|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$346.56
|
|
|
Service Code
|
NDC 00527410737
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.26
|
| Rate for Payer: Cash Price |
$277.25
|
| Rate for Payer: Cofinity Advantage |
$242.59
|
| Rate for Payer: Cofinity Commercial |
$298.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.25
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.92
|
| Rate for Payer: PHP Commercial |
$294.58
|
| Rate for Payer: Priority Health SBD |
$218.33
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
OP
|
$346.56
|
|
|
Service Code
|
NDC 00527410737
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.58
|
| Rate for Payer: Aetna Medicare |
$173.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.26
|
| Rate for Payer: BCBS Complete |
$138.62
|
| Rate for Payer: Cash Price |
$277.25
|
| Rate for Payer: Cofinity Advantage |
$242.59
|
| Rate for Payer: Cofinity Commercial |
$298.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.25
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.92
|
| Rate for Payer: PHP Commercial |
$294.58
|
| Rate for Payer: Priority Health SBD |
$218.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.26
|
| Rate for Payer: UHC Core |
$180.56
|
| Rate for Payer: UHC Exchange |
$136.20
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00093874001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.41 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00093874001
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.98 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$95.64
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
301720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$86.08 |
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: Priority Health SBD |
$60.25
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$95.64
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
301720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$86.08 |
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna Medicare |
$47.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: BCBS Complete |
$38.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: Priority Health SBD |
$60.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$182.78
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$155.36
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$104.06
|
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna Commercial |
$84.23
|
| Rate for Payer: Aetna Medicare |
$61.21
|
| Rate for Payer: Aetna Medicare |
$91.39
|
| Rate for Payer: Aetna Medicare |
$308.69
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: Aetna Medicare |
$47.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$73.11
|
| Rate for Payer: BCBS Complete |
$48.97
|
| Rate for Payer: BCBS Complete |
$38.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: BCN Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cofinity Advantage |
$85.69
|
| Rate for Payer: Cofinity Advantage |
$69.37
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Advantage |
$69.38
|
| Rate for Payer: Cofinity Advantage |
$432.17
|
| Rate for Payer: Cofinity Advantage |
$127.95
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$157.19
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Healthscope Commercial |
$89.19
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Commercial |
$110.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$104.06
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: PHP Commercial |
$84.23
|
| Rate for Payer: Priority Health SBD |
$62.43
|
| Rate for Payer: Priority Health SBD |
$115.15
|
| Rate for Payer: Priority Health SBD |
$62.44
|
| Rate for Payer: Priority Health SBD |
$60.25
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$77.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Core |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$182.78
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$155.36
|
| Rate for Payer: Aetna Commercial |
$81.29
|
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Commercial |
$84.23
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$104.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.17
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cofinity Advantage |
$66.95
|
| Rate for Payer: Cofinity Advantage |
$85.69
|
| Rate for Payer: Cofinity Advantage |
$69.38
|
| Rate for Payer: Cofinity Advantage |
$127.95
|
| Rate for Payer: Cofinity Advantage |
$69.37
|
| Rate for Payer: Cofinity Advantage |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$157.19
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$85.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.29
|
| Rate for Payer: Healthscope Commercial |
$110.18
|
| Rate for Payer: Healthscope Commercial |
$89.19
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$89.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$463.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.73
|
| Rate for Payer: PHP Commercial |
$81.29
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Commercial |
$84.23
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$104.06
|
| Rate for Payer: PHP Commercial |
$84.24
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$60.25
|
| Rate for Payer: Priority Health SBD |
$62.43
|
| Rate for Payer: Priority Health SBD |
$77.12
|
| Rate for Payer: Priority Health SBD |
$115.15
|
| Rate for Payer: Priority Health SBD |
$62.44
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$164.32
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.52 |
| Max. Negotiated Rate |
$147.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.81
|
| Rate for Payer: Cash Price |
$131.46
|
| Rate for Payer: Cofinity Advantage |
$115.02
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.46
|
| Rate for Payer: Healthscope Commercial |
$147.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.24
|
| Rate for Payer: PHP Commercial |
$139.67
|
| Rate for Payer: Priority Health SBD |
$103.52
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
OP
|
$164.32
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$147.89 |
| Rate for Payer: Aetna Commercial |
$139.67
|
| Rate for Payer: Aetna Medicare |
$82.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.81
|
| Rate for Payer: BCBS Complete |
$65.73
|
| Rate for Payer: Cash Price |
$131.46
|
| Rate for Payer: Cofinity Advantage |
$115.02
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.46
|
| Rate for Payer: Healthscope Commercial |
$147.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.24
|
| Rate for Payer: PHP Commercial |
$139.67
|
| Rate for Payer: Priority Health SBD |
$103.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.81
|
| Rate for Payer: UHC Core |
$85.61
|
| Rate for Payer: UHC Exchange |
$64.58
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.71
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Exchange |
$6.47
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Advantage |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: UHC Exchange |
$9.87
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Advantage |
$11.53
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: PHP Commercial |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.38
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Advantage |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.83
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health SBD |
$15.82
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$20.33
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Advantage |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.94
|
| Rate for Payer: PHP Commercial |
$20.33
|
| Rate for Payer: Priority Health SBD |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.55
|
| Rate for Payer: UHC Core |
$12.46
|
| Rate for Payer: UHC Exchange |
$9.40
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: Cash Price |
$35.59
|
| Rate for Payer: Cofinity Advantage |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$40.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health SBD |
$28.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.92
|
| Rate for Payer: UHC Core |
$23.18
|
| Rate for Payer: UHC Exchange |
$17.48
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Advantage |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health SBD |
$17.85
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Cash Price |
$35.59
|
| Rate for Payer: Cofinity Advantage |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$40.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health SBD |
$28.03
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Advantage |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.94
|
| Rate for Payer: PHP Commercial |
$20.33
|
| Rate for Payer: Priority Health SBD |
$15.07
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Advantage |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Core |
$14.76
|
| Rate for Payer: UHC Exchange |
$11.13
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.18
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health SBD |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Exchange |
$10.99
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 53329016979
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health SBD |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.42
|
| Rate for Payer: UHC Core |
$11.56
|
| Rate for Payer: UHC Exchange |
$8.72
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 53329016979
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health SBD |
$13.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health SBD |
$13.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health SBD |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.42
|
| Rate for Payer: UHC Core |
$11.56
|
| Rate for Payer: UHC Exchange |
$8.72
|
|
