|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna American Axle |
$28.92
|
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: Cash Price |
$35.59
|
| Rate for Payer: Cofinity Advantage |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$40.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health SBD |
$28.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.92
|
| Rate for Payer: UHC Core |
$23.18
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$16.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.37
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna Medicare |
$14.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Advantage |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Core |
$14.76
|
| Rate for Payer: UHC Exchange |
$11.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$21.81
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$19.63 |
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna Commercial |
$18.54
|
| Rate for Payer: Aetna Medicare |
$10.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cofinity Advantage |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$19.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.36
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: Priority Health SBD |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.18
|
| Rate for Payer: UHC Core |
$11.36
|
| Rate for Payer: UHC Exchange |
$8.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna American Axle |
$18.18
|
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.18
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health SBD |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.18
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Exchange |
$10.99
|
| Rate for Payer: UMR Bronson Commercial |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.95
|
|
|
Service Code
|
NDC 53329017079
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna American Axle |
$14.92
|
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.92
|
| Rate for Payer: BCBS Complete |
$9.18
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cofinity Advantage |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.21
|
| Rate for Payer: PHP Commercial |
$19.51
|
| Rate for Payer: Priority Health SBD |
$14.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.92
|
| Rate for Payer: UHC Core |
$11.96
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.21
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$25.63
|
|
|
Service Code
|
NDC 80196075365
|
| 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 Advantage |
$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 Commercial |
$21.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.22
|
| Rate for Payer: PHP Commercial |
$21.79
|
| 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
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| 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 Advantage |
$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 Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| 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
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 11523091901
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.95
|
| Rate for Payer: UHC Core |
$11.98
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$8.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna American Axle |
$14.42
|
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health SBD |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.42
|
| Rate for Payer: UHC Core |
$11.56
|
| Rate for Payer: UHC Exchange |
$8.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.95
|
|
|
Service Code
|
NDC 53329017079
|
| 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 Advantage |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.21
|
| Rate for Payer: PHP Commercial |
$19.51
|
| 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
|
$21.81
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.63 |
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna Commercial |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cofinity Advantage |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$19.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.36
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: Priority Health SBD |
$13.74
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna American Axle |
$18.18
|
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.18
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health SBD |
$17.62
|
| Rate for Payer: UMR Bronson Commercial |
$12.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 11523091901
|
| 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 Advantage |
$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 Commercial |
$19.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PHP Commercial |
$19.55
|
| 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
|
OP
|
$25.63
|
|
|
Service Code
|
NDC 80196075365
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Aetna American Axle |
$16.66
|
| Rate for Payer: Aetna Commercial |
$21.79
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.66
|
| Rate for Payer: BCBS Complete |
$10.25
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.22
|
| Rate for Payer: PHP Commercial |
$21.79
|
| Rate for Payer: Priority Health SBD |
$16.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.66
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.22
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
NDC 51672203506
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.77
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$21.47
|
|
|
Service Code
|
NDC 61269073041
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: PHP Commercial |
$18.25
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
NDC 00904773445
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.77
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
NDC 51672203506
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.40
|
| Rate for Payer: UHC Core |
$12.35
|
| Rate for Payer: UHC Exchange |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.77
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$21.47
|
|
|
Service Code
|
NDC 61269073063
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: PHP Commercial |
$18.25
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.96
|
| Rate for Payer: UHC Core |
$11.19
|
| Rate for Payer: UHC Exchange |
$8.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$21.47
|
|
|
Service Code
|
NDC 61269073063
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: PHP Commercial |
$18.25
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$21.47
|
|
|
Service Code
|
NDC 61269073041
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$19.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: PHP Commercial |
$18.25
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.96
|
| Rate for Payer: UHC Core |
$11.19
|
| Rate for Payer: UHC Exchange |
$8.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
NDC 00904773445
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.40
|
| Rate for Payer: UHC Core |
$12.35
|
| Rate for Payer: UHC Exchange |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.77
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$1,025.98
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$451.43 |
| Max. Negotiated Rate |
$923.38 |
| Rate for Payer: Aetna American Axle |
$666.89
|
| Rate for Payer: Aetna Commercial |
$872.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$666.89
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Advantage |
$718.19
|
| Rate for Payer: Cofinity Commercial |
$882.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Healthscope Commercial |
$923.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.49
|
| Rate for Payer: PHP Commercial |
$872.08
|
| Rate for Payer: Priority Health SBD |
$646.37
|
| Rate for Payer: UMR Bronson Commercial |
$451.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.49
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
OP
|
$1,025.98
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$379.61 |
| Max. Negotiated Rate |
$923.38 |
| Rate for Payer: Aetna American Axle |
$666.89
|
| Rate for Payer: Aetna Commercial |
$872.08
|
| Rate for Payer: Aetna Medicare |
$512.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$666.89
|
| Rate for Payer: BCBS Complete |
$410.39
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Advantage |
$718.19
|
| Rate for Payer: Cofinity Commercial |
$882.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Healthscope Commercial |
$923.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$820.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.49
|
| Rate for Payer: PHP Commercial |
$872.08
|
| Rate for Payer: Priority Health SBD |
$646.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.89
|
| Rate for Payer: UHC Core |
$534.54
|
| Rate for Payer: UHC Exchange |
$403.21
|
| Rate for Payer: UMR Bronson Commercial |
$379.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.49
|
|
