Axle |
$176.73
|
| Rate for Payer: Aetna Commercial |
$231.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.73
|
| Rate for Payer: Cash Price |
$217.51
|
| Rate for Payer: Cofinity Commercial |
$190.32
|
| Rate for Payer: Cofinity Commercial |
$233.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.51
|
| Rate for Payer: Healthscope Commercial |
$244.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.11
|
| Rate for Payer: PHP Commercial |
$231.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.32
|
| Rate for Payer: Priority Health SBD |
$171.29
|
| Rate for Payer: UMR Bronson Commercial |
$119.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.92
|
|
|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$251.14
|
|
|
Service Code
|
NDC 0527-1932-06
|
| 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: 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 Multiplan/Beech St/PHCS |
$213.47
|
| Rate for Payer: PHP Commercial |
$213.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.80
|
| 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
|
$9,057.42
|
|
|
Service Code
|
CPT 23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$589.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CLINDAMYCIN 100 MG/ML CUSTOM INJECTION
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.96 |
| Max. Negotiated Rate |
$480.60 |
| Rate for Payer: Aetna American Axle |
$347.10
|
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$453.90
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$427.20
|
| 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 |
$373.80
|
| Rate for Payer: Cofinity Commercial |
$459.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$480.60
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$453.90
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$453.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health SBD |
$336.42
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$234.96
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
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 |
$61.79
|
| Rate for Payer: Aetna American Axle |
$12.32
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$16.12
|
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.79
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$81.98
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Commercial |
$66.54
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$85.79
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$85.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.54
|
| 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: Lakeland Regional Health Systems Commercial |
$71.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.89
|
| Rate for Payer: PHP Commercial |
$81.02
|
| Rate for Payer: PHP Commercial |
$16.12
|
| Rate for Payer: PHP Commercial |
$80.80
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.38
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$59.89
|
| Rate for Payer: Priority Health SBD |
$11.94
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$60.05
|
| Rate for Payer: UMR Bronson Commercial |
$8.34
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$41.94
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$41.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.30
|
| 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 |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.49
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION (BMH OSC)
|
Facility
|
IP
|
$95.06
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
169407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$85.55 |
| Rate for Payer: Aetna American Axle |
$61.79
|
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.79
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cofinity Commercial |
$66.54
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.05
|
| Rate for Payer: Healthscope Commercial |
$85.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.80
|
| Rate for Payer: PHP Commercial |
$80.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.54
|
| Rate for Payer: Priority Health SBD |
$59.89
|
| Rate for Payer: UMR Bronson Commercial |
$41.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.30
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM
|
Facility
|
IP
|
$279.72
|
|
|
Service Code
|
NDC 59762-5009-1
|
| 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: 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 Multiplan/Beech St/PHCS |
$237.76
|
| Rate for Payer: PHP Commercial |
$237.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.80
|
| 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
|
$216.44
|
|
|
Service Code
|
NDC 0168-0277-40
|
| Hospital Charge Code |
9624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.23 |
| Max. Negotiated Rate |
$194.80 |
| Rate for Payer: Aetna American Axle |
$140.69
|
| Rate for Payer: Aetna Commercial |
$183.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.69
|
| Rate for Payer: Cash Price |
$173.15
|
| Rate for Payer: Cofinity Commercial |
$151.51
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.15
|
| Rate for Payer: Healthscope Commercial |
$194.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.97
|
| Rate for Payer: PHP Commercial |
$183.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.51
|
| Rate for Payer: Priority Health SBD |
$136.36
|
| Rate for Payer: UMR Bronson Commercial |
$95.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.33
|
|
|
CLINDAMYCIN 300 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.02
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$34.49
|
|
|
Service Code
|
NDC 0781-3289-91
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Aetna American Axle |
$22.42
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.42
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.59
|
| Rate for Payer: Healthscope Commercial |
$31.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.87
|
|
