|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 0093-8740-01
|
| Hospital Charge Code |
10596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.57
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
MEXILETINE 250 MG CAPSULE
|
Facility
|
IP
|
$822.24
|
|
|
Service Code
|
NDC 0093-8741-01
|
| Hospital Charge Code |
10597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.79 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.90
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.57
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UMR Bronson Commercial |
$361.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$202.96
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$182.66 |
| Rate for Payer: Aetna American Axle |
$131.92
|
| Rate for Payer: Aetna Commercial |
$172.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.92
|
| Rate for Payer: Cash Price |
$162.37
|
| Rate for Payer: Cofinity Commercial |
$142.07
|
| Rate for Payer: Cofinity Commercial |
$174.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.37
|
| Rate for Payer: Healthscope Commercial |
$182.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.52
|
| Rate for Payer: PHP Commercial |
$172.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.07
|
| Rate for Payer: Priority Health SBD |
$127.86
|
| Rate for Payer: UMR Bronson Commercial |
$89.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.22
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$140.67
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$126.60 |
| Rate for Payer: Aetna American Axle |
$91.44
|
| Rate for Payer: Aetna American Axle |
$89.04
|
| Rate for Payer: Aetna American Axle |
$89.04
|
| Rate for Payer: Aetna American Axle |
$123.33
|
| Rate for Payer: Aetna Commercial |
$116.44
|
| Rate for Payer: Aetna Commercial |
$116.43
|
| Rate for Payer: Aetna Commercial |
$119.57
|
| Rate for Payer: Aetna Commercial |
$161.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.33
|
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$109.58
|
| Rate for Payer: Cofinity Commercial |
$120.98
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Cofinity Commercial |
$163.18
|
| Rate for Payer: Cofinity Commercial |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$95.89
|
| Rate for Payer: Cofinity Commercial |
$132.82
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$95.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.59
|
| Rate for Payer: Healthscope Commercial |
$170.77
|
| Rate for Payer: Healthscope Commercial |
$123.28
|
| Rate for Payer: Healthscope Commercial |
$123.29
|
| Rate for Payer: Healthscope Commercial |
$126.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.43
|
| Rate for Payer: PHP Commercial |
$119.57
|
| Rate for Payer: PHP Commercial |
$116.43
|
| Rate for Payer: PHP Commercial |
$161.28
|
| Rate for Payer: PHP Commercial |
$116.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.47
|
| Rate for Payer: Priority Health SBD |
$86.30
|
| Rate for Payer: Priority Health SBD |
$88.62
|
| Rate for Payer: Priority Health SBD |
$119.54
|
| Rate for Payer: Priority Health SBD |
$86.30
|
| Rate for Payer: UMR Bronson Commercial |
$60.28
|
| Rate for Payer: UMR Bronson Commercial |
$61.89
|
| Rate for Payer: UMR Bronson Commercial |
$60.27
|
| Rate for Payer: UMR Bronson Commercial |
$83.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.74
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$617.39
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$555.65 |
| Rate for Payer: Aetna American Axle |
$401.30
|
| Rate for Payer: Aetna American Axle |
$91.44
|
| Rate for Payer: Aetna American Axle |
$118.81
|
| Rate for Payer: Aetna Commercial |
$155.36
|
| Rate for Payer: Aetna Commercial |
$119.57
|
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.81
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Complete |
$73.11
|
| Rate for Payer: BCBS Complete |
$56.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$146.22
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Cofinity Commercial |
$120.98
|
| Rate for Payer: Cofinity Commercial |
$98.47
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$157.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.22
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Healthscope Commercial |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.36
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Commercial |
$119.57
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.47
|
| Rate for Payer: Priority Health SBD |
$88.62
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$115.15
|
| Rate for Payer: UMR Bronson Commercial |
$52.05
|
| Rate for Payer: UMR Bronson Commercial |
$228.43
|
| Rate for Payer: UMR Bronson Commercial |
$67.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.08
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$92.33
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
41144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$83.10 |
| Rate for Payer: Aetna American Axle |
$60.01
|
| Rate for Payer: Aetna American Axle |
$39.55
|
| Rate for Payer: Aetna American Axle |
$104.99
|
| Rate for Payer: Aetna American Axle |
$48.42
|
| Rate for Payer: Aetna American Axle |
$200.66
|
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$262.40
|
| Rate for Payer: Aetna Commercial |
$78.48
|
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.55
|
| Rate for Payer: Cash Price |
$48.67
|
| Rate for Payer: Cash Price |
$246.97
|
| Rate for Payer: Cash Price |
$73.86
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cofinity Commercial |
$52.32
|
| Rate for Payer: Cofinity Commercial |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$216.10
|
| Rate for Payer: Cofinity Commercial |
$265.49
|
| Rate for Payer: Cofinity Commercial |
$64.63
|
| Rate for Payer: Cofinity Commercial |
$42.59
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$79.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.67
|
| Rate for Payer: Healthscope Commercial |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Healthscope Commercial |
$83.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.40
|
| Rate for Payer: PHP Commercial |
$78.48
|
| Rate for Payer: PHP Commercial |
$51.71
|
| Rate for Payer: PHP Commercial |
$262.40
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: PHP Commercial |
$63.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.59
|
| Rate for Payer: Priority Health SBD |
$194.49
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health SBD |
$38.33
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: Priority Health SBD |
$58.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.78
|
| Rate for Payer: UMR Bronson Commercial |
$26.77
|
| Rate for Payer: UMR Bronson Commercial |
$135.83
|
| Rate for Payer: UMR Bronson Commercial |
$71.07
|
| Rate for Payer: UMR Bronson Commercial |
$40.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
|
|
MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
NDC 61269-736-07
|
| Hospital Charge Code |
10603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.97
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
IP
|
$120.47
|
|
|
Service Code
|
NDC 0472-1738-03
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$108.42 |
| Rate for Payer: Aetna American Axle |
$78.31
|
| Rate for Payer: Aetna Commercial |
$102.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.31
|
| Rate for Payer: Cash Price |
$96.38
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$84.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.38
|
| Rate for Payer: Healthscope Commercial |
$108.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.40
|
| Rate for Payer: PHP Commercial |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.33
|
| Rate for Payer: Priority Health SBD |
$75.90
|
| Rate for Payer: UMR Bronson Commercial |
$53.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.35
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
NDC 0536-1134-28
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
NDC 61269-735-56
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Aetna American Axle |
$5.90
|
| Rate for Payer: Aetna Commercial |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.90
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Commercial |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$8.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.72
|
| Rate for Payer: PHP Commercial |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health SBD |
$5.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.81
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 43553-0003-5
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna American Axle |
$24.70
|
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.70
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$26.60
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.30
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health SBD |
$23.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$46.72
|
|
|
Service Code
|
NDC 11701-067-14
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$42.05 |
| Rate for Payer: Aetna American Axle |
$30.37
|
| Rate for Payer: Aetna Commercial |
$39.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.37
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$32.70
|
| Rate for Payer: Cofinity Commercial |
$40.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$42.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.71
|
| Rate for Payer: PHP Commercial |
$39.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.70
|
| Rate for Payer: Priority Health SBD |
$29.43
|
| Rate for Payer: UMR Bronson Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
NDC 11701-067-23
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna American Axle |
$17.90
|
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health SBD |
$17.35
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$25.63
|
|
|
Service Code
|
NDC 8019675365
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna American Axle |
$16.66
|
| Rate for Payer: Aetna Commercial |
$21.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.66
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.50
|
| Rate for Payer: Healthscope Commercial |
$23.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.79
|
| Rate for Payer: PHP Commercial |
$21.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.94
|
| Rate for Payer: Priority Health SBD |
$16.15
|
| Rate for Payer: UMR Bronson Commercial |
$11.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.22
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 11523-0919-1
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 8019652856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna American Axle |
$14.42
|
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.86
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.53
|
| Rate for Payer: Priority Health SBD |
$13.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.95
|
|
|
Service Code
|
NDC 53329-170-79
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna American Axle |
$14.92
|
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.92
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cofinity Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$20.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.51
|
| Rate for Payer: PHP Commercial |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.06
|
| Rate for Payer: Priority Health SBD |
$14.46
|
| Rate for Payer: UMR Bronson Commercial |
$10.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.21
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 0316-0225-30
|
| Hospital Charge Code |
10599
|
|
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 Commercial |
$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 Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.66
|
| 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
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 1101725030
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.08
|
|
|
Service Code
|
NDC 11701-038-16
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna American Axle |
$17.60
|
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.60
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.66
|
| Rate for Payer: Healthscope Commercial |
$24.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.02
|
| Rate for Payer: PHP Commercial |
$23.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.96
|
| Rate for Payer: Priority Health SBD |
$17.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.31
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
NDC 0904-7734-45
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Aetna American Axle |
$13.69
|
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.69
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.90
|
| Rate for Payer: PHP Commercial |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.74
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$26.73
|
|
|
Service Code
|
NDC 61269-730-63
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$24.06 |
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Commercial |
$22.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$24.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.72
|
| Rate for Payer: PHP Commercial |
$22.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$16.84
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.05
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 61269-730-41
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.18
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.33
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 51672-2035-6
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna American Axle |
$10.27
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00173
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
