|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$505.47
|
|
|
Service Code
|
NDC 00781708035
|
| 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 Advantage |
$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 Commercial |
$429.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.10
|
| Rate for Payer: PHP Commercial |
$429.65
|
| 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
|
OP
|
$220.92
|
|
|
Service Code
|
NDC 51672421503
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.74 |
| Max. Negotiated Rate |
$198.83 |
| Rate for Payer: Aetna American Axle |
$143.60
|
| Rate for Payer: Aetna Commercial |
$187.78
|
| Rate for Payer: Aetna Medicare |
$110.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.60
|
| Rate for Payer: BCBS Complete |
$88.37
|
| Rate for Payer: Cash Price |
$176.74
|
| Rate for Payer: Cofinity Advantage |
$154.64
|
| Rate for Payer: Cofinity Commercial |
$189.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.74
|
| Rate for Payer: Healthscope Commercial |
$198.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.69
|
| Rate for Payer: PHP Commercial |
$187.78
|
| Rate for Payer: Priority Health SBD |
$139.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.60
|
| Rate for Payer: UHC Core |
$115.10
|
| Rate for Payer: UHC Exchange |
$86.82
|
| Rate for Payer: UMR Bronson Commercial |
$81.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.69
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$55.94
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna American Axle |
$36.36
|
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Aetna Medicare |
$27.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.36
|
| Rate for Payer: BCBS Complete |
$22.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cofinity Advantage |
$39.16
|
| Rate for Payer: Cofinity Commercial |
$48.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.75
|
| Rate for Payer: Healthscope Commercial |
$50.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.55
|
| Rate for Payer: Priority Health SBD |
$35.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.95
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$55.94
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna American Axle |
$36.36
|
| Rate for Payer: Aetna Commercial |
$47.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.36
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cofinity Advantage |
$39.16
|
| Rate for Payer: Cofinity Commercial |
$48.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.75
|
| Rate for Payer: Healthscope Commercial |
$50.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.55
|
| Rate for Payer: Priority Health SBD |
$35.24
|
| Rate for Payer: UMR Bronson Commercial |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.95
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$450.30
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.61 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna American Axle |
$292.69
|
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: Aetna Medicare |
$225.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.69
|
| Rate for Payer: BCBS Complete |
$180.12
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Advantage |
$315.21
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PHP Commercial |
$382.75
|
| Rate for Payer: Priority Health SBD |
$283.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.69
|
| Rate for Payer: UHC Core |
$234.61
|
| Rate for Payer: UHC Exchange |
$176.97
|
| Rate for Payer: UMR Bronson Commercial |
$166.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.73
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.13 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna American Axle |
$292.69
|
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.69
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Advantage |
$315.21
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PHP Commercial |
$382.75
|
| Rate for Payer: Priority Health SBD |
$283.69
|
| Rate for Payer: UMR Bronson Commercial |
$198.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.73
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.93
|
| Rate for Payer: Priority Health SBD |
$2.91
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.93
|
| Rate for Payer: Priority Health SBD |
$2.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: UHC Exchange |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$267.36
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna Medicare |
$133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: BCBS Complete |
$106.94
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Advantage |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.78
|
| Rate for Payer: UHC Core |
$139.29
|
| Rate for Payer: UHC Exchange |
$105.07
|
| Rate for Payer: UMR Bronson Commercial |
$98.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna American Axle |
$157.87
|
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.87
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Advantage |
$170.02
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: Priority Health SBD |
$153.01
|
| Rate for Payer: UMR Bronson Commercial |
$106.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna American Axle |
$157.87
|
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: Aetna Medicare |
$121.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.87
|
| Rate for Payer: BCBS Complete |
$97.15
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Advantage |
$170.02
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: Priority Health SBD |
$153.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.87
|
| Rate for Payer: UHC Core |
$126.54
|
| Rate for Payer: UHC Exchange |
$95.45
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$120.27
|
| Rate for Payer: UHC Exchange |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$267.36
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna American Axle |
$173.78
|
| Rate for Payer: Aetna Commercial |
$227.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.78
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: Cofinity Advantage |
$187.15
|
| Rate for Payer: Cofinity Commercial |
$229.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.89
|
| Rate for Payer: Healthscope Commercial |
$240.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.52
|
| Rate for Payer: PHP Commercial |
$227.26
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UMR Bronson Commercial |
$117.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.52
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.74
|
| Rate for Payer: UHC Core |
$1.40
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
OP
|
$662.63
|
|
|
Service Code
|
NDC 65628020205
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.17 |
| Max. Negotiated Rate |
$596.37 |
| Rate for Payer: Aetna American Axle |
$430.71
|
| Rate for Payer: Aetna Commercial |
$563.24
|
| Rate for Payer: Aetna Medicare |
$331.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.71
|
| Rate for Payer: BCBS Complete |
$265.05
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$530.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.97
|
| Rate for Payer: PHP Commercial |
$563.24
|
| Rate for Payer: Priority Health SBD |
$417.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.71
|
| Rate for Payer: UHC Core |
$345.23
|
| Rate for Payer: UHC Exchange |
$260.41
|
| Rate for Payer: UMR Bronson Commercial |
$245.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.97
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 09900001032
|
| Hospital Charge Code |
200170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$131.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.38
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.92
|
| Rate for Payer: UHC Core |
$85.70
|
| Rate for Payer: UHC Exchange |
$64.65
|
| Rate for Payer: UMR Bronson Commercial |
$60.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METRONIDAZOLE 50 MG/ML SUSPENSION (SIMPLE)
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 09900001032
|
| 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 Advantage |
$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 Commercial |
$139.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.38
|
| Rate for Payer: PHP Commercial |
$139.82
|
| 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 65628020205
|
| 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 Advantage |
$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 Commercial |
$563.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.97
|
| Rate for Payer: PHP Commercial |
$563.24
|
| 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
|
OP
|
$577.44
|
|
|
Service Code
|
NDC 00093873901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.65 |
| Max. Negotiated Rate |
$519.70 |
| Rate for Payer: Aetna American Axle |
$375.34
|
| Rate for Payer: Aetna Commercial |
$490.82
|
| Rate for Payer: Aetna Medicare |
$288.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.34
|
| Rate for Payer: BCBS Complete |
$230.98
|
| Rate for Payer: Cash Price |
$461.95
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$461.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.08
|
| Rate for Payer: PHP Commercial |
$490.82
|
| Rate for Payer: Priority Health SBD |
$363.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.34
|
| Rate for Payer: UHC Core |
$300.85
|
| Rate for Payer: UHC Exchange |
$226.93
|
| Rate for Payer: UMR Bronson Commercial |
$213.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.08
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Advantage |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.60
|
| Rate for Payer: UHC Core |
$158.38
|
| Rate for Payer: UHC Exchange |
$119.47
|
| Rate for Payer: UMR Bronson Commercial |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$577.44
|
|
|
Service Code
|
NDC 00093873901
|
| 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 Advantage |
$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 Commercial |
$490.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.08
|
| Rate for Payer: PHP Commercial |
$490.82
|
| 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
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
10595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Advantage |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UMR Bronson Commercial |
$133.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
MEXILETINE 200 MG CAPSULE
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00093874001
|
| 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 Advantage |
$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 Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| 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
|
|
