Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$11,086.14

Service Code	MS-DRG 191
Min. Negotiated Rate	$8,425.46
Max. Negotiated Rate	$11,086.14
Rate for Payer: Aetna Medicare	$8,868.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,086.14
Rate for Payer: Amish Plain Church Group Commercial	$11,086.14
Rate for Payer: BCBS MAPPO	$8,868.91
Rate for Payer: BCN Medicare Advantage	$8,868.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,868.91
Rate for Payer: Humana Choice PPO Medicare	$8,868.91
Rate for Payer: Mclaren Medicare	$8,868.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,312.36
Rate for Payer: MI Amish Medical Board Commercial	$10,199.25
Rate for Payer: PACE Medicare	$8,425.46
Rate for Payer: PACE SWMI	$8,868.91
Rate for Payer: PHP Commercial	$9,755.80
Rate for Payer: PHP Medicare Advantage	$8,868.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,901.16
Rate for Payer: Priority Health Medicare	$8,868.91
Rate for Payer: Priority Health Narrow Network	$8,720.93
Rate for Payer: Railroad Medicare Medicare	$8,868.91
Rate for Payer: UHC Medicare Advantage	$9,134.98
Rate for Payer: VA VA	$8,868.91

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$14,149.68

Service Code	MS-DRG 190
Min. Negotiated Rate	$10,460.36
Max. Negotiated Rate	$14,149.68
Rate for Payer: Aetna Medicare	$11,010.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,763.62
Rate for Payer: Amish Plain Church Group Commercial	$13,763.62
Rate for Payer: BCBS MAPPO	$11,010.90
Rate for Payer: BCN Medicare Advantage	$11,010.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,010.90
Rate for Payer: Humana Choice PPO Medicare	$11,010.90
Rate for Payer: Mclaren Medicare	$11,010.90
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,561.44
Rate for Payer: MI Amish Medical Board Commercial	$12,662.54
Rate for Payer: PACE Medicare	$10,460.36
Rate for Payer: PACE SWMI	$11,010.90
Rate for Payer: PHP Commercial	$12,111.99
Rate for Payer: PHP Medicare Advantage	$11,010.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,149.68
Rate for Payer: Priority Health Medicare	$11,010.90
Rate for Payer: Priority Health Narrow Network	$11,319.74
Rate for Payer: Railroad Medicare Medicare	$11,010.90
Rate for Payer: UHC Medicare Advantage	$11,341.23
Rate for Payer: VA VA	$11,010.90

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$8,893.35

Service Code	MS-DRG 192
Min. Negotiated Rate	$6,592.57
Max. Negotiated Rate	$8,893.35
Rate for Payer: Aetna Medicare	$7,114.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,893.35
Rate for Payer: Amish Plain Church Group Commercial	$8,893.35
Rate for Payer: BCBS MAPPO	$7,114.68
Rate for Payer: BCN Medicare Advantage	$7,114.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,114.68
Rate for Payer: Humana Choice PPO Medicare	$7,114.68
Rate for Payer: Mclaren Medicare	$7,114.68
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,470.41
Rate for Payer: MI Amish Medical Board Commercial	$8,181.88
Rate for Payer: PACE Medicare	$6,758.95
Rate for Payer: PACE SWMI	$7,114.68
Rate for Payer: PHP Commercial	$7,826.15
Rate for Payer: PHP Medicare Advantage	$7,114.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,240.71
Rate for Payer: Priority Health Medicare	$7,114.68
Rate for Payer: Priority Health Narrow Network	$6,592.57
Rate for Payer: Railroad Medicare Medicare	$7,114.68
Rate for Payer: UHC Medicare Advantage	$7,328.12
Rate for Payer: VA VA	$7,114.68

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$394.14

Service Code	NDC 43598-326-75
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$275.90
Max. Negotiated Rate	$394.14
Rate for Payer: Aetna Commercial	$354.73
Rate for Payer: ASR ASR	$382.32
Rate for Payer: BCBS Trust/PPO	$305.58
Rate for Payer: BCN Commercial	$305.58
Rate for Payer: Cash Price	$315.32
Rate for Payer: Cofinity Commercial	$370.49
Rate for Payer: Encore Health Key Benefits Commercial	$315.31
Rate for Payer: Healthscope Commercial	$394.14
Rate for Payer: Healthscope Whirlpool	$382.32
Rate for Payer: Mclaren Commercial	$354.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$335.02
Rate for Payer: Priority Health Cigna Priority Health	$275.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$346.84

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$729.72

Service Code	NDC 0781-6186-67
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$510.80
Max. Negotiated Rate	$729.72
Rate for Payer: Aetna Commercial	$656.75
Rate for Payer: ASR ASR	$707.83
Rate for Payer: BCBS Trust/PPO	$565.75
Rate for Payer: BCN Commercial	$565.75
Rate for Payer: Cash Price	$583.78
Rate for Payer: Cofinity Commercial	$685.94
Rate for Payer: Encore Health Key Benefits Commercial	$583.78
Rate for Payer: Healthscope Commercial	$729.72
Rate for Payer: Healthscope Whirlpool	$707.83
Rate for Payer: Mclaren Commercial	$656.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$620.26
Rate for Payer: Priority Health Cigna Priority Health	$510.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$642.15

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$34.20

Service Code	NDC 61314-656-25
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: ASR ASR	$33.17
Rate for Payer: BCBS Trust/PPO	$26.52
Rate for Payer: BCN Commercial	$26.52
Rate for Payer: Cash Price	$27.36
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$27.36
Rate for Payer: Healthscope Commercial	$34.20
Rate for Payer: Healthscope Whirlpool	$33.17
Rate for Payer: Mclaren Commercial	$30.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.07
Rate for Payer: Priority Health Cigna Priority Health	$23.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.10

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$24.50

Service Code	NDC 17478-714-25
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: ASR ASR	$23.76
Rate for Payer: BCBS Trust/PPO	$18.99
Rate for Payer: BCN Commercial	$18.99
Rate for Payer: Cash Price	$19.60
Rate for Payer: Cofinity Commercial	$23.03
Rate for Payer: Encore Health Key Benefits Commercial	$19.60
Rate for Payer: Healthscope Commercial	$24.50
Rate for Payer: Healthscope Whirlpool	$23.76
Rate for Payer: Mclaren Commercial	$22.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.82
Rate for Payer: Priority Health Cigna Priority Health	$17.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.56

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$21.24

Service Code	NDC 69315-308-02
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$21.24
Rate for Payer: Aetna Commercial	$19.12
Rate for Payer: ASR ASR	$20.60
Rate for Payer: BCBS Trust/PPO	$16.47
Rate for Payer: BCN Commercial	$16.47
Rate for Payer: Cash Price	$16.99
Rate for Payer: Cofinity Commercial	$19.97
Rate for Payer: Encore Health Key Benefits Commercial	$16.99
Rate for Payer: Healthscope Commercial	$21.24
Rate for Payer: Healthscope Whirlpool	$20.60
Rate for Payer: Mclaren Commercial	$19.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.05
Rate for Payer: Priority Health Cigna Priority Health	$14.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.69

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$27,677.90

Service Code	MS-DRG 286
Min. Negotiated Rate	$18,934.54
Max. Negotiated Rate	$27,677.90
Rate for Payer: Aetna Medicare	$19,931.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,913.88
Rate for Payer: Amish Plain Church Group Commercial	$24,913.88
Rate for Payer: BCBS MAPPO	$19,931.10
Rate for Payer: BCN Medicare Advantage	$19,931.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,931.10
Rate for Payer: Humana Choice PPO Medicare	$19,931.10
Rate for Payer: Mclaren Medicare	$19,931.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$20,927.66
Rate for Payer: MI Amish Medical Board Commercial	$22,920.76
Rate for Payer: PACE Medicare	$18,934.54
Rate for Payer: PACE SWMI	$19,931.10
Rate for Payer: PHP Commercial	$21,924.21
Rate for Payer: PHP Medicare Advantage	$19,931.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27,677.90
Rate for Payer: Priority Health Medicare	$19,931.10
Rate for Payer: Priority Health Narrow Network	$22,142.32
Rate for Payer: Railroad Medicare Medicare	$19,931.10
Rate for Payer: UHC Medicare Advantage	$20,529.03
Rate for Payer: VA VA	$19,931.10

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$13,887.74

Service Code	MS-DRG 287
Min. Negotiated Rate	$10,296.28
Max. Negotiated Rate	$13,887.74
Rate for Payer: Aetna Medicare	$10,838.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,547.74
Rate for Payer: Amish Plain Church Group Commercial	$13,547.74
Rate for Payer: BCBS MAPPO	$10,838.19
Rate for Payer: BCN Medicare Advantage	$10,838.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,838.19
Rate for Payer: Humana Choice PPO Medicare	$10,838.19
Rate for Payer: Mclaren Medicare	$10,838.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,380.10
Rate for Payer: MI Amish Medical Board Commercial	$12,463.92
Rate for Payer: PACE Medicare	$10,296.28
Rate for Payer: PACE SWMI	$10,838.19
Rate for Payer: PHP Commercial	$11,922.01
Rate for Payer: PHP Medicare Advantage	$10,838.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,887.74
Rate for Payer: Priority Health Medicare	$10,838.19
Rate for Payer: Priority Health Narrow Network	$11,110.19
Rate for Payer: Railroad Medicare Medicare	$10,838.19
Rate for Payer: UHC Medicare Advantage	$11,163.34
Rate for Payer: VA VA	$10,838.19

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$13,238.04

Service Code	MS-DRG 433
Min. Negotiated Rate	$9,889.31
Max. Negotiated Rate	$13,238.04
Rate for Payer: Aetna Medicare	$10,409.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,012.25
Rate for Payer: Amish Plain Church Group Commercial	$13,012.25
Rate for Payer: BCBS MAPPO	$10,409.80
Rate for Payer: BCN Medicare Advantage	$10,409.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,409.80
Rate for Payer: Humana Choice PPO Medicare	$10,409.80
Rate for Payer: Mclaren Medicare	$10,409.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,930.29
Rate for Payer: MI Amish Medical Board Commercial	$11,971.27
Rate for Payer: PACE Medicare	$9,889.31
Rate for Payer: PACE SWMI	$10,409.80
Rate for Payer: PHP Commercial	$11,450.78
Rate for Payer: PHP Medicare Advantage	$10,409.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,238.04
Rate for Payer: Priority Health Medicare	$10,409.80
Rate for Payer: Priority Health Narrow Network	$10,590.43
Rate for Payer: Railroad Medicare Medicare	$10,409.80
Rate for Payer: UHC Medicare Advantage	$10,722.09
Rate for Payer: VA VA	$10,409.80

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$24,601.44

Service Code	MS-DRG 432
Min. Negotiated Rate	$17,007.42
Max. Negotiated Rate	$24,601.44
Rate for Payer: Aetna Medicare	$17,902.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,378.19
Rate for Payer: Amish Plain Church Group Commercial	$22,378.19
Rate for Payer: BCBS MAPPO	$17,902.55
Rate for Payer: BCN Medicare Advantage	$17,902.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,902.55
Rate for Payer: Humana Choice PPO Medicare	$17,902.55
Rate for Payer: Mclaren Medicare	$17,902.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$18,797.68
Rate for Payer: MI Amish Medical Board Commercial	$20,587.93
Rate for Payer: PACE Medicare	$17,007.42
Rate for Payer: PACE SWMI	$17,902.55
Rate for Payer: PHP Commercial	$19,692.80
Rate for Payer: PHP Medicare Advantage	$17,902.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24,601.44
Rate for Payer: Priority Health Medicare	$17,902.55
Rate for Payer: Priority Health Narrow Network	$19,681.15
Rate for Payer: Railroad Medicare Medicare	$17,902.55
Rate for Payer: UHC Medicare Advantage	$18,439.63
Rate for Payer: VA VA	$17,902.55

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$9,186.48

Service Code	MS-DRG 434
Min. Negotiated Rate	$6,877.10
Max. Negotiated Rate	$9,186.48
Rate for Payer: Aetna Medicare	$7,349.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,186.48
Rate for Payer: Amish Plain Church Group Commercial	$9,186.48
Rate for Payer: BCBS MAPPO	$7,349.18
Rate for Payer: BCN Medicare Advantage	$7,349.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,349.18
Rate for Payer: Humana Choice PPO Medicare	$7,349.18
Rate for Payer: Mclaren Medicare	$7,349.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,716.64
Rate for Payer: MI Amish Medical Board Commercial	$8,451.56
Rate for Payer: PACE Medicare	$6,981.72
Rate for Payer: PACE SWMI	$7,349.18
Rate for Payer: PHP Commercial	$8,084.10
Rate for Payer: PHP Medicare Advantage	$7,349.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,596.38
Rate for Payer: Priority Health Medicare	$7,349.18
Rate for Payer: Priority Health Narrow Network	$6,877.10
Rate for Payer: Railroad Medicare Medicare	$7,349.18
Rate for Payer: UHC Medicare Advantage	$7,569.66
Rate for Payer: VA VA	$7,349.18

CITALOPRAM 20 MG TABLET

Facility

$13.16

Service Code	NDC 0904-6085-61
Hospital Charge Code	21062
Hospital Revenue Code	637
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$13.16
Rate for Payer: Aetna Commercial	$11.84
Rate for Payer: ASR ASR	$12.77
Rate for Payer: BCBS Trust/PPO	$10.20
Rate for Payer: BCN Commercial	$10.20
Rate for Payer: Cash Price	$10.53
Rate for Payer: Cofinity Commercial	$12.37
Rate for Payer: Encore Health Key Benefits Commercial	$10.53
Rate for Payer: Healthscope Commercial	$13.16
Rate for Payer: Healthscope Whirlpool	$12.77
Rate for Payer: Mclaren Commercial	$11.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.19
Rate for Payer: Priority Health Cigna Priority Health	$9.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.58

CLINDAMYCIN 150 MG/ML INJECTION SOLUTION

Facility

$28.19

Service Code	HCPCS J0736
Hospital Charge Code	1743
Hospital Revenue Code	636
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$28.19
Rate for Payer: Aetna Commercial	$25.37
Rate for Payer: ASR ASR	$27.34
Rate for Payer: BCBS Trust/PPO	$21.86
Rate for Payer: BCN Commercial	$21.86
Rate for Payer: Cash Price	$22.55
Rate for Payer: Cofinity Commercial	$26.50
Rate for Payer: Encore Health Key Benefits Commercial	$22.55
Rate for Payer: Healthscope Commercial	$28.19
Rate for Payer: Healthscope Whirlpool	$27.34
Rate for Payer: Mclaren Commercial	$25.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.96
Rate for Payer: Priority Health Cigna Priority Health	$19.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.81

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$362.78

Service Code	NDC 0781-9221-91
Hospital Charge Code	9626
Hospital Revenue Code	250
Min. Negotiated Rate	$253.95
Max. Negotiated Rate	$362.78
Rate for Payer: Aetna Commercial	$326.50
Rate for Payer: ASR ASR	$351.90
Rate for Payer: BCBS Trust/PPO	$281.26
Rate for Payer: BCN Commercial	$281.26
Rate for Payer: Cash Price	$290.22
Rate for Payer: Cofinity Commercial	$341.01
Rate for Payer: Encore Health Key Benefits Commercial	$290.22
Rate for Payer: Healthscope Commercial	$362.78
Rate for Payer: Healthscope Whirlpool	$351.90
Rate for Payer: Mclaren Commercial	$326.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$308.36
Rate for Payer: Priority Health Cigna Priority Health	$253.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$319.25

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$362.78

Service Code	NDC 0781-9221-09
Hospital Charge Code	9626
Hospital Revenue Code	250
Min. Negotiated Rate	$253.95
Max. Negotiated Rate	$362.78
Rate for Payer: Aetna Commercial	$326.50
Rate for Payer: ASR ASR	$351.90
Rate for Payer: BCBS Trust/PPO	$281.26
Rate for Payer: BCN Commercial	$281.26
Rate for Payer: Cash Price	$290.22
Rate for Payer: Cofinity Commercial	$341.01
Rate for Payer: Encore Health Key Benefits Commercial	$290.22
Rate for Payer: Healthscope Commercial	$362.78
Rate for Payer: Healthscope Whirlpool	$351.90
Rate for Payer: Mclaren Commercial	$326.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$308.36
Rate for Payer: Priority Health Cigna Priority Health	$253.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$319.25

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$23.36

Service Code	NDC 0781-9221-09
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$23.36
Rate for Payer: Aetna Commercial	$21.02
Rate for Payer: ASR ASR	$22.66
Rate for Payer: BCBS Trust/PPO	$18.11
Rate for Payer: BCN Commercial	$18.11
Rate for Payer: Cash Price	$18.69
Rate for Payer: Cofinity Commercial	$21.96
Rate for Payer: Encore Health Key Benefits Commercial	$18.69
Rate for Payer: Healthscope Commercial	$23.36
Rate for Payer: Healthscope Whirlpool	$22.66
Rate for Payer: Mclaren Commercial	$21.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.86
Rate for Payer: Priority Health Cigna Priority Health	$16.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.56

CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$23.36

Service Code	NDC 0781-9221-91
Hospital Charge Code	300021
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$23.36
Rate for Payer: Aetna Commercial	$21.02
Rate for Payer: ASR ASR	$22.66
Rate for Payer: BCBS Trust/PPO	$18.11
Rate for Payer: BCN Commercial	$18.11
Rate for Payer: Cash Price	$18.69
Rate for Payer: Cofinity Commercial	$21.96
Rate for Payer: Encore Health Key Benefits Commercial	$18.69
Rate for Payer: Healthscope Commercial	$23.36
Rate for Payer: Healthscope Whirlpool	$22.66
Rate for Payer: Mclaren Commercial	$21.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.86
Rate for Payer: Priority Health Cigna Priority Health	$16.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.56

CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$656.45

Service Code	NDC 0781-3290-09
Hospital Charge Code	9627
Hospital Revenue Code	250
Min. Negotiated Rate	$459.52
Max. Negotiated Rate	$656.45
Rate for Payer: Aetna Commercial	$590.80
Rate for Payer: ASR ASR	$636.76
Rate for Payer: BCBS Trust/PPO	$508.95
Rate for Payer: BCN Commercial	$508.95
Rate for Payer: Cash Price	$525.16
Rate for Payer: Cofinity Commercial	$617.06
Rate for Payer: Encore Health Key Benefits Commercial	$525.16
Rate for Payer: Healthscope Commercial	$656.45
Rate for Payer: Healthscope Whirlpool	$636.76
Rate for Payer: Mclaren Commercial	$590.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$557.98
Rate for Payer: Priority Health Cigna Priority Health	$459.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$577.68

CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$428.42

Service Code	NDC 0781-9222-91
Hospital Charge Code	9627
Hospital Revenue Code	250
Min. Negotiated Rate	$299.89
Max. Negotiated Rate	$428.42
Rate for Payer: Aetna Commercial	$385.58
Rate for Payer: ASR ASR	$415.57
Rate for Payer: BCBS Trust/PPO	$332.15
Rate for Payer: BCN Commercial	$332.15
Rate for Payer: Cash Price	$342.74
Rate for Payer: Cofinity Commercial	$402.71
Rate for Payer: Encore Health Key Benefits Commercial	$342.74
Rate for Payer: Healthscope Commercial	$428.42
Rate for Payer: Healthscope Whirlpool	$415.57
Rate for Payer: Mclaren Commercial	$385.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.16
Rate for Payer: Priority Health Cigna Priority Health	$299.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$377.01

CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$27.59

Service Code	NDC 0781-9222-91
Hospital Charge Code	300022
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$27.59
Rate for Payer: Aetna Commercial	$24.83
Rate for Payer: ASR ASR	$26.76
Rate for Payer: BCBS Trust/PPO	$21.39
Rate for Payer: BCN Commercial	$21.39
Rate for Payer: Cash Price	$22.07
Rate for Payer: Cofinity Commercial	$25.93
Rate for Payer: Encore Health Key Benefits Commercial	$22.07
Rate for Payer: Healthscope Commercial	$27.59
Rate for Payer: Healthscope Whirlpool	$26.76
Rate for Payer: Mclaren Commercial	$24.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.45
Rate for Payer: Priority Health Cigna Priority Health	$19.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.28

CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM

Facility

$27.59

Service Code	NDC 0781-9222-09
Hospital Charge Code	300022
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$27.59
Rate for Payer: Aetna Commercial	$24.83
Rate for Payer: ASR ASR	$26.76
Rate for Payer: BCBS Trust/PPO	$21.39
Rate for Payer: BCN Commercial	$21.39
Rate for Payer: Cash Price	$22.07
Rate for Payer: Cofinity Commercial	$25.93
Rate for Payer: Encore Health Key Benefits Commercial	$22.07
Rate for Payer: Healthscope Commercial	$27.59
Rate for Payer: Healthscope Whirlpool	$26.76
Rate for Payer: Mclaren Commercial	$24.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.45
Rate for Payer: Priority Health Cigna Priority Health	$19.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.28

CLINDAMYCIN HCL 150 MG CAPSULE

Facility

$336.05

Service Code	NDC 0904-5959-61
Hospital Charge Code	1740
Hospital Revenue Code	637
Min. Negotiated Rate	$235.24
Max. Negotiated Rate	$336.05
Rate for Payer: Aetna Commercial	$302.44
Rate for Payer: ASR ASR	$325.97
Rate for Payer: BCBS Trust/PPO	$260.54
Rate for Payer: BCN Commercial	$260.54
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$315.89
Rate for Payer: Encore Health Key Benefits Commercial	$268.84
Rate for Payer: Healthscope Commercial	$336.05
Rate for Payer: Healthscope Whirlpool	$325.97
Rate for Payer: Mclaren Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$295.72

CLINDAMYCIN HCL 150 MG CAPSULE

Facility

$441.80

Service Code	NDC 63739-059-10
Hospital Charge Code	1740
Hospital Revenue Code	637
Min. Negotiated Rate	$309.26
Max. Negotiated Rate	$441.80
Rate for Payer: Aetna Commercial	$397.62
Rate for Payer: ASR ASR	$428.55
Rate for Payer: BCBS Trust/PPO	$342.53
Rate for Payer: BCN Commercial	$342.53
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$415.29
Rate for Payer: Encore Health Key Benefits Commercial	$353.44
Rate for Payer: Healthscope Commercial	$441.80
Rate for Payer: Healthscope Whirlpool	$428.55
Rate for Payer: Mclaren Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$309.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$388.78

Know your out-of-pocket cost for care.

All Charges