|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY
|
Facility
|
OP
|
$121.96
|
|
|
Service Code
|
NDC 00472173803
|
| Hospital Charge Code |
109535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$109.76 |
| Rate for Payer: Aetna American Axle |
$79.27
|
| Rate for Payer: Aetna Commercial |
$103.67
|
| Rate for Payer: Aetna Medicare |
$60.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.27
|
| Rate for Payer: BCBS Complete |
$48.78
|
| Rate for Payer: Cash Price |
$97.57
|
| Rate for Payer: Cofinity Commercial |
$104.89
|
| Rate for Payer: Cofinity Commercial |
$85.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.57
|
| Rate for Payer: Healthscope Commercial |
$109.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.67
|
| Rate for Payer: PHP Commercial |
$103.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.27
|
| Rate for Payer: Priority Health SBD |
$76.83
|
| Rate for Payer: UMR Bronson Commercial |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.47
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: UMR Bronson Commercial |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health SBD |
$15.82
|
| Rate for Payer: UMR Bronson Commercial |
$11.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$25.11
|
|
|
Service Code
|
NDC 00536113428
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health SBD |
$15.82
|
| Rate for Payer: UMR Bronson Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$63.51
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna American Axle |
$41.28
|
| Rate for Payer: Aetna Commercial |
$53.98
|
| Rate for Payer: Aetna Medicare |
$31.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.28
|
| Rate for Payer: BCBS Complete |
$25.40
|
| Rate for Payer: Cash Price |
$50.81
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.81
|
| Rate for Payer: Healthscope Commercial |
$57.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.98
|
| Rate for Payer: PHP Commercial |
$53.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health SBD |
$40.01
|
| Rate for Payer: UMR Bronson Commercial |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.63
|
|
|
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 Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.83
|
| 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: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.06
|
| Rate for Payer: UMR Bronson Commercial |
$21.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna American Axle |
$18.41
|
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.83
|
| 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: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: PHP Commercial |
$24.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.06
|
| Rate for Payer: UMR Bronson Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$63.51
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: Aetna American Axle |
$41.28
|
| Rate for Payer: Aetna Commercial |
$53.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.28
|
| Rate for Payer: Cash Price |
$50.81
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.81
|
| Rate for Payer: Healthscope Commercial |
$57.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.98
|
| Rate for Payer: PHP Commercial |
$53.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health SBD |
$40.01
|
| Rate for Payer: UMR Bronson Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.63
|
|
|
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 Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.94
|
| 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: PHP Commercial |
$21.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.66
|
| 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
|
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 Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| 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: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| 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 Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.53
|
| 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: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health SBD |
$13.98
|
| 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
|
$22.19
|
|
|
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 Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.53
|
| 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: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| 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
|
$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 |
$12.82
|
| 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 Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.94
|
| 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: PHP Commercial |
$21.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.66
|
| Rate for Payer: Priority Health SBD |
$16.15
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.22
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
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 |
$11.48
|
| 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 Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$20.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.51
|
| Rate for Payer: PHP Commercial |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.92
|
| Rate for Payer: Priority Health SBD |
$14.46
|
| 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
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 11017025030
|
| 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 Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| 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: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| 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
|
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 Commercial |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$20.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.51
|
| Rate for Payer: PHP Commercial |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.92
|
| 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
|
$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 Commercial |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.58
|
| 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: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| 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 Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| 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: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| 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
|
$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 Commercial |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.58
|
| 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: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health SBD |
$17.62
|
| 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
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 11017025030
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| 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: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| 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
|
|
