|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-1778-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna American Axle |
$8.70
|
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health SBD |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.88
|
|
|
Service Code
|
NDC 72611-740-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: Aetna American Axle |
$10.32
|
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.32
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.50
|
| Rate for Payer: PHP Commercial |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health SBD |
$10.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.91
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
NDC 36000-033-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna American Axle |
$10.89
|
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 0143-9660-01
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna American Axle |
$10.85
|
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.68
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.88
|
|
|
Service Code
|
NDC 72611-740-01
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: Aetna American Axle |
$10.32
|
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.32
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.50
|
| Rate for Payer: PHP Commercial |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health SBD |
$10.00
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.91
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-1778-15
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna American Axle |
$8.70
|
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health SBD |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.94
|
|
|
Service Code
|
NDC 63323-660-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna American Axle |
$12.96
|
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.96
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.95
|
| Rate for Payer: PHP Commercial |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health SBD |
$12.56
|
| Rate for Payer: UMR Bronson Commercial |
$8.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.96
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.77
|
|
|
Service Code
|
NDC 55390-073-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$24.99 |
| Rate for Payer: Aetna American Axle |
$18.05
|
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.05
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Cofinity Commercial |
$23.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Healthscope Commercial |
$24.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.60
|
| Rate for Payer: PHP Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.83
|
|
|
METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
NDC 0245-0860-70
|
| Hospital Charge Code |
10592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$106.95 |
| Rate for Payer: Aetna American Axle |
$77.24
|
| Rate for Payer: Aetna Commercial |
$101.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.24
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Cofinity Commercial |
$102.19
|
| Rate for Payer: Cofinity Commercial |
$83.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.06
|
| Rate for Payer: Healthscope Commercial |
$106.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.01
|
| Rate for Payer: PHP Commercial |
$101.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.18
|
| Rate for Payer: Priority Health SBD |
$74.86
|
| Rate for Payer: UMR Bronson Commercial |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.12
|
|
|
METRONIDAZOLE 0.75 % TOPICAL CREAM
|
Facility
|
IP
|
$149.16
|
|
|
Service Code
|
NDC 0168-0323-46
|
| Hospital Charge Code |
19805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$134.24 |
| Rate for Payer: Aetna American Axle |
$96.95
|
| Rate for Payer: Aetna Commercial |
$126.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.95
|
| Rate for Payer: Cash Price |
$119.33
|
| Rate for Payer: Cofinity Commercial |
$104.41
|
| Rate for Payer: Cofinity Commercial |
$128.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.33
|
| Rate for Payer: Healthscope Commercial |
$134.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.79
|
| Rate for Payer: PHP Commercial |
$126.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.41
|
| Rate for Payer: Priority Health SBD |
$93.97
|
| Rate for Payer: UMR Bronson Commercial |
$65.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.87
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$1,225.35
|
|
|
Service Code
|
NDC 0299-3820-60
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$539.15 |
| Max. Negotiated Rate |
$1,102.82 |
| Rate for Payer: Aetna American Axle |
$796.48
|
| Rate for Payer: Aetna Commercial |
$1,041.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.48
|
| Rate for Payer: Cash Price |
$980.28
|
| Rate for Payer: Cofinity Commercial |
$1,053.80
|
| Rate for Payer: Cofinity Commercial |
$857.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.28
|
| Rate for Payer: Healthscope Commercial |
$1,102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$857.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,041.55
|
| Rate for Payer: PHP Commercial |
$1,041.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.74
|
| Rate for Payer: Priority Health SBD |
$771.97
|
| Rate for Payer: UMR Bronson Commercial |
$539.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.01
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$505.47
|
|
|
Service Code
|
NDC 0781-7080-35
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.41 |
| Max. Negotiated Rate |
$454.92 |
| Rate for Payer: Aetna American Axle |
$328.56
|
| Rate for Payer: Aetna Commercial |
$429.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.56
|
| Rate for Payer: Cash Price |
$404.38
|
| Rate for Payer: Cofinity Commercial |
$353.83
|
| Rate for Payer: Cofinity Commercial |
$434.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.38
|
| Rate for Payer: Healthscope Commercial |
$454.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.65
|
| Rate for Payer: PHP Commercial |
$429.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.83
|
| Rate for Payer: Priority Health SBD |
$318.45
|
| Rate for Payer: UMR Bronson Commercial |
$222.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.10
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$303.03
|
|
|
Service Code
|
NDC 51672-4215-3
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.33 |
| Max. Negotiated Rate |
$272.73 |
| Rate for Payer: Aetna American Axle |
$196.97
|
| Rate for Payer: Aetna Commercial |
$257.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.97
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Cofinity Commercial |
$212.12
|
| Rate for Payer: Cofinity Commercial |
$260.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.42
|
| Rate for Payer: Healthscope Commercial |
$272.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.58
|
| Rate for Payer: PHP Commercial |
$257.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.12
|
| Rate for Payer: Priority Health SBD |
$190.91
|
| Rate for Payer: UMR Bronson Commercial |
$133.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.27
|
|
|
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 |
$27.69 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna American Axle |
$40.90
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| 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 |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| 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 Multiplan/Beech St/PHCS |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$27.69
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| 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
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Mclaren Medicaid |
$0.01
|
| Rate for Payer: Mclaren Medicare |
$0.02
|
| Rate for Payer: Meridian Medicaid |
$0.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PACE Medicare |
$0.02
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: VA VA |
$0.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50268-535-11
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 50111-334-01
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.02
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687-550-01
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.03
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$108.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687-550-11
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna American Axle |
$1.60
|
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$438.90
|
|
|
Service Code
|
NDC 0904-7126-61
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.12 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna American Axle |
$285.28
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.28
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Commercial |
$307.23
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.06
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.23
|
| Rate for Payer: Priority Health SBD |
$276.51
|
| Rate for Payer: UMR Bronson Commercial |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$211.38
|
|
|
Service Code
|
NDC 50268-535-15
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.01 |
| Max. Negotiated Rate |
$190.24 |
| Rate for Payer: Aetna American Axle |
$137.40
|
| Rate for Payer: Aetna Commercial |
$179.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.40
|
| Rate for Payer: Cash Price |
$169.10
|
| Rate for Payer: Cofinity Commercial |
$147.97
|
| Rate for Payer: Cofinity Commercial |
$181.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.10
|
| Rate for Payer: Healthscope Commercial |
$190.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.67
|
| Rate for Payer: PHP Commercial |
$179.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.97
|
| Rate for Payer: Priority Health SBD |
$133.17
|
| Rate for Payer: UMR Bronson Commercial |
$93.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.54
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 9900-0010-32
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$72.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
IP
|
$662.63
|
|
|
Service Code
|
NDC 65628-202-05
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$596.37 |
| Rate for Payer: Aetna American Axle |
$430.71
|
| Rate for Payer: Aetna Commercial |
$563.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.71
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cofinity Commercial |
$463.84
|
| Rate for Payer: Cofinity Commercial |
$569.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.10
|
| Rate for Payer: Healthscope Commercial |
$596.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.24
|
| Rate for Payer: PHP Commercial |
$563.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.84
|
| Rate for Payer: Priority Health SBD |
$417.46
|
| Rate for Payer: UMR Bronson Commercial |
$291.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.97
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 50742-239-01
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$577.44
|
|
|
Service Code
|
NDC 0093-8739-01
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$519.70 |
| Rate for Payer: Aetna American Axle |
$375.34
|
| Rate for Payer: Aetna Commercial |
$490.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.34
|
| Rate for Payer: Cash Price |
$461.95
|
| Rate for Payer: Cofinity Commercial |
$404.21
|
| Rate for Payer: Cofinity Commercial |
$496.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.95
|
| Rate for Payer: Healthscope Commercial |
$519.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.82
|
| Rate for Payer: PHP Commercial |
$490.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.21
|
| Rate for Payer: Priority Health SBD |
$363.79
|
| Rate for Payer: UMR Bronson Commercial |
$254.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.08
|
|
