|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLORIDE IVPB (PARTIAL PACKAGE)
|
Facility
|
OP
|
$55.94
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
165987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.48
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$13.98
|
| Rate for Payer: BCBS Trust/PPO |
$45.99
|
| Rate for Payer: BCN Commercial |
$45.99
|
| Rate for Payer: BCN Medicare Advantage |
$13.98
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cofinity Commercial |
$48.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$50.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.95
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.68
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.55
|
| Rate for Payer: Nomi Health Commercial |
$45.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PACE Senior Care Partners |
$13.29
|
| Rate for Payer: PACE SWMI |
$13.98
|
| Rate for Payer: PHP Commercial |
$47.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.67
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.23
|
| Rate for Payer: UHC Core |
$46.71
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Medicaid |
$9.86
|
| Rate for Payer: UHC Medicare Advantage |
$13.98
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$13.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.95
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$55.94
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Medicare |
$22.72
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.31
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS Complete |
$16.18
|
| Rate for Payer: BCBS MAPPO |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$21.85
|
| Rate for Payer: BCBS Trust/PPO |
$45.99
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Commercial |
$45.99
|
| Rate for Payer: BCN Medicare Advantage |
$21.85
|
| Rate for Payer: BCN Medicare Advantage |
$13.98
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$48.11
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$15.41
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.68
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: Meridian Medicaid |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.55
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Nomi Health Commercial |
$45.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: PACE Senior Care Partners |
$20.76
|
| Rate for Payer: PACE Senior Care Partners |
$13.29
|
| Rate for Payer: PACE SWMI |
$21.85
|
| Rate for Payer: PACE SWMI |
$13.98
|
| Rate for Payer: PHP Commercial |
$47.55
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Medicare Advantage |
$13.98
|
| Rate for Payer: PHP Medicare Advantage |
$21.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.67
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.98
|
| Rate for Payer: Railroad Medicare Medicare |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.91
|
| Rate for Payer: UHC Core |
$72.98
|
| Rate for Payer: UHC Core |
$46.71
|
| Rate for Payer: UHC Exchange |
$21.85
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Medicaid |
$15.41
|
| Rate for Payer: UHC Medicaid |
$9.86
|
| Rate for Payer: UHC Medicare Advantage |
$13.98
|
| Rate for Payer: UHC Medicare Advantage |
$21.85
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: UHCCP Medicaid |
$15.41
|
| Rate for Payer: VA VA |
$13.98
|
| Rate for Payer: VA VA |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.95
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$55.94
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: BCBS Trust/PPO |
$46.20
|
| Rate for Payer: BCBS Trust/PPO |
$72.18
|
| Rate for Payer: BCN Commercial |
$46.20
|
| Rate for Payer: BCN Commercial |
$72.18
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Cofinity Commercial |
$48.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.75
|
| Rate for Payer: Healthscope Commercial |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Nomi Health Commercial |
$45.87
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$47.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.91
|
| Rate for Payer: UHC Core |
$46.71
|
| Rate for Payer: UHC Core |
$72.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.55
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$444.60
|
|
|
Service Code
|
NDC 42292000120
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: Aetna Medicare |
$115.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.94
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS MAPPO |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$365.51
|
| Rate for Payer: BCN Commercial |
$365.51
|
| Rate for Payer: BCN Medicare Advantage |
$111.15
|
| Rate for Payer: Cash Price |
$355.68
|
| Rate for Payer: Cofinity Commercial |
$382.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.15
|
| Rate for Payer: Healthscope Commercial |
$400.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.45
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.71
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.91
|
| Rate for Payer: Nomi Health Commercial |
$364.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.45
|
| Rate for Payer: PACE Senior Care Partners |
$105.59
|
| Rate for Payer: PACE SWMI |
$111.15
|
| Rate for Payer: PHP Commercial |
$377.91
|
| Rate for Payer: PHP Medicare Advantage |
$111.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$386.80
|
| Rate for Payer: Priority Health Medicare |
$112.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$309.44
|
| Rate for Payer: Railroad Medicare Medicare |
$111.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.25
|
| Rate for Payer: UHC Core |
$371.24
|
| Rate for Payer: UHC Exchange |
$111.15
|
| Rate for Payer: UHC Medicaid |
$78.38
|
| Rate for Payer: UHC Medicare Advantage |
$111.15
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
| Rate for Payer: VA VA |
$111.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.45
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$444.60
|
|
|
Service Code
|
NDC 42292000120
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.44 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: BCBS Trust/PPO |
$367.20
|
| Rate for Payer: BCN Commercial |
$367.20
|
| Rate for Payer: Cash Price |
$355.68
|
| Rate for Payer: Cofinity Commercial |
$382.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.68
|
| Rate for Payer: Healthscope Commercial |
$400.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.91
|
| Rate for Payer: Nomi Health Commercial |
$364.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$333.45
|
| Rate for Payer: PHP Commercial |
$377.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$386.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$309.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.25
|
| Rate for Payer: UHC Core |
$371.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.45
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.66
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Mclaren Medicaid |
$0.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: Meridian Medicaid |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Nomi Health Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PACE Senior Care Partners |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.87
|
| Rate for Payer: Priority Health Medicare |
$1.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicaid |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$267.36
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.08 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: BCBS Trust/PPO |
$220.81
|
| Rate for Payer: BCN Commercial |
$220.81
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Nomi Health Commercial |
$219.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$232.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.28
|
| Rate for Payer: UHC Core |
$223.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Nomi Health Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.04 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: BCBS Trust/PPO |
$200.59
|
| Rate for Payer: BCN Commercial |
$200.59
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.73
|
| Rate for Payer: UHC Core |
$202.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$267.36
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna Medicare |
$69.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.55
|
| Rate for Payer: BCBS Complete |
$49.49
|
| Rate for Payer: BCBS MAPPO |
$66.84
|
| Rate for Payer: BCBS Trust/PPO |
$219.80
|
| Rate for Payer: BCN Commercial |
$219.80
|
| Rate for Payer: BCN Medicare Advantage |
$66.84
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Mclaren Medicaid |
$47.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.18
|
| Rate for Payer: Meridian Medicaid |
$49.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Nomi Health Commercial |
$219.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PACE Senior Care Partners |
$63.50
|
| Rate for Payer: PACE SWMI |
$66.84
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: PHP Medicare Advantage |
$66.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$232.60
|
| Rate for Payer: Priority Health Medicare |
$67.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.08
|
| Rate for Payer: Railroad Medicare Medicare |
$66.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.28
|
| Rate for Payer: UHC Core |
$223.25
|
| Rate for Payer: UHC Exchange |
$66.84
|
| Rate for Payer: UHC Medicaid |
$47.14
|
| Rate for Payer: UHC Medicare Advantage |
$66.84
|
| Rate for Payer: UHCCP Medicaid |
$47.14
|
| Rate for Payer: VA VA |
$66.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.82 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: Aetna Medicare |
$63.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.90
|
| Rate for Payer: BCBS Complete |
$44.96
|
| Rate for Payer: BCBS MAPPO |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$199.67
|
| Rate for Payer: BCN Commercial |
$199.67
|
| Rate for Payer: BCN Medicare Advantage |
$60.72
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.72
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: Mclaren Medicaid |
$42.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.76
|
| Rate for Payer: Meridian Medicaid |
$44.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: PACE Senior Care Partners |
$57.68
|
| Rate for Payer: PACE SWMI |
$60.72
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: PHP Medicare Advantage |
$60.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$211.31
|
| Rate for Payer: Priority Health Medicare |
$61.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.04
|
| Rate for Payer: Railroad Medicare Medicare |
$60.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.73
|
| Rate for Payer: UHC Core |
$202.80
|
| Rate for Payer: UHC Exchange |
$60.72
|
| Rate for Payer: UHC Medicaid |
$42.82
|
| Rate for Payer: UHC Medicare Advantage |
$60.72
|
| Rate for Payer: UHCCP Medicaid |
$42.82
|
| Rate for Payer: VA VA |
$60.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$450.30
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: Aetna Medicare |
$117.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.72
|
| Rate for Payer: BCBS Complete |
$83.35
|
| Rate for Payer: BCBS MAPPO |
$112.58
|
| Rate for Payer: BCBS Trust/PPO |
$370.19
|
| Rate for Payer: BCN Commercial |
$370.19
|
| Rate for Payer: BCN Medicare Advantage |
$112.58
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.58
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.73
|
| Rate for Payer: Mclaren Medicaid |
$79.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.20
|
| Rate for Payer: Meridian Medicaid |
$83.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Nomi Health Commercial |
$369.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PACE Senior Care Partners |
$106.95
|
| Rate for Payer: PACE SWMI |
$112.58
|
| Rate for Payer: PHP Commercial |
$382.75
|
| Rate for Payer: PHP Medicare Advantage |
$112.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.76
|
| Rate for Payer: Priority Health Medicare |
$113.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.41
|
| Rate for Payer: Railroad Medicare Medicare |
$112.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.26
|
| Rate for Payer: UHC Core |
$376.00
|
| Rate for Payer: UHC Exchange |
$112.58
|
| Rate for Payer: UHC Medicaid |
$79.39
|
| Rate for Payer: UHC Medicare Advantage |
$112.58
|
| Rate for Payer: UHCCP Medicaid |
$79.39
|
| Rate for Payer: VA VA |
$112.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.73
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicaid |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.41 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: BCBS Trust/PPO |
$371.90
|
| Rate for Payer: BCN Commercial |
$371.90
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Nomi Health Commercial |
$369.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PHP Commercial |
$382.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.26
|
| Rate for Payer: UHC Core |
$376.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.73
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$14.99
|
|
|
Service Code
|
NDC 00536137575
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.68
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.32
|
| Rate for Payer: BCN Commercial |
$12.32
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.04
|
| Rate for Payer: Priority Health Medicare |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.19
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicaid |
$2.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 61269073514
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.77
|
| Rate for Payer: BCN Commercial |
$7.77
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.06
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.28
|
| Rate for Payer: UHC Core |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.41
|
|
|
Service Code
|
NDC 61269073514
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: Aetna Medicare |
$2.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: BCBS MAPPO |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.74
|
| Rate for Payer: BCN Medicare Advantage |
$2.35
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.35
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Mclaren Medicaid |
$1.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.47
|
| Rate for Payer: Meridian Medicaid |
$1.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.06
|
| Rate for Payer: PACE Senior Care Partners |
$2.23
|
| Rate for Payer: PACE SWMI |
$2.35
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: PHP Medicare Advantage |
$2.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.28
|
| Rate for Payer: UHC Core |
$7.86
|
| Rate for Payer: UHC Exchange |
$2.35
|
| Rate for Payer: UHC Medicaid |
$1.66
|
| Rate for Payer: UHC Medicare Advantage |
$2.35
|
| Rate for Payer: UHCCP Medicaid |
$1.66
|
| Rate for Payer: VA VA |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$14.99
|
|
|
Service Code
|
NDC 00536137575
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.19
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.91
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS MAPPO |
$11.93
|
| Rate for Payer: BCBS Trust/PPO |
$39.23
|
| Rate for Payer: BCN Commercial |
$39.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.93
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.93
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Mclaren Medicaid |
$8.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.53
|
| Rate for Payer: Meridian Medicaid |
$8.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Nomi Health Commercial |
$39.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.79
|
| Rate for Payer: PACE Senior Care Partners |
$11.33
|
| Rate for Payer: PACE SWMI |
$11.93
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: PHP Medicare Advantage |
$11.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.21
|
| Rate for Payer: Railroad Medicare Medicare |
$11.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.99
|
| Rate for Payer: UHC Core |
$39.85
|
| Rate for Payer: UHC Exchange |
$11.93
|
| Rate for Payer: UHC Medicaid |
$8.41
|
| Rate for Payer: UHC Medicare Advantage |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$8.41
|
| Rate for Payer: VA VA |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Nomi Health Commercial |
$39.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.79
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.99
|
| Rate for Payer: UHC Core |
$39.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$31.38
|
| Rate for Payer: BCN Commercial |
$31.38
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.30
|
| Rate for Payer: Nomi Health Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.44
|
| Rate for Payer: UHC Core |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.88
|
| Rate for Payer: BCBS Complete |
$7.03
|
| Rate for Payer: BCBS MAPPO |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.24
|
| Rate for Payer: BCN Commercial |
$31.24
|
| Rate for Payer: BCN Medicare Advantage |
$9.50
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Mclaren Medicaid |
$6.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.97
|
| Rate for Payer: Meridian Medicaid |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.30
|
| Rate for Payer: Nomi Health Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: PACE Senior Care Partners |
$9.03
|
| Rate for Payer: PACE SWMI |
$9.50
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$9.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Medicare |
$9.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.44
|
| Rate for Payer: UHC Core |
$31.73
|
| Rate for Payer: UHC Exchange |
$9.50
|
| Rate for Payer: UHC Medicaid |
$6.70
|
| Rate for Payer: UHC Medicare Advantage |
$9.50
|
| Rate for Payer: UHCCP Medicaid |
$6.70
|
| Rate for Payer: VA VA |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$23.10
|
| Rate for Payer: BCN Commercial |
$23.10
|
| Rate for Payer: Cash Price |
$22.38
|
| 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: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.61
|
| Rate for Payer: UHC Core |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.33
|
| Rate for Payer: BCN Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$17.75
|
| 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: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
