|
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
|
|
|
CLINDAMYCIN 600 MG (IV PREMIX)
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
500559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$64.04 |
| Rate for Payer: Aetna American Axle |
$46.25
|
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.25
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cofinity Commercial |
$49.80
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.48
|
| Rate for Payer: PHP Commercial |
$60.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.80
|
| Rate for Payer: Priority Health SBD |
$44.82
|
| Rate for Payer: UMR Bronson Commercial |
$31.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.36
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$416.10
|
|
|
Service Code
|
NDC 65862-596-01
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.08 |
| Max. Negotiated Rate |
$374.49 |
| Rate for Payer: Aetna American Axle |
$270.46
|
| Rate for Payer: Aetna Commercial |
$353.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: Cash Price |
$332.88
|
| Rate for Payer: Cofinity Commercial |
$291.27
|
| Rate for Payer: Cofinity Commercial |
$357.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.88
|
| Rate for Payer: Healthscope Commercial |
$374.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.68
|
| Rate for Payer: PHP Commercial |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.27
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.08
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 59762-0016-1
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.02
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 0574-0129-01
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.78
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 65162-468-19
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.26
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.26
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$186.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$20.47
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Aetna American Axle |
$13.31
|
| Rate for Payer: Aetna Commercial |
$17.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.31
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$14.33
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.40
|
| Rate for Payer: PHP Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health SBD |
$12.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$23.81
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna American Axle |
$15.48
|
| Rate for Payer: Aetna American Axle |
$13.31
|
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna Commercial |
$17.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.31
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cash Price |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$14.33
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.24
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.67
|
| Rate for Payer: Priority Health SBD |
$15.00
|
| Rate for Payer: Priority Health SBD |
$12.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$54.07
|
|
|
Service Code
|
NDC 43066-995-24
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$48.66 |
| Rate for Payer: Aetna American Axle |
$35.15
|
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.15
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cofinity Commercial |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$46.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.96
|
| Rate for Payer: PHP Commercial |
$45.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$42.28
|
|
|
Service Code
|
NDC 0781-3290-09
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$38.05 |
| Rate for Payer: Aetna American Axle |
$27.48
|
| Rate for Payer: Aetna Commercial |
$35.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.48
|
| Rate for Payer: Cash Price |
$33.82
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$36.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.82
|
| Rate for Payer: Healthscope Commercial |
$38.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.94
|
| Rate for Payer: PHP Commercial |
$35.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.60
|
| Rate for Payer: Priority Health SBD |
$26.64
|
| Rate for Payer: UMR Bronson Commercial |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.71
|
|
|
CLINDAMYCIN 900 MG (IV PREMIX)
|
Facility
|
IP
|
$85.34
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
500560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$76.81 |
| Rate for Payer: Aetna American Axle |
$55.47
|
| Rate for Payer: Aetna Commercial |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.47
|
| Rate for Payer: Cash Price |
$68.27
|
| Rate for Payer: Cofinity Commercial |
$59.74
|
| Rate for Payer: Cofinity Commercial |
$73.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.27
|
| Rate for Payer: Healthscope Commercial |
$76.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.54
|
| Rate for Payer: PHP Commercial |
$72.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.74
|
| Rate for Payer: Priority Health SBD |
$53.76
|
| Rate for Payer: UMR Bronson Commercial |
$37.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.00
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$319.60
|
|
|
Service Code
|
NDC 42571-251-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$287.64 |
| Rate for Payer: Aetna American Axle |
$207.74
|
| Rate for Payer: Aetna Commercial |
$271.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.74
|
| Rate for Payer: Cash Price |
$255.68
|
| Rate for Payer: Cofinity Commercial |
$274.86
|
| Rate for Payer: Cofinity Commercial |
$223.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.68
|
| Rate for Payer: Healthscope Commercial |
$287.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.66
|
| Rate for Payer: PHP Commercial |
$271.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.72
|
| Rate for Payer: Priority Health SBD |
$201.35
|
| Rate for Payer: UMR Bronson Commercial |
$140.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.70
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 65862-185-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.46
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 63739-059-10
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.53
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.26
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UMR Bronson Commercial |
$194.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 68084-243-11
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68084-243-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.04
|
| Rate for Payer: PHP Commercial |
$176.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.97
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UMR Bronson Commercial |
$91.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 42292-018-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna American Axle |
$2.95
|
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.86
|
| Rate for Payer: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.18
|
| Rate for Payer: Priority Health SBD |
$2.86
|
| Rate for Payer: UMR Bronson Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 42292-018-20
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 63304-692-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.76
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.28
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 0591-5708-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.78
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 59762-3328-1
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$387.84
|
|
|
Service Code
|
NDC 0904-7194-61
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.65 |
| Max. Negotiated Rate |
$349.06 |
| Rate for Payer: Aetna American Axle |
$252.10
|
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.10
|
| Rate for Payer: Cash Price |
$310.27
|
| Rate for Payer: Cofinity Commercial |
$271.49
|
| Rate for Payer: Cofinity Commercial |
$333.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.27
|
| Rate for Payer: Healthscope Commercial |
$349.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.66
|
| Rate for Payer: PHP Commercial |
$329.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.49
|
| Rate for Payer: Priority Health SBD |
$244.34
|
| Rate for Payer: UMR Bronson Commercial |
$170.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.88
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$473.76
|
|
|
Service Code
|
NDC 68084-244-11
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.45 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna American Axle |
$307.94
|
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.01
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.63
|
| Rate for Payer: Priority Health SBD |
$298.47
|
| Rate for Payer: UMR Bronson Commercial |
$208.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.32
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$473.76
|
|
|
Service Code
|
NDC 68084-244-01
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.45 |
| Max. Negotiated Rate |
$426.38 |
| Rate for Payer: Aetna American Axle |
$307.94
|
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.94
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$331.63
|
| Rate for Payer: Cofinity Commercial |
$407.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.01
|
| Rate for Payer: Healthscope Commercial |
$426.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.70
|
| Rate for Payer: PHP Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.63
|
| Rate for Payer: Priority Health SBD |
$298.47
|
| Rate for Payer: UMR Bronson Commercial |
$208.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.32
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 42571-252-01
|
| Hospital Charge Code |
9621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.76
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.28
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
