|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$171.70
|
|
|
Service Code
|
NDC 00574010770
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$154.53 |
| Rate for Payer: Aetna American Axle |
$111.61
|
| Rate for Payer: Aetna Commercial |
$145.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.61
|
| Rate for Payer: Cash Price |
$137.36
|
| Rate for Payer: Cofinity Advantage |
$120.19
|
| Rate for Payer: Cofinity Commercial |
$147.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.36
|
| Rate for Payer: Healthscope Commercial |
$154.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.78
|
| Rate for Payer: PHP Commercial |
$145.94
|
| Rate for Payer: Priority Health SBD |
$108.17
|
| Rate for Payer: UMR Bronson Commercial |
$75.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.78
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$258.72
|
|
|
Service Code
|
NDC 00574010777
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$232.85 |
| Rate for Payer: Aetna American Axle |
$168.17
|
| Rate for Payer: Aetna Commercial |
$219.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.17
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cofinity Advantage |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$222.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.98
|
| Rate for Payer: Healthscope Commercial |
$232.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.04
|
| Rate for Payer: PHP Commercial |
$219.91
|
| Rate for Payer: Priority Health SBD |
$162.99
|
| Rate for Payer: UMR Bronson Commercial |
$113.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.04
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
OP
|
$662.01
|
|
|
Service Code
|
NDC 00054814622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$595.81 |
| Rate for Payer: Aetna American Axle |
$430.31
|
| Rate for Payer: Aetna Commercial |
$562.71
|
| Rate for Payer: Aetna Medicare |
$331.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.31
|
| Rate for Payer: BCBS Complete |
$264.80
|
| Rate for Payer: Cash Price |
$529.61
|
| Rate for Payer: Cofinity Advantage |
$463.41
|
| Rate for Payer: Cofinity Commercial |
$569.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.61
|
| Rate for Payer: Healthscope Commercial |
$595.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$529.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.51
|
| Rate for Payer: PHP Commercial |
$562.71
|
| Rate for Payer: Priority Health SBD |
$417.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.31
|
| Rate for Payer: UHC Core |
$344.91
|
| Rate for Payer: UHC Exchange |
$260.17
|
| Rate for Payer: UMR Bronson Commercial |
$244.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.51
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$662.01
|
|
|
Service Code
|
NDC 00054814622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.28 |
| Max. Negotiated Rate |
$595.81 |
| Rate for Payer: Aetna American Axle |
$430.31
|
| Rate for Payer: Aetna Commercial |
$562.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.31
|
| Rate for Payer: Cash Price |
$529.61
|
| Rate for Payer: Cofinity Advantage |
$463.41
|
| Rate for Payer: Cofinity Commercial |
$569.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.61
|
| Rate for Payer: Healthscope Commercial |
$595.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.51
|
| Rate for Payer: PHP Commercial |
$562.71
|
| Rate for Payer: Priority Health SBD |
$417.07
|
| Rate for Payer: UMR Bronson Commercial |
$291.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.51
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
NDC 51672200201
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna American Axle |
$16.89
|
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.89
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Advantage |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: Priority Health SBD |
$16.37
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
NDC 00536126511
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.36
|
|
|
Service Code
|
NDC 00536126511
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.08
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$33.87
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$30.48 |
| Rate for Payer: Aetna American Axle |
$22.02
|
| Rate for Payer: Aetna Commercial |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.02
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cofinity Advantage |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.10
|
| Rate for Payer: Healthscope Commercial |
$30.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.40
|
| Rate for Payer: PHP Commercial |
$28.79
|
| Rate for Payer: Priority Health SBD |
$21.34
|
| Rate for Payer: UMR Bronson Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.40
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$6.81
|
|
|
Service Code
|
NDC 00536127211
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna American Axle |
$4.43
|
| Rate for Payer: Aetna Commercial |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.43
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cofinity Advantage |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$5.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.45
|
| Rate for Payer: Healthscope Commercial |
$6.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.11
|
| Rate for Payer: PHP Commercial |
$5.79
|
| Rate for Payer: Priority Health SBD |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
NDC 51672200201
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna American Axle |
$16.89
|
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.89
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Advantage |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: Priority Health SBD |
$16.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.89
|
| Rate for Payer: UHC Core |
$13.54
|
| Rate for Payer: UHC Exchange |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$33.87
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$30.48 |
| Rate for Payer: Aetna American Axle |
$22.02
|
| Rate for Payer: Aetna Commercial |
$28.79
|
| Rate for Payer: Aetna Medicare |
$16.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.02
|
| Rate for Payer: BCBS Complete |
$13.55
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cofinity Advantage |
$23.71
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.10
|
| Rate for Payer: Healthscope Commercial |
$30.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.40
|
| Rate for Payer: PHP Commercial |
$28.79
|
| Rate for Payer: Priority Health SBD |
$21.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.02
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: UHC Exchange |
$13.31
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.40
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.84
|
|
|
Service Code
|
NDC 51672127501
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$12.46 |
| Rate for Payer: Aetna American Axle |
$9.00
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.00
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cofinity Advantage |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.07
|
| Rate for Payer: Healthscope Commercial |
$12.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.38
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health SBD |
$8.72
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.38
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.44
|
|
|
Service Code
|
NDC 45802043401
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna American Axle |
$8.74
|
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.74
|
| Rate for Payer: BCBS Complete |
$5.38
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cofinity Advantage |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.08
|
| Rate for Payer: PHP Commercial |
$11.42
|
| Rate for Payer: Priority Health SBD |
$8.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.74
|
| Rate for Payer: UHC Core |
$7.00
|
| Rate for Payer: UHC Exchange |
$5.28
|
| Rate for Payer: UMR Bronson Commercial |
$4.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.08
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.44
|
|
|
Service Code
|
NDC 45802043401
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna American Axle |
$8.74
|
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.74
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cofinity Advantage |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.08
|
| Rate for Payer: PHP Commercial |
$11.42
|
| Rate for Payer: Priority Health SBD |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$5.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.08
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$6.81
|
|
|
Service Code
|
NDC 00536127211
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna American Axle |
$4.43
|
| Rate for Payer: Aetna Commercial |
$5.79
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.43
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cofinity Advantage |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$5.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.45
|
| Rate for Payer: Healthscope Commercial |
$6.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.11
|
| Rate for Payer: PHP Commercial |
$5.79
|
| Rate for Payer: Priority Health SBD |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.43
|
| Rate for Payer: UHC Core |
$3.55
|
| Rate for Payer: UHC Exchange |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.84
|
|
|
Service Code
|
NDC 51672127501
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$12.46 |
| Rate for Payer: Aetna American Axle |
$9.00
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna Medicare |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.00
|
| Rate for Payer: BCBS Complete |
$5.54
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cofinity Advantage |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.07
|
| Rate for Payer: Healthscope Commercial |
$12.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.38
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health SBD |
$8.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.00
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.38
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 61269022063
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 61269022041
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.88
|
| Rate for Payer: UHC Core |
$11.93
|
| Rate for Payer: UHC Exchange |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 61269022041
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
NDC 51672200306
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna American Axle |
$11.06
|
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna Medicare |
$8.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cofinity Advantage |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$14.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.61
|
| Rate for Payer: Healthscope Commercial |
$15.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.76
|
| Rate for Payer: PHP Commercial |
$14.46
|
| Rate for Payer: Priority Health SBD |
$10.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.06
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 61269022063
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.88
|
| Rate for Payer: UHC Core |
$11.93
|
| Rate for Payer: UHC Exchange |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
IP
|
$17.01
|
|
|
Service Code
|
NDC 51672200306
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna American Axle |
$11.06
|
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.06
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cofinity Advantage |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$14.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.61
|
| Rate for Payer: Healthscope Commercial |
$15.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.76
|
| Rate for Payer: PHP Commercial |
$14.46
|
| Rate for Payer: Priority Health SBD |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.76
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Advantage |
$13.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Advantage |
$13.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.68
|
| Rate for Payer: UHC Core |
$10.16
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UMR Bronson Commercial |
$7.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$26.15
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna Commercial |
$22.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cofinity Advantage |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.61
|
| Rate for Payer: PHP Commercial |
$22.23
|
| Rate for Payer: Priority Health SBD |
$16.47
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.61
|
|
