|
METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL
|
Facility
|
IP
|
$276.85
|
|
|
Service Code
|
NDC 45802013970
|
| Hospital Charge Code |
10592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.81 |
| Max. Negotiated Rate |
$249.16 |
| Rate for Payer: Aetna American Axle |
$179.95
|
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.95
|
| Rate for Payer: Cash Price |
$221.48
|
| Rate for Payer: Cofinity Commercial |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$238.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.48
|
| Rate for Payer: Healthscope Commercial |
$249.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.32
|
| Rate for Payer: PHP Commercial |
$235.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.95
|
| Rate for Payer: Priority Health SBD |
$174.42
|
| Rate for Payer: UMR Bronson Commercial |
$121.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.64
|
|
|
METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL
|
Facility
|
OP
|
$276.85
|
|
|
Service Code
|
NDC 45802013970
|
| Hospital Charge Code |
10592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$249.16 |
| Rate for Payer: Aetna American Axle |
$179.95
|
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna Medicare |
$138.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.95
|
| Rate for Payer: BCBS Complete |
$110.74
|
| Rate for Payer: Cash Price |
$221.48
|
| Rate for Payer: Cofinity Commercial |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$238.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.48
|
| Rate for Payer: Healthscope Commercial |
$249.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.32
|
| Rate for Payer: PHP Commercial |
$235.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.95
|
| Rate for Payer: Priority Health SBD |
$174.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.64
|
|
|
METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL
|
Facility
|
IP
|
$118.83
|
|
|
Service Code
|
NDC 00245086070
|
| Hospital Charge Code |
10592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$106.95 |
| Rate for Payer: Aetna American Axle |
$77.24
|
| Rate for Payer: Aetna Commercial |
$101.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.24
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Cofinity Commercial |
$102.19
|
| Rate for Payer: Cofinity Commercial |
$83.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.06
|
| Rate for Payer: Healthscope Commercial |
$106.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.01
|
| Rate for Payer: PHP Commercial |
$101.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.24
|
| Rate for Payer: Priority Health SBD |
$74.86
|
| Rate for Payer: UMR Bronson Commercial |
$52.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.12
|
|
|
METRONIDAZOLE 0.75 % TOPICAL CREAM
|
Facility
|
IP
|
$153.57
|
|
|
Service Code
|
NDC 00168032346
|
| Hospital Charge Code |
19805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$138.21 |
| Rate for Payer: Cofinity Commercial |
$132.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.50
|
| Rate for Payer: Aetna American Axle |
$99.82
|
| Rate for Payer: Aetna Commercial |
$130.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.82
|
| Rate for Payer: Cash Price |
$122.86
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.86
|
| Rate for Payer: Healthscope Commercial |
$138.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.53
|
| Rate for Payer: PHP Commercial |
$130.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.82
|
| Rate for Payer: Priority Health SBD |
$96.75
|
| Rate for Payer: UMR Bronson Commercial |
$67.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.18
|
|
|
METRONIDAZOLE 0.75 % TOPICAL CREAM
|
Facility
|
OP
|
$153.57
|
|
|
Service Code
|
NDC 00168032346
|
| Hospital Charge Code |
19805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$138.21 |
| Rate for Payer: Aetna American Axle |
$99.82
|
| Rate for Payer: Aetna Commercial |
$130.53
|
| Rate for Payer: Aetna Medicare |
$76.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.82
|
| Rate for Payer: BCBS Complete |
$61.43
|
| Rate for Payer: Cash Price |
$122.86
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$132.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.86
|
| Rate for Payer: Healthscope Commercial |
$138.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.53
|
| Rate for Payer: PHP Commercial |
$130.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.82
|
| Rate for Payer: Priority Health SBD |
$96.75
|
| Rate for Payer: UMR Bronson Commercial |
$56.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.18
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$309.96
|
|
|
Service Code
|
NDC 51672421503
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$278.96 |
| Rate for Payer: Aetna American Axle |
$201.47
|
| Rate for Payer: Aetna Commercial |
$263.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.47
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cofinity Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.97
|
| Rate for Payer: Healthscope Commercial |
$278.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.47
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UMR Bronson Commercial |
$136.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
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 Commercial |
$353.83
|
| Rate for Payer: Cofinity Commercial |
$434.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.83
|
| 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: PHP Commercial |
$429.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.56
|
| Rate for Payer: Priority Health SBD |
$318.45
|
| Rate for Payer: UMR Bronson Commercial |
$222.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.10
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
IP
|
$1,225.35
|
|
|
Service Code
|
NDC 00299382060
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$539.15 |
| Max. Negotiated Rate |
$1,102.82 |
| Rate for Payer: Aetna American Axle |
$796.48
|
| Rate for Payer: Aetna Commercial |
$1,041.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.48
|
| Rate for Payer: Cash Price |
$980.28
|
| Rate for Payer: Cofinity Commercial |
$1,053.80
|
| Rate for Payer: Cofinity Commercial |
$857.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$857.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.28
|
| Rate for Payer: Healthscope Commercial |
$1,102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$857.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.55
|
| Rate for Payer: PHP Commercial |
$1,041.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.48
|
| Rate for Payer: Priority Health SBD |
$771.97
|
| Rate for Payer: UMR Bronson Commercial |
$539.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.01
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
OP
|
$505.47
|
|
|
Service Code
|
NDC 00781708035
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$454.92 |
| Rate for Payer: Aetna American Axle |
$328.56
|
| Rate for Payer: Aetna Commercial |
$429.65
|
| Rate for Payer: Aetna Medicare |
$252.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.56
|
| Rate for Payer: BCBS Complete |
$202.19
|
| Rate for Payer: Cash Price |
$404.38
|
| Rate for Payer: Cofinity Commercial |
$353.83
|
| Rate for Payer: Cofinity Commercial |
$434.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.83
|
| 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: PHP Commercial |
$429.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.56
|
| Rate for Payer: Priority Health SBD |
$318.45
|
| Rate for Payer: UMR Bronson Commercial |
$187.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.10
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
OP
|
$309.96
|
|
|
Service Code
|
NDC 51672421503
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$278.96 |
| Rate for Payer: Aetna American Axle |
$201.47
|
| Rate for Payer: Aetna Commercial |
$263.47
|
| Rate for Payer: Aetna Medicare |
$154.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.47
|
| Rate for Payer: BCBS Complete |
$123.98
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cofinity Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.97
|
| Rate for Payer: Healthscope Commercial |
$278.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.47
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UMR Bronson Commercial |
$114.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL
|
Facility
|
OP
|
$1,225.35
|
|
|
Service Code
|
NDC 00299382060
|
| Hospital Charge Code |
41899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$453.38 |
| Max. Negotiated Rate |
$1,102.82 |
| Rate for Payer: Aetna American Axle |
$796.48
|
| Rate for Payer: Aetna Commercial |
$1,041.55
|
| Rate for Payer: Aetna Medicare |
$612.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.48
|
| Rate for Payer: BCBS Complete |
$490.14
|
| Rate for Payer: Cash Price |
$980.28
|
| Rate for Payer: Cofinity Commercial |
$1,053.80
|
| Rate for Payer: Cofinity Commercial |
$857.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$857.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.28
|
| Rate for Payer: Healthscope Commercial |
$1,102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$857.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.55
|
| Rate for Payer: PHP Commercial |
$1,041.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.48
|
| Rate for Payer: Priority Health SBD |
$771.97
|
| Rate for Payer: UMR Bronson Commercial |
$453.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.01
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$62.93
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna American Axle |
$40.90
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$39.65
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$27.69
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$62.93
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna American Axle |
$40.90
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$25.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$23.28
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.22
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna Medicare |
$124.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$92.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.22
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$244.32
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna Medicare |
$122.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$90.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.71 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$197.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 60687055011
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$214.23
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.27 |
| Max. Negotiated Rate |
$192.81 |
| Rate for Payer: Aetna American Axle |
$139.25
|
| Rate for Payer: Aetna Commercial |
$182.10
|
| Rate for Payer: Aetna Medicare |
$107.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.25
|
| Rate for Payer: BCBS Complete |
$85.69
|
| Rate for Payer: Cash Price |
$171.38
|
| Rate for Payer: Cofinity Commercial |
$149.96
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.38
|
| Rate for Payer: Healthscope Commercial |
$192.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.10
|
| Rate for Payer: PHP Commercial |
$182.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.25
|
| Rate for Payer: Priority Health SBD |
$134.96
|
| Rate for Payer: UMR Bronson Commercial |
$79.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.67
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 50111033401
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$214.23
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.26 |
| Max. Negotiated Rate |
$192.81 |
| Rate for Payer: Aetna American Axle |
$139.25
|
| Rate for Payer: Aetna Commercial |
$182.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.25
|
| Rate for Payer: Cash Price |
$171.38
|
| Rate for Payer: Cofinity Commercial |
$149.96
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.38
|
| Rate for Payer: Healthscope Commercial |
$192.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.10
|
| Rate for Payer: PHP Commercial |
$182.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.25
|
| Rate for Payer: Priority Health SBD |
$134.96
|
| Rate for Payer: UMR Bronson Commercial |
$94.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.67
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna Medicare |
$224.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$166.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
