|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$268.71 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$77.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.30
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: BCBS MAPPO |
$74.64
|
| Rate for Payer: BCBS Trust/PPO |
$245.45
|
| Rate for Payer: BCN Commercial |
$245.45
|
| Rate for Payer: BCN Medicare Advantage |
$74.64
|
| Rate for Payer: Cash Price |
$238.86
|
| Rate for Payer: Cofinity Commercial |
$256.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.64
|
| Rate for Payer: Healthscope Commercial |
$268.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.93
|
| Rate for Payer: Mclaren Medicaid |
$52.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.37
|
| Rate for Payer: Meridian Medicaid |
$55.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.93
|
| Rate for Payer: PACE Senior Care Partners |
$70.91
|
| Rate for Payer: PACE SWMI |
$74.64
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: PHP Medicare Advantage |
$74.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.76
|
| Rate for Payer: Priority Health Medicare |
$75.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.80
|
| Rate for Payer: Railroad Medicare Medicare |
$74.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.74
|
| Rate for Payer: UHC Core |
$249.31
|
| Rate for Payer: UHC Exchange |
$74.64
|
| Rate for Payer: UHC Medicaid |
$52.64
|
| Rate for Payer: UHC Medicare Advantage |
$74.64
|
| Rate for Payer: UHCCP Medicaid |
$52.64
|
| Rate for Payer: VA VA |
$74.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.93
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna Medicare |
$87.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.09
|
| Rate for Payer: BCBS Complete |
$62.25
|
| Rate for Payer: BCBS MAPPO |
$84.08
|
| Rate for Payer: BCBS Trust/PPO |
$276.47
|
| Rate for Payer: BCN Commercial |
$276.47
|
| Rate for Payer: BCN Medicare Advantage |
$84.08
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.08
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Mclaren Medicaid |
$59.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.28
|
| Rate for Payer: Meridian Medicaid |
$62.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PACE Senior Care Partners |
$79.87
|
| Rate for Payer: PACE SWMI |
$84.08
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: PHP Medicare Advantage |
$84.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Medicare |
$84.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.06
|
| Rate for Payer: Railroad Medicare Medicare |
$84.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: UHC Exchange |
$84.08
|
| Rate for Payer: UHC Medicaid |
$59.29
|
| Rate for Payer: UHC Medicare Advantage |
$84.08
|
| Rate for Payer: UHCCP Medicaid |
$59.29
|
| Rate for Payer: VA VA |
$84.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: BCBS Trust/PPO |
$277.75
|
| Rate for Payer: BCN Commercial |
$277.75
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 67877075701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$182.44
|
| Rate for Payer: BCN Commercial |
$182.44
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 67877075701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$57.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.03
|
| Rate for Payer: BCBS Complete |
$40.89
|
| Rate for Payer: BCBS MAPPO |
$55.23
|
| Rate for Payer: BCBS Trust/PPO |
$181.60
|
| Rate for Payer: BCN Commercial |
$181.60
|
| Rate for Payer: BCN Medicare Advantage |
$55.23
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.23
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Mclaren Medicaid |
$38.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.99
|
| Rate for Payer: Meridian Medicaid |
$40.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PACE Senior Care Partners |
$52.46
|
| Rate for Payer: PACE SWMI |
$55.23
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: PHP Medicare Advantage |
$55.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Medicare |
$55.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.75
|
| Rate for Payer: Railroad Medicare Medicare |
$55.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: UHC Exchange |
$55.23
|
| Rate for Payer: UHC Medicaid |
$38.94
|
| Rate for Payer: UHC Medicare Advantage |
$55.23
|
| Rate for Payer: UHCCP Medicaid |
$38.94
|
| Rate for Payer: VA VA |
$55.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
OP
|
$452.51
|
|
|
Service Code
|
NDC 50268062415
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$407.26 |
| Rate for Payer: Aetna Commercial |
$384.63
|
| Rate for Payer: Aetna Medicare |
$117.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.41
|
| Rate for Payer: BCBS Complete |
$83.76
|
| Rate for Payer: BCBS MAPPO |
$113.13
|
| Rate for Payer: BCBS Trust/PPO |
$372.01
|
| Rate for Payer: BCN Commercial |
$372.01
|
| Rate for Payer: BCN Medicare Advantage |
$113.13
|
| Rate for Payer: Cash Price |
$362.01
|
| Rate for Payer: Cofinity Commercial |
$389.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.13
|
| Rate for Payer: Healthscope Commercial |
$407.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.38
|
| Rate for Payer: Mclaren Medicaid |
$79.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.78
|
| Rate for Payer: Meridian Medicaid |
$83.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.63
|
| Rate for Payer: Nomi Health Commercial |
$371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.38
|
| Rate for Payer: PACE Senior Care Partners |
$107.47
|
| Rate for Payer: PACE SWMI |
$113.13
|
| Rate for Payer: PHP Commercial |
$384.63
|
| Rate for Payer: PHP Medicare Advantage |
$113.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.68
|
| Rate for Payer: Priority Health Medicare |
$114.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.95
|
| Rate for Payer: Railroad Medicare Medicare |
$113.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.21
|
| Rate for Payer: UHC Core |
$377.85
|
| Rate for Payer: UHC Exchange |
$113.13
|
| Rate for Payer: UHC Medicaid |
$79.78
|
| Rate for Payer: UHC Medicare Advantage |
$113.13
|
| Rate for Payer: UHCCP Medicaid |
$79.78
|
| Rate for Payer: VA VA |
$113.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.38
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$452.51
|
|
|
Service Code
|
NDC 50268062415
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.95 |
| Max. Negotiated Rate |
$407.26 |
| Rate for Payer: Aetna Commercial |
$384.63
|
| Rate for Payer: BCBS Trust/PPO |
$373.73
|
| Rate for Payer: BCN Commercial |
$373.73
|
| Rate for Payer: Cash Price |
$362.01
|
| Rate for Payer: Cofinity Commercial |
$389.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.01
|
| Rate for Payer: Healthscope Commercial |
$407.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.63
|
| Rate for Payer: Nomi Health Commercial |
$371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.38
|
| Rate for Payer: PHP Commercial |
$384.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.21
|
| Rate for Payer: UHC Core |
$377.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.38
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$9.06
|
|
|
Service Code
|
NDC 50268062411
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.48
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.25
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.70
|
| Rate for Payer: Nomi Health Commercial |
$7.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.79
|
| Rate for Payer: PHP Commercial |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.97
|
| Rate for Payer: UHC Core |
$7.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.79
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
OP
|
$9.06
|
|
|
Service Code
|
NDC 50268062411
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCN Commercial |
$7.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.27
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.79
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.38
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.70
|
| Rate for Payer: Nomi Health Commercial |
$7.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.79
|
| Rate for Payer: PACE Senior Care Partners |
$2.15
|
| Rate for Payer: PACE SWMI |
$2.27
|
| Rate for Payer: PHP Commercial |
$7.70
|
| Rate for Payer: PHP Medicare Advantage |
$2.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.88
|
| Rate for Payer: Priority Health Medicare |
$2.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.31
|
| Rate for Payer: Railroad Medicare Medicare |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.97
|
| Rate for Payer: UHC Core |
$7.57
|
| Rate for Payer: UHC Exchange |
$2.27
|
| Rate for Payer: UHC Medicaid |
$1.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.27
|
| Rate for Payer: UHCCP Medicaid |
$1.60
|
| Rate for Payer: VA VA |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.79
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$349.44
|
|
|
Service Code
|
NDC 50268062315
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Aetna Commercial |
$297.02
|
| Rate for Payer: Aetna Medicare |
$90.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.20
|
| Rate for Payer: BCBS Complete |
$64.68
|
| Rate for Payer: BCBS MAPPO |
$87.36
|
| Rate for Payer: BCBS Trust/PPO |
$287.27
|
| Rate for Payer: BCN Commercial |
$287.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.36
|
| Rate for Payer: Cash Price |
$279.55
|
| Rate for Payer: Cofinity Commercial |
$300.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$314.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.08
|
| Rate for Payer: Mclaren Medicaid |
$61.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.73
|
| Rate for Payer: Meridian Medicaid |
$64.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.02
|
| Rate for Payer: Nomi Health Commercial |
$286.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.08
|
| Rate for Payer: PACE Senior Care Partners |
$82.99
|
| Rate for Payer: PACE SWMI |
$87.36
|
| Rate for Payer: PHP Commercial |
$297.02
|
| Rate for Payer: PHP Medicare Advantage |
$87.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.01
|
| Rate for Payer: Priority Health Medicare |
$88.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.21
|
| Rate for Payer: Railroad Medicare Medicare |
$87.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.51
|
| Rate for Payer: UHC Core |
$291.78
|
| Rate for Payer: UHC Exchange |
$87.36
|
| Rate for Payer: UHC Medicaid |
$61.61
|
| Rate for Payer: UHC Medicare Advantage |
$87.36
|
| Rate for Payer: UHCCP Medicaid |
$61.61
|
| Rate for Payer: VA VA |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.08
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$617.28
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$555.55 |
| Rate for Payer: Aetna Commercial |
$524.69
|
| Rate for Payer: Aetna Medicare |
$160.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.90
|
| Rate for Payer: BCBS Complete |
$114.26
|
| Rate for Payer: BCBS MAPPO |
$154.32
|
| Rate for Payer: BCBS Trust/PPO |
$507.47
|
| Rate for Payer: BCN Commercial |
$507.47
|
| Rate for Payer: BCN Medicare Advantage |
$154.32
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Cofinity Commercial |
$530.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.32
|
| Rate for Payer: Healthscope Commercial |
$555.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.96
|
| Rate for Payer: Mclaren Medicaid |
$108.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.04
|
| Rate for Payer: Meridian Medicaid |
$114.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.69
|
| Rate for Payer: Nomi Health Commercial |
$506.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.96
|
| Rate for Payer: PACE Senior Care Partners |
$146.60
|
| Rate for Payer: PACE SWMI |
$154.32
|
| Rate for Payer: PHP Commercial |
$524.69
|
| Rate for Payer: PHP Medicare Advantage |
$154.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$537.03
|
| Rate for Payer: Priority Health Medicare |
$155.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.63
|
| Rate for Payer: Railroad Medicare Medicare |
$154.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.21
|
| Rate for Payer: UHC Core |
$515.43
|
| Rate for Payer: UHC Exchange |
$154.32
|
| Rate for Payer: UHC Medicaid |
$108.83
|
| Rate for Payer: UHC Medicare Advantage |
$154.32
|
| Rate for Payer: UHCCP Medicaid |
$108.83
|
| Rate for Payer: VA VA |
$154.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.96
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$6.99
|
|
|
Service Code
|
NDC 50268062311
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Aetna Commercial |
$5.94
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: BCBS MAPPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.75
|
| Rate for Payer: BCN Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.75
|
| Rate for Payer: Healthscope Commercial |
$6.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.24
|
| Rate for Payer: Mclaren Medicaid |
$1.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.83
|
| Rate for Payer: Meridian Medicaid |
$1.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.94
|
| Rate for Payer: Nomi Health Commercial |
$5.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.24
|
| Rate for Payer: PACE Senior Care Partners |
$1.66
|
| Rate for Payer: PACE SWMI |
$1.75
|
| Rate for Payer: PHP Commercial |
$5.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.08
|
| Rate for Payer: Priority Health Medicare |
$1.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.15
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UHC Medicaid |
$1.23
|
| Rate for Payer: UHC Medicare Advantage |
$1.75
|
| Rate for Payer: UHCCP Medicaid |
$1.23
|
| Rate for Payer: VA VA |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.24
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$6.99
|
|
|
Service Code
|
NDC 50268062311
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Aetna Commercial |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$5.77
|
| Rate for Payer: BCN Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.59
|
| Rate for Payer: Healthscope Commercial |
$6.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.94
|
| Rate for Payer: Nomi Health Commercial |
$5.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.24
|
| Rate for Payer: PHP Commercial |
$5.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.15
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.24
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$617.28
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.63 |
| Max. Negotiated Rate |
$555.55 |
| Rate for Payer: Aetna Commercial |
$524.69
|
| Rate for Payer: BCBS Trust/PPO |
$509.81
|
| Rate for Payer: BCN Commercial |
$509.81
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Cofinity Commercial |
$530.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.82
|
| Rate for Payer: Healthscope Commercial |
$555.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.69
|
| Rate for Payer: Nomi Health Commercial |
$506.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.96
|
| Rate for Payer: PHP Commercial |
$524.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$537.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.21
|
| Rate for Payer: UHC Core |
$515.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.96
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$349.44
|
|
|
Service Code
|
NDC 50268062315
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.21 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Aetna Commercial |
$297.02
|
| Rate for Payer: BCBS Trust/PPO |
$288.60
|
| Rate for Payer: BCN Commercial |
$288.60
|
| Rate for Payer: Cash Price |
$279.55
|
| Rate for Payer: Cofinity Commercial |
$300.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.55
|
| Rate for Payer: Healthscope Commercial |
$314.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.02
|
| Rate for Payer: Nomi Health Commercial |
$286.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.08
|
| Rate for Payer: PHP Commercial |
$297.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$304.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.51
|
| Rate for Payer: UHC Core |
$291.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.08
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$613.41 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$727.90
|
| Rate for Payer: BCN Commercial |
$727.90
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$757.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$793.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.76 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna Medicare |
$73.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.20
|
| Rate for Payer: BCBS Complete |
$52.24
|
| Rate for Payer: BCBS MAPPO |
$70.56
|
| Rate for Payer: BCBS Trust/PPO |
$232.03
|
| Rate for Payer: BCN Commercial |
$232.03
|
| Rate for Payer: BCN Medicare Advantage |
$70.56
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Mclaren Medicaid |
$49.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.09
|
| Rate for Payer: Meridian Medicaid |
$52.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: PACE Senior Care Partners |
$67.03
|
| Rate for Payer: PACE SWMI |
$70.56
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: PHP Medicare Advantage |
$70.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.55
|
| Rate for Payer: Priority Health Medicare |
$71.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.44
|
| Rate for Payer: Railroad Medicare Medicare |
$70.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.37
|
| Rate for Payer: UHC Core |
$235.67
|
| Rate for Payer: UHC Exchange |
$70.56
|
| Rate for Payer: UHC Medicaid |
$49.76
|
| Rate for Payer: UHC Medicare Advantage |
$70.56
|
| Rate for Payer: UHCCP Medicaid |
$49.76
|
| Rate for Payer: VA VA |
$70.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.38 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: Aetna Medicare |
$229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.42
|
| Rate for Payer: BCBS Complete |
$163.14
|
| Rate for Payer: BCBS MAPPO |
$220.34
|
| Rate for Payer: BCBS Trust/PPO |
$724.55
|
| Rate for Payer: BCN Commercial |
$724.55
|
| Rate for Payer: BCN Medicare Advantage |
$220.34
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$757.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.34
|
| Rate for Payer: Healthscope Commercial |
$793.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Mclaren Medicaid |
$155.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.35
|
| Rate for Payer: Meridian Medicaid |
$163.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$242.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: PACE Senior Care Partners |
$209.32
|
| Rate for Payer: PACE SWMI |
$220.34
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: PHP Medicare Advantage |
$220.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Medicare |
$222.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.41
|
| Rate for Payer: Railroad Medicare Medicare |
$220.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: UHC Exchange |
$220.34
|
| Rate for Payer: UHC Medicaid |
$155.38
|
| Rate for Payer: UHC Medicare Advantage |
$220.34
|
| Rate for Payer: UHCCP Medicaid |
$155.38
|
| Rate for Payer: VA VA |
$220.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$447.33
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$402.60 |
| Rate for Payer: Aetna Commercial |
$380.23
|
| Rate for Payer: BCBS Trust/PPO |
$369.45
|
| Rate for Payer: BCN Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$357.86
|
| Rate for Payer: Cofinity Commercial |
$384.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.86
|
| Rate for Payer: Healthscope Commercial |
$402.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.23
|
| Rate for Payer: Nomi Health Commercial |
$366.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.50
|
| Rate for Payer: PHP Commercial |
$380.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.65
|
| Rate for Payer: UHC Core |
$373.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.50
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.86 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: BCBS Trust/PPO |
$259.70
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$273.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.72
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna Commercial |
$7.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.39
|
| Rate for Payer: BCN Commercial |
$7.39
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$8.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.61
|
| Rate for Payer: Nomi Health Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.71
|
| Rate for Payer: PHP Commercial |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.88
|
| Rate for Payer: UHC Core |
$7.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.71
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.44 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: BCBS Trust/PPO |
$233.10
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.37
|
| Rate for Payer: UHC Core |
$235.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$314.45
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.27
|
| Rate for Payer: BCBS Complete |
$58.20
|
| Rate for Payer: BCBS MAPPO |
$78.61
|
| Rate for Payer: BCBS Trust/PPO |
$258.51
|
| Rate for Payer: BCN Commercial |
$258.51
|
| Rate for Payer: BCN Medicare Advantage |
$78.61
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.61
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Mclaren Medicaid |
$55.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.54
|
| Rate for Payer: Meridian Medicaid |
$58.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PACE Senior Care Partners |
$74.68
|
| Rate for Payer: PACE SWMI |
$78.61
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: PHP Medicare Advantage |
$78.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$273.57
|
| Rate for Payer: Priority Health Medicare |
$79.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.86
|
| Rate for Payer: Railroad Medicare Medicare |
$78.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.72
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: UHC Exchange |
$78.61
|
| Rate for Payer: UHC Medicaid |
$55.44
|
| Rate for Payer: UHC Medicare Advantage |
$78.61
|
| Rate for Payer: UHCCP Medicaid |
$55.44
|
| Rate for Payer: VA VA |
$78.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.38 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: Aetna Medicare |
$229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.42
|
| Rate for Payer: BCBS Complete |
$163.14
|
| Rate for Payer: BCBS MAPPO |
$220.34
|
| Rate for Payer: BCBS Trust/PPO |
$724.55
|
| Rate for Payer: BCN Commercial |
$724.55
|
| Rate for Payer: BCN Medicare Advantage |
$220.34
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$757.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.34
|
| Rate for Payer: Healthscope Commercial |
$793.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Mclaren Medicaid |
$155.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.35
|
| Rate for Payer: Meridian Medicaid |
$163.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$242.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: PACE Senior Care Partners |
$209.32
|
| Rate for Payer: PACE SWMI |
$220.34
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: PHP Medicare Advantage |
$220.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Medicare |
$222.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.41
|
| Rate for Payer: Railroad Medicare Medicare |
$220.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: UHC Exchange |
$220.34
|
| Rate for Payer: UHC Medicaid |
$155.38
|
| Rate for Payer: UHC Medicare Advantage |
$220.34
|
| Rate for Payer: UHCCP Medicaid |
$155.38
|
| Rate for Payer: VA VA |
$220.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$447.33
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.86 |
| Max. Negotiated Rate |
$402.60 |
| Rate for Payer: Aetna Commercial |
$380.23
|
| Rate for Payer: Aetna Medicare |
$116.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.79
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$111.83
|
| Rate for Payer: BCBS Trust/PPO |
$367.75
|
| Rate for Payer: BCN Commercial |
$367.75
|
| Rate for Payer: BCN Medicare Advantage |
$111.83
|
| Rate for Payer: Cash Price |
$357.86
|
| Rate for Payer: Cofinity Commercial |
$384.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.83
|
| Rate for Payer: Healthscope Commercial |
$402.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.50
|
| Rate for Payer: Mclaren Medicaid |
$78.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.42
|
| Rate for Payer: Meridian Medicaid |
$82.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.23
|
| Rate for Payer: Nomi Health Commercial |
$366.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.24
|
| Rate for Payer: PACE SWMI |
$111.83
|
| Rate for Payer: PHP Commercial |
$380.23
|
| Rate for Payer: PHP Medicare Advantage |
$111.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.18
|
| Rate for Payer: Priority Health Medicare |
$112.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.34
|
| Rate for Payer: Railroad Medicare Medicare |
$111.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.65
|
| Rate for Payer: UHC Core |
$373.52
|
| Rate for Payer: UHC Exchange |
$111.83
|
| Rate for Payer: UHC Medicaid |
$78.86
|
| Rate for Payer: UHC Medicare Advantage |
$111.83
|
| Rate for Payer: UHCCP Medicaid |
$78.86
|
| Rate for Payer: VA VA |
$111.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.50
|
|
