|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLORIDE IVPB (PARTIAL PACKAGE)
|
Facility
|
IP
|
$62.93
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
165987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.37
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$48.63
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$51.60
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.90
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$54.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$52.55
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.67
|
| Rate for Payer: BCBS Complete |
$25.17
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS MAPPO |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$51.73
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Commercial |
$48.93
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$15.73
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$51.60
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE Senior Care Partners |
$14.95
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PACE SWMI |
$15.73
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Medicare Advantage |
$15.73
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.90
|
| Rate for Payer: Priority Health HMO/PPO |
$54.75
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$15.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$52.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.73
|
| Rate for Payer: UHC Exchange |
$15.73
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$15.73
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: VA VA |
$15.73
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$62.93
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.37
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$48.63
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$51.60
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.90
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$54.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$52.55
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.78
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2.17
|
| Rate for Payer: Priority Health Medicare |
$0.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$2.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.81 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: BCBS Trust/PPO |
$199.44
|
| Rate for Payer: BCN Commercial |
$188.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health HMO/PPO |
$212.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.00
|
| Rate for Payer: UHC Core |
$204.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.24 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: BCBS Trust/PPO |
$203.75
|
| Rate for Payer: BCN Commercial |
$192.89
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health HMO/PPO |
$217.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$244.32
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna Medicare |
$63.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.35
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$61.08
|
| Rate for Payer: BCBS Trust/PPO |
$200.86
|
| Rate for Payer: BCN Commercial |
$189.96
|
| Rate for Payer: BCN Medicare Advantage |
$61.08
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.08
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PACE Senior Care Partners |
$58.03
|
| Rate for Payer: PACE SWMI |
$61.08
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: PHP Medicare Advantage |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health HMO/PPO |
$212.56
|
| Rate for Payer: Priority Health Medicare |
$61.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.69
|
| Rate for Payer: Railroad Medicare Medicare |
$61.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.00
|
| Rate for Payer: UHC Core |
$204.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.08
|
| Rate for Payer: UHC Exchange |
$61.08
|
| Rate for Payer: UHC Medicare Advantage |
$61.08
|
| Rate for Payer: VA VA |
$61.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna Medicare |
$64.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.00
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS MAPPO |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$205.20
|
| Rate for Payer: BCN Commercial |
$194.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.40
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE Senior Care Partners |
$59.28
|
| Rate for Payer: PACE SWMI |
$62.40
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: PHP Medicare Advantage |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health HMO/PPO |
$217.15
|
| Rate for Payer: Priority Health Medicare |
$63.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.40
|
| Rate for Payer: UHC Exchange |
$62.40
|
| Rate for Payer: UHC Medicare Advantage |
$62.40
|
| Rate for Payer: VA VA |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.44
|
| 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: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.98
|
| 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
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: BCBS Trust/PPO |
$366.80
|
| Rate for Payer: BCN Commercial |
$347.26
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health HMO/PPO |
$390.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Core |
$375.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.72 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna Medicare |
$116.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.42
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: BCBS MAPPO |
$112.34
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$349.37
|
| Rate for Payer: BCN Medicare Advantage |
$112.34
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.34
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: PACE Senior Care Partners |
$106.72
|
| Rate for Payer: PACE SWMI |
$112.34
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: PHP Medicare Advantage |
$112.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health HMO/PPO |
$390.93
|
| Rate for Payer: Priority Health Medicare |
$113.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.06
|
| Rate for Payer: Railroad Medicare Medicare |
$112.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Core |
$375.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.34
|
| Rate for Payer: UHC Exchange |
$112.34
|
| Rate for Payer: UHC Medicare Advantage |
$112.34
|
| Rate for Payer: VA VA |
$112.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| 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 |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.66
|
| Rate for Payer: BCN Commercial |
$3.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Nomi Health Commercial |
$3.65
|
| 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 Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.87
|
| Rate for Payer: Priority Health Medicare |
$1.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.98
|
| 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 Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$444.60
|
|
|
Service Code
|
NDC 42292000120
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.99 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: BCBS Trust/PPO |
$362.93
|
| Rate for Payer: BCN Commercial |
$343.59
|
| 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: PHP Commercial |
$377.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.99
|
| Rate for Payer: Priority Health HMO/PPO |
$386.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.88
|
| 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
|
$444.60
|
|
|
Service Code
|
NDC 42292000120
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.59 |
| 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 |
$177.84
|
| Rate for Payer: BCBS MAPPO |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$365.51
|
| Rate for Payer: BCN Commercial |
$345.68
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.91
|
| Rate for Payer: Nomi Health Commercial |
$364.57
|
| 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 Cigna Priority Health |
$288.99
|
| Rate for Payer: Priority Health HMO/PPO |
$386.80
|
| Rate for Payer: Priority Health Medicare |
$112.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.88
|
| 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 Dual Complete DSNP |
$111.15
|
| Rate for Payer: UHC Exchange |
$111.15
|
| Rate for Payer: UHC Medicare Advantage |
$111.15
|
| Rate for Payer: VA VA |
$111.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.45
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.41
|
|
|
Service Code
|
NDC 61269073514
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| 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 |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.32
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| 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 Cigna Priority Health |
$6.12
|
| Rate for Payer: Priority Health HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| 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 Dual Complete DSNP |
$2.35
|
| Rate for Payer: UHC Exchange |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$2.35
|
| 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
|
$9.41
|
|
|
Service Code
|
NDC 61269073514
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.27
|
| 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: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.12
|
| Rate for Payer: Priority Health HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| 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 OINTMENT
|
Facility
|
OP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.33 |
| 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 |
$19.09
|
| Rate for Payer: BCBS MAPPO |
$11.93
|
| Rate for Payer: BCBS Trust/PPO |
$39.23
|
| Rate for Payer: BCN Commercial |
$37.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Nomi Health Commercial |
$39.13
|
| 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 Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.97
|
| 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 Dual Complete DSNP |
$11.93
|
| Rate for Payer: UHC Exchange |
$11.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.93
|
| Rate for Payer: VA VA |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.03 |
| 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 |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.24
|
| Rate for Payer: BCN Commercial |
$29.55
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.30
|
| Rate for Payer: Nomi Health Commercial |
$31.16
|
| 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 Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Medicare |
$9.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| 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 Dual Complete DSNP |
$9.50
|
| Rate for Payer: UHC Exchange |
$9.50
|
| Rate for Payer: UHC Medicare Advantage |
$9.50
|
| Rate for Payer: VA VA |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$31.02
|
| Rate for Payer: BCN Commercial |
$29.37
|
| 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: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| 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
|
IP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$38.95
|
| Rate for Payer: BCN Commercial |
$36.88
|
| 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: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.97
|
| 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 POWDER
|
Facility
|
OP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.74
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS MAPPO |
$6.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.99
|
| Rate for Payer: BCN Commercial |
$21.75
|
| Rate for Payer: BCN Medicare Advantage |
$6.99
|
| 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: Health Alliance Plan Medicare Advantage |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: PACE Senior Care Partners |
$6.64
|
| Rate for Payer: PACE SWMI |
$6.99
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: PHP Medicare Advantage |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health HMO/PPO |
$24.33
|
| Rate for Payer: Priority Health Medicare |
$7.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.61
|
| Rate for Payer: UHC Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.99
|
| Rate for Payer: UHC Exchange |
$6.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.99
|
| Rate for Payer: VA VA |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.93
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: BCN Medicare Advantage |
$5.55
|
| 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: Health Alliance Plan Medicare Advantage |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PACE Senior Care Partners |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.55
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.55
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: VA VA |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$21.62
|
| 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: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health HMO/PPO |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.74
|
| 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
|
|
