|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
OP
|
$713.62
|
|
|
Service Code
|
NDC 00555105686
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.04 |
| Max. Negotiated Rate |
$642.26 |
| Rate for Payer: Aetna American Axle |
$463.85
|
| Rate for Payer: Aetna Commercial |
$606.58
|
| Rate for Payer: Aetna Medicare |
$356.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.85
|
| Rate for Payer: BCBS Complete |
$285.45
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cofinity Commercial |
$499.53
|
| Rate for Payer: Cofinity Commercial |
$613.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.90
|
| Rate for Payer: Healthscope Commercial |
$642.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.58
|
| Rate for Payer: PHP Commercial |
$606.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.85
|
| Rate for Payer: Priority Health SBD |
$449.58
|
| Rate for Payer: UMR Bronson Commercial |
$264.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.22
|
|
|
ISOTRETINOIN 30 MG CAPSULE
|
Facility
|
OP
|
$401.71
|
|
|
Service Code
|
NDC 61748030313
|
| Hospital Charge Code |
36845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.63 |
| Max. Negotiated Rate |
$361.54 |
| Rate for Payer: Aetna American Axle |
$261.11
|
| Rate for Payer: Aetna Commercial |
$341.45
|
| Rate for Payer: Aetna Medicare |
$200.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.11
|
| Rate for Payer: BCBS Complete |
$160.68
|
| Rate for Payer: Cash Price |
$321.37
|
| Rate for Payer: Cofinity Commercial |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$345.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.37
|
| Rate for Payer: Healthscope Commercial |
$361.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.45
|
| Rate for Payer: PHP Commercial |
$341.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.11
|
| Rate for Payer: Priority Health SBD |
$253.08
|
| Rate for Payer: UMR Bronson Commercial |
$148.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.28
|
|
|
ISOTRETINOIN 40 MG CAPSULE
|
Facility
|
IP
|
$720.06
|
|
|
Service Code
|
NDC 61748030413
|
| Hospital Charge Code |
10361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.83 |
| Max. Negotiated Rate |
$648.05 |
| Rate for Payer: Aetna American Axle |
$468.04
|
| Rate for Payer: Aetna Commercial |
$612.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.04
|
| Rate for Payer: Cash Price |
$576.05
|
| Rate for Payer: Cofinity Commercial |
$504.04
|
| Rate for Payer: Cofinity Commercial |
$619.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.05
|
| Rate for Payer: Healthscope Commercial |
$648.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.05
|
| Rate for Payer: PHP Commercial |
$612.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.04
|
| Rate for Payer: Priority Health SBD |
$453.64
|
| Rate for Payer: UMR Bronson Commercial |
$316.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.04
|
|
|
ISOTRETINOIN 40 MG CAPSULE
|
Facility
|
OP
|
$720.06
|
|
|
Service Code
|
NDC 61748030413
|
| Hospital Charge Code |
10361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.42 |
| Max. Negotiated Rate |
$648.05 |
| Rate for Payer: Aetna American Axle |
$468.04
|
| Rate for Payer: Aetna Commercial |
$612.05
|
| Rate for Payer: Aetna Medicare |
$360.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.04
|
| Rate for Payer: BCBS Complete |
$288.02
|
| Rate for Payer: Cash Price |
$576.05
|
| Rate for Payer: Cofinity Commercial |
$504.04
|
| Rate for Payer: Cofinity Commercial |
$619.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.05
|
| Rate for Payer: Healthscope Commercial |
$648.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.05
|
| Rate for Payer: PHP Commercial |
$612.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.04
|
| Rate for Payer: Priority Health SBD |
$453.64
|
| Rate for Payer: UMR Bronson Commercial |
$266.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.04
|
|
|
ISRADIPINE 5 MG CAPSULE
|
Facility
|
IP
|
$894.72
|
|
|
Service Code
|
NDC 16252054001
|
| Hospital Charge Code |
10363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$805.25 |
| Rate for Payer: Aetna American Axle |
$581.57
|
| Rate for Payer: Aetna Commercial |
$760.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.57
|
| Rate for Payer: Cash Price |
$715.78
|
| Rate for Payer: Cofinity Commercial |
$626.30
|
| Rate for Payer: Cofinity Commercial |
$769.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.78
|
| Rate for Payer: Healthscope Commercial |
$805.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.51
|
| Rate for Payer: PHP Commercial |
$760.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.57
|
| Rate for Payer: Priority Health SBD |
$563.67
|
| Rate for Payer: UMR Bronson Commercial |
$393.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.04
|
|
|
ISRADIPINE 5 MG CAPSULE
|
Facility
|
OP
|
$894.72
|
|
|
Service Code
|
NDC 16252054001
|
| Hospital Charge Code |
10363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.05 |
| Max. Negotiated Rate |
$805.25 |
| Rate for Payer: Aetna American Axle |
$581.57
|
| Rate for Payer: Aetna Commercial |
$760.51
|
| Rate for Payer: Aetna Medicare |
$447.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.57
|
| Rate for Payer: BCBS Complete |
$357.89
|
| Rate for Payer: Cash Price |
$715.78
|
| Rate for Payer: Cofinity Commercial |
$626.30
|
| Rate for Payer: Cofinity Commercial |
$769.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.78
|
| Rate for Payer: Healthscope Commercial |
$805.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.51
|
| Rate for Payer: PHP Commercial |
$760.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.57
|
| Rate for Payer: Priority Health SBD |
$563.67
|
| Rate for Payer: UMR Bronson Commercial |
$331.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.04
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$227.96
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.37
|
| Rate for Payer: Cofinity Commercial |
$159.57
|
| Rate for Payer: Cofinity Commercial |
$196.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.37
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.77
|
| Rate for Payer: PHP Commercial |
$193.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$100.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$227.96
|
|
|
Service Code
|
NDC 13668046330
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna American Axle |
$148.17
|
| Rate for Payer: Aetna Commercial |
$193.77
|
| Rate for Payer: Aetna Medicare |
$113.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: Cash Price |
$182.37
|
| Rate for Payer: Cofinity Commercial |
$159.57
|
| Rate for Payer: Cofinity Commercial |
$196.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.37
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.77
|
| Rate for Payer: PHP Commercial |
$193.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health SBD |
$143.61
|
| Rate for Payer: UMR Bronson Commercial |
$84.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.97
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.47 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna Medicare |
$383.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: BCBS Complete |
$306.45
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Commercial |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.98
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$283.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$9.12
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna American Axle |
$5.93
|
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.93
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$8.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.93
|
| Rate for Payer: Priority Health SBD |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.84
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$182.27
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$164.04 |
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna Commercial |
$154.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$127.59
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$164.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.93
|
| Rate for Payer: PHP Commercial |
$154.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health SBD |
$114.83
|
| Rate for Payer: UMR Bronson Commercial |
$80.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$182.27
|
|
|
Service Code
|
NDC 50268045012
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$164.04 |
| Rate for Payer: Aetna American Axle |
$118.48
|
| Rate for Payer: Aetna Commercial |
$154.93
|
| Rate for Payer: Aetna Medicare |
$91.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.48
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: Cash Price |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$127.59
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.82
|
| Rate for Payer: Healthscope Commercial |
$164.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.93
|
| Rate for Payer: PHP Commercial |
$154.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.48
|
| Rate for Payer: Priority Health SBD |
$114.83
|
| Rate for Payer: UMR Bronson Commercial |
$67.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna American Axle |
$92.95
|
| Rate for Payer: Aetna Commercial |
$121.55
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.95
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.40
|
| Rate for Payer: Healthscope Commercial |
$128.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.55
|
| Rate for Payer: PHP Commercial |
$121.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health SBD |
$90.09
|
| Rate for Payer: UMR Bronson Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.25
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$766.13
|
|
|
Service Code
|
NDC 10147170003
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.10 |
| Max. Negotiated Rate |
$689.52 |
| Rate for Payer: Aetna American Axle |
$497.98
|
| Rate for Payer: Aetna Commercial |
$651.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.98
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cofinity Commercial |
$536.29
|
| Rate for Payer: Cofinity Commercial |
$658.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.90
|
| Rate for Payer: Healthscope Commercial |
$689.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.21
|
| Rate for Payer: PHP Commercial |
$651.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.98
|
| Rate for Payer: Priority Health SBD |
$482.66
|
| Rate for Payer: UMR Bronson Commercial |
$337.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.60
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna American Axle |
$92.95
|
| Rate for Payer: Aetna Commercial |
$121.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.95
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.40
|
| Rate for Payer: Healthscope Commercial |
$128.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.55
|
| Rate for Payer: PHP Commercial |
$121.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health SBD |
$90.09
|
| Rate for Payer: UMR Bronson Commercial |
$62.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.25
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$9.12
|
|
|
Service Code
|
NDC 50268045011
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna American Axle |
$5.93
|
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.93
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$8.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.93
|
| Rate for Payer: Priority Health SBD |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.84
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.36 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.32 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.19 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna Medicare |
$590.80
|
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: BCBS Complete |
$472.64
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Cofinity Commercial |
$827.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.04
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UMR Bronson Commercial |
$437.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$519.90 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna American Axle |
$768.04
|
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Cofinity Commercial |
$827.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.04
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UMR Bronson Commercial |
$519.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.20
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$2,153.63
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$796.84 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna American Axle |
$1,399.86
|
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna Medicare |
$1,076.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: BCBS Complete |
$861.45
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$796.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.22
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
OP
|
$499.06
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.65 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna American Axle |
$324.39
|
| Rate for Payer: Aetna Commercial |
$424.20
|
| Rate for Payer: Aetna Medicare |
$249.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.39
|
| Rate for Payer: BCBS Complete |
$199.62
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cofinity Commercial |
$349.34
|
| Rate for Payer: Cofinity Commercial |
$429.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.25
|
| Rate for Payer: Healthscope Commercial |
$449.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.20
|
| Rate for Payer: PHP Commercial |
$424.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.39
|
| Rate for Payer: Priority Health SBD |
$314.41
|
| Rate for Payer: UMR Bronson Commercial |
$184.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.30
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$499.06
|
|
|
Service Code
|
NDC 50742036260
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.59 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna American Axle |
$324.39
|
| Rate for Payer: Aetna Commercial |
$424.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.39
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cofinity Commercial |
$349.34
|
| Rate for Payer: Cofinity Commercial |
$429.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.25
|
| Rate for Payer: Healthscope Commercial |
$449.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.20
|
| Rate for Payer: PHP Commercial |
$424.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.39
|
| Rate for Payer: Priority Health SBD |
$314.41
|
| Rate for Payer: UMR Bronson Commercial |
$219.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.30
|
|
|
IVABRADINE 5 MG TABLET
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
NDC 55513080060
|
| Hospital Charge Code |
161508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna American Axle |
$1,399.86
|
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$947.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.22
|
|
|
IVERMECTIN 3 MG TABLET
|
Facility
|
IP
|
$320.20
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
25820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.89 |
| Max. Negotiated Rate |
$288.18 |
| Rate for Payer: Aetna American Axle |
$208.13
|
| Rate for Payer: Aetna Commercial |
$272.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.13
|
| Rate for Payer: Cash Price |
$256.16
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Cofinity Commercial |
$275.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.16
|
| Rate for Payer: Healthscope Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.17
|
| Rate for Payer: PHP Commercial |
$272.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.13
|
| Rate for Payer: Priority Health SBD |
$201.73
|
| Rate for Payer: UMR Bronson Commercial |
$140.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.15
|
|
