|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$65.56
|
|
|
Service Code
|
NDC 43598044670
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$53.52
|
| Rate for Payer: BCN Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$52.45
|
| Rate for Payer: Cofinity Commercial |
$56.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.45
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.73
|
| Rate for Payer: Nomi Health Commercial |
$53.76
|
| Rate for Payer: PHP Commercial |
$55.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.69
|
| Rate for Payer: UHC Core |
$54.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.17
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$65.56
|
|
|
Service Code
|
NDC 43598044670
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: Aetna Medicare |
$17.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.49
|
| Rate for Payer: BCBS Complete |
$26.22
|
| Rate for Payer: BCBS MAPPO |
$16.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.90
|
| Rate for Payer: BCN Commercial |
$50.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.39
|
| Rate for Payer: Cash Price |
$52.45
|
| Rate for Payer: Cofinity Commercial |
$56.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.73
|
| Rate for Payer: Nomi Health Commercial |
$53.76
|
| Rate for Payer: PACE Senior Care Partners |
$15.57
|
| Rate for Payer: PACE SWMI |
$16.39
|
| Rate for Payer: PHP Commercial |
$55.73
|
| Rate for Payer: PHP Medicare Advantage |
$16.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.93
|
| Rate for Payer: Railroad Medicare Medicare |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.69
|
| Rate for Payer: UHC Core |
$54.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.39
|
| Rate for Payer: UHC Exchange |
$16.39
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: VA VA |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.17
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 43598044671
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.56
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Nomi Health Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: BCBS Trust/PPO |
$236.19
|
| Rate for Payer: BCN Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: Nomi Health Commercial |
$237.26
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health HMO/PPO |
$251.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.62
|
| Rate for Payer: UHC Core |
$241.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: Aetna Medicare |
$25.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$38.58
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$79.29
|
| Rate for Payer: BCN Commercial |
$74.99
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.91
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health HMO/PPO |
$83.91
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.62
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$80.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.69 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$78.73
|
| Rate for Payer: BCN Commercial |
$74.54
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Healthscope Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health HMO/PPO |
$83.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$80.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: Aetna Medicare |
$75.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.42
|
| Rate for Payer: BCBS Complete |
$115.74
|
| Rate for Payer: BCBS MAPPO |
$72.34
|
| Rate for Payer: BCBS Trust/PPO |
$237.87
|
| Rate for Payer: BCN Commercial |
$224.96
|
| Rate for Payer: BCN Medicare Advantage |
$72.34
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.34
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: Nomi Health Commercial |
$237.26
|
| Rate for Payer: PACE Senior Care Partners |
$68.72
|
| Rate for Payer: PACE SWMI |
$72.34
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: PHP Medicare Advantage |
$72.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health HMO/PPO |
$251.73
|
| Rate for Payer: Priority Health Medicare |
$73.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.86
|
| Rate for Payer: Railroad Medicare Medicare |
$72.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.62
|
| Rate for Payer: UHC Core |
$241.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.34
|
| Rate for Payer: UHC Exchange |
$72.34
|
| Rate for Payer: UHC Medicare Advantage |
$72.34
|
| Rate for Payer: VA VA |
$72.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: Aetna Medicare |
$84.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.12
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS MAPPO |
$81.70
|
| Rate for Payer: BCBS Trust/PPO |
$268.66
|
| Rate for Payer: BCN Commercial |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$81.70
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PACE Senior Care Partners |
$77.62
|
| Rate for Payer: PACE SWMI |
$81.70
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: PHP Medicare Advantage |
$81.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: Railroad Medicare Medicare |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.70
|
| Rate for Payer: UHC Exchange |
$81.70
|
| Rate for Payer: UHC Medicare Advantage |
$81.70
|
| Rate for Payer: VA VA |
$81.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: BCBS Trust/PPO |
$266.77
|
| Rate for Payer: BCN Commercial |
$252.55
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
OP
|
$7.69
|
|
|
Service Code
|
NDC 50268062411
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.54
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.40
|
| Rate for Payer: BCBS Complete |
$3.08
|
| Rate for Payer: BCBS MAPPO |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$5.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.92
|
| Rate for Payer: Cash Price |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$6.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.54
|
| Rate for Payer: Nomi Health Commercial |
$6.31
|
| Rate for Payer: PACE Senior Care Partners |
$1.83
|
| Rate for Payer: PACE SWMI |
$1.92
|
| Rate for Payer: PHP Commercial |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.00
|
| Rate for Payer: Priority Health HMO/PPO |
$6.69
|
| Rate for Payer: Priority Health Medicare |
$1.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.77
|
| Rate for Payer: UHC Core |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.92
|
| Rate for Payer: UHC Medicare Advantage |
$1.92
|
| Rate for Payer: VA VA |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.77
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$7.69
|
|
|
Service Code
|
NDC 50268062411
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCN Commercial |
$5.94
|
| Rate for Payer: Cash Price |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.15
|
| Rate for Payer: Healthscope Commercial |
$6.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.54
|
| Rate for Payer: Nomi Health Commercial |
$6.31
|
| Rate for Payer: PHP Commercial |
$6.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.00
|
| Rate for Payer: Priority Health HMO/PPO |
$6.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.77
|
| Rate for Payer: UHC Core |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.77
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$384.06
|
|
|
Service Code
|
NDC 50268062415
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.64 |
| Max. Negotiated Rate |
$345.65 |
| Rate for Payer: Aetna Commercial |
$326.45
|
| Rate for Payer: BCBS Trust/PPO |
$313.51
|
| Rate for Payer: BCN Commercial |
$296.80
|
| Rate for Payer: Cash Price |
$307.25
|
| Rate for Payer: Cofinity Commercial |
$330.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.25
|
| Rate for Payer: Healthscope Commercial |
$345.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.45
|
| Rate for Payer: Nomi Health Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$326.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.64
|
| Rate for Payer: Priority Health HMO/PPO |
$334.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.97
|
| Rate for Payer: UHC Core |
$320.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.04
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
OP
|
$384.06
|
|
|
Service Code
|
NDC 50268062415
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$345.65 |
| Rate for Payer: Aetna Commercial |
$326.45
|
| Rate for Payer: Aetna Medicare |
$99.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.02
|
| Rate for Payer: BCBS Complete |
$153.62
|
| Rate for Payer: BCBS MAPPO |
$96.02
|
| Rate for Payer: BCBS Trust/PPO |
$315.74
|
| Rate for Payer: BCN Commercial |
$298.61
|
| Rate for Payer: BCN Medicare Advantage |
$96.02
|
| Rate for Payer: Cash Price |
$307.25
|
| Rate for Payer: Cofinity Commercial |
$330.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.02
|
| Rate for Payer: Healthscope Commercial |
$345.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.45
|
| Rate for Payer: Nomi Health Commercial |
$314.93
|
| Rate for Payer: PACE Senior Care Partners |
$91.21
|
| Rate for Payer: PACE SWMI |
$96.02
|
| Rate for Payer: PHP Commercial |
$326.45
|
| Rate for Payer: PHP Medicare Advantage |
$96.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.64
|
| Rate for Payer: Priority Health HMO/PPO |
$334.13
|
| Rate for Payer: Priority Health Medicare |
$96.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.32
|
| Rate for Payer: Railroad Medicare Medicare |
$96.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.97
|
| Rate for Payer: UHC Core |
$320.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.02
|
| Rate for Payer: UHC Exchange |
$96.02
|
| Rate for Payer: UHC Medicare Advantage |
$96.02
|
| Rate for Payer: VA VA |
$96.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.04
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$617.28
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.60 |
| 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 |
$246.91
|
| Rate for Payer: BCBS MAPPO |
$154.32
|
| Rate for Payer: BCBS Trust/PPO |
$507.47
|
| Rate for Payer: BCN Commercial |
$479.94
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.69
|
| Rate for Payer: Nomi Health Commercial |
$506.17
|
| 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 Cigna Priority Health |
$401.23
|
| Rate for Payer: Priority Health HMO/PPO |
$537.03
|
| Rate for Payer: Priority Health Medicare |
$155.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.58
|
| 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 Dual Complete DSNP |
$154.32
|
| Rate for Payer: UHC Exchange |
$154.32
|
| Rate for Payer: UHC Medicare Advantage |
$154.32
|
| 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
|
$6.25
|
|
|
Service Code
|
NDC 50268062311
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.95
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$5.14
|
| Rate for Payer: BCN Commercial |
$4.86
|
| Rate for Payer: BCN Medicare Advantage |
$1.56
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.56
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.48
|
| Rate for Payer: PACE SWMI |
$1.56
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO |
$5.44
|
| Rate for Payer: Priority Health Medicare |
$1.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.50
|
| Rate for Payer: UHC Core |
$5.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UHC Medicare Advantage |
$1.56
|
| Rate for Payer: VA VA |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$312.24
|
|
|
Service Code
|
NDC 50268062315
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.96 |
| Max. Negotiated Rate |
$281.02 |
| Rate for Payer: Aetna Commercial |
$265.40
|
| Rate for Payer: BCBS Trust/PPO |
$254.88
|
| Rate for Payer: BCN Commercial |
$241.30
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cofinity Commercial |
$268.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.79
|
| Rate for Payer: Healthscope Commercial |
$281.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.40
|
| Rate for Payer: Nomi Health Commercial |
$256.04
|
| Rate for Payer: PHP Commercial |
$265.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.96
|
| Rate for Payer: Priority Health HMO/PPO |
$271.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.77
|
| Rate for Payer: UHC Core |
$260.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.18
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
NDC 50268062311
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$5.10
|
| Rate for Payer: BCN Commercial |
$4.83
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$5.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.31
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.50
|
| Rate for Payer: UHC Core |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$617.28
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.23 |
| Max. Negotiated Rate |
$555.55 |
| Rate for Payer: Aetna Commercial |
$524.69
|
| Rate for Payer: BCBS Trust/PPO |
$503.89
|
| Rate for Payer: BCN Commercial |
$477.03
|
| 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: PHP Commercial |
$524.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.23
|
| Rate for Payer: Priority Health HMO/PPO |
$537.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.58
|
| 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
|
OP
|
$312.24
|
|
|
Service Code
|
NDC 50268062315
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$281.02 |
| Rate for Payer: Aetna Commercial |
$265.40
|
| Rate for Payer: Aetna Medicare |
$81.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.58
|
| Rate for Payer: BCBS Complete |
$124.90
|
| Rate for Payer: BCBS MAPPO |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$256.69
|
| Rate for Payer: BCN Commercial |
$242.77
|
| Rate for Payer: BCN Medicare Advantage |
$78.06
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cofinity Commercial |
$268.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$281.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.40
|
| Rate for Payer: Nomi Health Commercial |
$256.04
|
| Rate for Payer: PACE Senior Care Partners |
$74.16
|
| Rate for Payer: PACE SWMI |
$78.06
|
| Rate for Payer: PHP Commercial |
$265.40
|
| Rate for Payer: PHP Medicare Advantage |
$78.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.96
|
| Rate for Payer: Priority Health HMO/PPO |
$271.65
|
| Rate for Payer: Priority Health Medicare |
$78.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.20
|
| Rate for Payer: Railroad Medicare Medicare |
$78.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.77
|
| Rate for Payer: UHC Core |
$260.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.06
|
| Rate for Payer: UHC Exchange |
$78.06
|
| Rate for Payer: UHC Medicare Advantage |
$78.06
|
| Rate for Payer: VA VA |
$78.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.18
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$451.44
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Aetna Commercial |
$383.72
|
| Rate for Payer: BCBS Trust/PPO |
$368.51
|
| Rate for Payer: BCN Commercial |
$348.87
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$388.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.15
|
| Rate for Payer: Healthscope Commercial |
$406.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.72
|
| Rate for Payer: Nomi Health Commercial |
$370.18
|
| Rate for Payer: PHP Commercial |
$383.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: Priority Health HMO/PPO |
$392.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.27
|
| Rate for Payer: UHC Core |
$376.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.82
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS MAPPO |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$7.42
|
| Rate for Payer: BCN Commercial |
$7.02
|
| Rate for Payer: BCN Medicare Advantage |
$2.26
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: PACE Senior Care Partners |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.26
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.87
|
| Rate for Payer: Priority Health HMO/PPO |
$7.86
|
| Rate for Payer: Priority Health Medicare |
$2.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.95
|
| Rate for Payer: UHC Core |
$7.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.26
|
| Rate for Payer: UHC Exchange |
$2.26
|
| Rate for Payer: UHC Medicare Advantage |
$2.26
|
| Rate for Payer: VA VA |
$2.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.77
|
|
|
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 |
$183.46 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: BCBS Trust/PPO |
$230.39
|
| Rate for Payer: BCN Commercial |
$218.12
|
| 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: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health HMO/PPO |
$245.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| 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
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.87 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$719.44
|
| Rate for Payer: BCN Commercial |
$681.10
|
| 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: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.50
|
| 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
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.32 |
| 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 |
$352.54
|
| Rate for Payer: BCBS MAPPO |
$220.34
|
| Rate for Payer: BCBS Trust/PPO |
$724.55
|
| Rate for Payer: BCN Commercial |
$685.24
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| 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 Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Medicare |
$222.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.50
|
| 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 Dual Complete DSNP |
$220.34
|
| Rate for Payer: UHC Exchange |
$220.34
|
| Rate for Payer: UHC Medicare Advantage |
$220.34
|
| 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
|
$451.44
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.22 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Aetna Commercial |
$383.72
|
| Rate for Payer: Aetna Medicare |
$117.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.08
|
| Rate for Payer: BCBS Complete |
$180.58
|
| Rate for Payer: BCBS MAPPO |
$112.86
|
| Rate for Payer: BCBS Trust/PPO |
$371.13
|
| Rate for Payer: BCN Commercial |
$350.99
|
| Rate for Payer: BCN Medicare Advantage |
$112.86
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$388.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$406.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.72
|
| Rate for Payer: Nomi Health Commercial |
$370.18
|
| Rate for Payer: PACE Senior Care Partners |
$107.22
|
| Rate for Payer: PACE SWMI |
$112.86
|
| Rate for Payer: PHP Commercial |
$383.72
|
| Rate for Payer: PHP Medicare Advantage |
$112.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: Priority Health HMO/PPO |
$392.75
|
| Rate for Payer: Priority Health Medicare |
$113.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.27
|
| Rate for Payer: UHC Core |
$376.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.86
|
| Rate for Payer: UHC Exchange |
$112.86
|
| Rate for Payer: UHC Medicare Advantage |
$112.86
|
| Rate for Payer: VA VA |
$112.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.58
|
|
