|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$130.47
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna American Axle |
$84.81
|
| Rate for Payer: Aetna Commercial |
$110.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.81
|
| Rate for Payer: Cash Price |
$104.38
|
| Rate for Payer: Cofinity Advantage |
$91.33
|
| Rate for Payer: Cofinity Commercial |
$112.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.38
|
| Rate for Payer: Healthscope Commercial |
$117.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.85
|
| Rate for Payer: PHP Commercial |
$110.90
|
| Rate for Payer: Priority Health SBD |
$82.20
|
| Rate for Payer: UMR Bronson Commercial |
$57.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.85
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,771.56
|
|
|
Service Code
|
NDC 57664013565
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.49 |
| Max. Negotiated Rate |
$1,594.40 |
| Rate for Payer: Aetna American Axle |
$1,151.51
|
| Rate for Payer: Aetna Commercial |
$1,505.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.51
|
| Rate for Payer: Cash Price |
$1,417.25
|
| Rate for Payer: Cofinity Advantage |
$1,240.09
|
| Rate for Payer: Cofinity Commercial |
$1,523.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.25
|
| Rate for Payer: Healthscope Commercial |
$1,594.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,505.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,328.67
|
| Rate for Payer: PHP Commercial |
$1,505.83
|
| Rate for Payer: Priority Health SBD |
$1,116.08
|
| Rate for Payer: UMR Bronson Commercial |
$779.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.67
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$535.68
|
|
|
Service Code
|
NDC 23155051200
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$482.11 |
| Rate for Payer: Aetna American Axle |
$348.19
|
| Rate for Payer: Aetna Commercial |
$455.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.19
|
| Rate for Payer: Cash Price |
$428.54
|
| Rate for Payer: Cofinity Advantage |
$374.98
|
| Rate for Payer: Cofinity Commercial |
$460.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.54
|
| Rate for Payer: Healthscope Commercial |
$482.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.76
|
| Rate for Payer: PHP Commercial |
$455.33
|
| Rate for Payer: Priority Health SBD |
$337.48
|
| Rate for Payer: UMR Bronson Commercial |
$235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.76
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$17.72
|
|
|
Service Code
|
NDC 57664013560
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Medicare |
$8.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Advantage |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.29
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.52
|
| Rate for Payer: UHC Core |
$9.23
|
| Rate for Payer: UHC Exchange |
$6.96
|
| Rate for Payer: UMR Bronson Commercial |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$497.28
|
|
|
Service Code
|
NDC 69452020920
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.99 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna American Axle |
$323.23
|
| Rate for Payer: Aetna Commercial |
$422.69
|
| Rate for Payer: Aetna Medicare |
$248.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.23
|
| Rate for Payer: BCBS Complete |
$198.91
|
| Rate for Payer: Cash Price |
$397.82
|
| Rate for Payer: Cofinity Advantage |
$348.10
|
| Rate for Payer: Cofinity Commercial |
$427.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.82
|
| Rate for Payer: Healthscope Commercial |
$447.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.96
|
| Rate for Payer: PHP Commercial |
$422.69
|
| Rate for Payer: Priority Health SBD |
$313.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.23
|
| Rate for Payer: UHC Core |
$259.08
|
| Rate for Payer: UHC Exchange |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$183.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.96
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$17.72
|
|
|
Service Code
|
NDC 57664013560
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Advantage |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.29
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$1,771.56
|
|
|
Service Code
|
NDC 57664013565
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$655.48 |
| Max. Negotiated Rate |
$1,594.40 |
| Rate for Payer: Aetna American Axle |
$1,151.51
|
| Rate for Payer: Aetna Commercial |
$1,505.83
|
| Rate for Payer: Aetna Medicare |
$885.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.51
|
| Rate for Payer: BCBS Complete |
$708.62
|
| Rate for Payer: Cash Price |
$1,417.25
|
| Rate for Payer: Cofinity Advantage |
$1,240.09
|
| Rate for Payer: Cofinity Commercial |
$1,523.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.25
|
| Rate for Payer: Healthscope Commercial |
$1,594.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,505.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,328.67
|
| Rate for Payer: PHP Commercial |
$1,505.83
|
| Rate for Payer: Priority Health SBD |
$1,116.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.51
|
| Rate for Payer: UHC Core |
$922.98
|
| Rate for Payer: UHC Exchange |
$696.22
|
| Rate for Payer: UMR Bronson Commercial |
$655.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.67
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$379.07
|
|
|
Service Code
|
NDC 24338026010
|
| Hospital Charge Code |
193497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.26 |
| Max. Negotiated Rate |
$341.16 |
| Rate for Payer: Aetna American Axle |
$246.40
|
| Rate for Payer: Aetna Commercial |
$322.21
|
| Rate for Payer: Aetna Medicare |
$189.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.40
|
| Rate for Payer: BCBS Complete |
$151.63
|
| Rate for Payer: Cash Price |
$303.26
|
| Rate for Payer: Cofinity Advantage |
$265.35
|
| Rate for Payer: Cofinity Commercial |
$326.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.26
|
| Rate for Payer: Healthscope Commercial |
$341.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.30
|
| Rate for Payer: PHP Commercial |
$322.21
|
| Rate for Payer: Priority Health SBD |
$238.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.40
|
| Rate for Payer: UHC Core |
$197.50
|
| Rate for Payer: UHC Exchange |
$148.97
|
| Rate for Payer: UMR Bronson Commercial |
$140.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.30
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$379.07
|
|
|
Service Code
|
NDC 24338026010
|
| Hospital Charge Code |
193497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.79 |
| Max. Negotiated Rate |
$341.16 |
| Rate for Payer: Aetna American Axle |
$246.40
|
| Rate for Payer: Aetna Commercial |
$322.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.40
|
| Rate for Payer: Cash Price |
$303.26
|
| Rate for Payer: Cofinity Advantage |
$265.35
|
| Rate for Payer: Cofinity Commercial |
$326.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.26
|
| Rate for Payer: Healthscope Commercial |
$341.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.30
|
| Rate for Payer: PHP Commercial |
$322.21
|
| Rate for Payer: Priority Health SBD |
$238.81
|
| Rate for Payer: UMR Bronson Commercial |
$166.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.30
|
|
|
NIPOCALIMAB-AAHU 185 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32,125.21
|
|
|
Service Code
|
HCPCS J9256
|
| Hospital Charge Code |
211572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$28,912.69 |
| Rate for Payer: Aetna American Axle |
$20,881.39
|
| Rate for Payer: Aetna Commercial |
$27,306.43
|
| Rate for Payer: Aetna Medicare |
$33.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,881.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.84
|
| Rate for Payer: BCBS Complete |
$17.94
|
| Rate for Payer: BCBS MAPPO |
$32.67
|
| Rate for Payer: BCBS Trust/PPO |
$106.17
|
| Rate for Payer: BCN Commercial |
$106.17
|
| Rate for Payer: BCN Medicare Advantage |
$32.67
|
| Rate for Payer: Cash Price |
$25,700.17
|
| Rate for Payer: Cash Price |
$25,700.17
|
| Rate for Payer: Cofinity Advantage |
$22,487.65
|
| Rate for Payer: Cofinity Commercial |
$27,627.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,700.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.67
|
| Rate for Payer: Healthscope Commercial |
$28,912.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,487.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,093.91
|
| Rate for Payer: Mclaren Medicaid |
$32.67
|
| Rate for Payer: Mclaren Medicare |
$32.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.30
|
| Rate for Payer: Meridian Medicaid |
$34.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,306.43
|
| Rate for Payer: Nomi Health Commercial |
$98.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,093.91
|
| Rate for Payer: PACE Medicare |
$31.04
|
| Rate for Payer: PACE SWMI |
$32.67
|
| Rate for Payer: PHP Commercial |
$27,306.43
|
| Rate for Payer: PHP Medicare Advantage |
$32.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101.34
|
| Rate for Payer: Priority Health Medicare |
$32.67
|
| Rate for Payer: Priority Health SBD |
$20,238.88
|
| Rate for Payer: Priority Health Tiered Network |
$81.07
|
| Rate for Payer: Railroad Medicare Medicare |
$32.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.02
|
| Rate for Payer: UHC Core |
$54.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.67
|
| Rate for Payer: UHC Exchange |
$54.02
|
| Rate for Payer: UHC Medicaid |
$17.09
|
| Rate for Payer: UHCCP Medicaid |
$17.09
|
| Rate for Payer: UMR Bronson Commercial |
$11,886.33
|
| Rate for Payer: VA VA |
$32.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,093.91
|
|
|
NIPOCALIMAB-AAHU 185 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32,125.21
|
|
|
Service Code
|
HCPCS J9256
|
| Hospital Charge Code |
211572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,135.09 |
| Max. Negotiated Rate |
$28,912.69 |
| Rate for Payer: Aetna American Axle |
$20,881.39
|
| Rate for Payer: Aetna Commercial |
$27,306.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,881.39
|
| Rate for Payer: Cash Price |
$25,700.17
|
| Rate for Payer: Cofinity Advantage |
$22,487.65
|
| Rate for Payer: Cofinity Commercial |
$27,627.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,700.17
|
| Rate for Payer: Healthscope Commercial |
$28,912.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,487.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,093.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,306.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,093.91
|
| Rate for Payer: PHP Commercial |
$27,306.43
|
| Rate for Payer: Priority Health SBD |
$20,238.88
|
| Rate for Payer: UMR Bronson Commercial |
$14,135.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,093.91
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,423.35
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
204885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,893.84 |
| Rate for Payer: Aetna American Axle |
$925.18
|
| Rate for Payer: Aetna Commercial |
$1,209.85
|
| Rate for Payer: Aetna Medicare |
$711.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.18
|
| Rate for Payer: BCBS Complete |
$569.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.84
|
| Rate for Payer: BCN Commercial |
$1,893.84
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cofinity Advantage |
$996.35
|
| Rate for Payer: Cofinity Commercial |
$1,224.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.68
|
| Rate for Payer: Healthscope Commercial |
$1,281.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,138.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,067.51
|
| Rate for Payer: PHP Commercial |
$1,209.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$896.71
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
| Rate for Payer: UMR Bronson Commercial |
$526.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.51
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,423.35
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
204885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.27 |
| Max. Negotiated Rate |
$1,281.02 |
| Rate for Payer: Aetna American Axle |
$925.18
|
| Rate for Payer: Aetna Commercial |
$1,209.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.18
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cofinity Advantage |
$996.35
|
| Rate for Payer: Cofinity Commercial |
$1,224.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.68
|
| Rate for Payer: Healthscope Commercial |
$1,281.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,067.51
|
| Rate for Payer: PHP Commercial |
$1,209.85
|
| Rate for Payer: Priority Health SBD |
$896.71
|
| Rate for Payer: UMR Bronson Commercial |
$626.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.51
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,423.35
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
204884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.27 |
| Max. Negotiated Rate |
$1,281.02 |
| Rate for Payer: Aetna American Axle |
$925.18
|
| Rate for Payer: Aetna Commercial |
$1,209.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.18
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cofinity Advantage |
$996.35
|
| Rate for Payer: Cofinity Commercial |
$1,224.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.68
|
| Rate for Payer: Healthscope Commercial |
$1,281.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,067.51
|
| Rate for Payer: PHP Commercial |
$1,209.85
|
| Rate for Payer: Priority Health SBD |
$896.71
|
| Rate for Payer: UMR Bronson Commercial |
$626.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.51
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,423.35
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
204884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,893.84 |
| Rate for Payer: Aetna American Axle |
$925.18
|
| Rate for Payer: Aetna Commercial |
$1,209.85
|
| Rate for Payer: Aetna Medicare |
$711.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.18
|
| Rate for Payer: BCBS Complete |
$569.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.84
|
| Rate for Payer: BCN Commercial |
$1,893.84
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cash Price |
$1,138.68
|
| Rate for Payer: Cofinity Advantage |
$996.35
|
| Rate for Payer: Cofinity Commercial |
$1,224.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.68
|
| Rate for Payer: Healthscope Commercial |
$1,281.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,138.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,067.51
|
| Rate for Payer: PHP Commercial |
$1,209.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$896.71
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
| Rate for Payer: UMR Bronson Commercial |
$526.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.51
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$2,311.20
|
|
|
Service Code
|
NDC 64980052660
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,016.93 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna American Axle |
$1,502.28
|
| Rate for Payer: Aetna Commercial |
$1,964.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,502.28
|
| Rate for Payer: Cash Price |
$1,848.96
|
| Rate for Payer: Cofinity Advantage |
$1,617.84
|
| Rate for Payer: Cofinity Commercial |
$1,987.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.96
|
| Rate for Payer: Healthscope Commercial |
$2,080.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,733.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,964.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,733.40
|
| Rate for Payer: PHP Commercial |
$1,964.52
|
| Rate for Payer: Priority Health SBD |
$1,456.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,016.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,733.40
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$5,983.93
|
|
|
Service Code
|
NDC 67546011114
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,632.93 |
| Max. Negotiated Rate |
$5,385.54 |
| Rate for Payer: Aetna American Axle |
$3,889.55
|
| Rate for Payer: Aetna Commercial |
$5,086.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,889.55
|
| Rate for Payer: Cash Price |
$4,787.14
|
| Rate for Payer: Cofinity Advantage |
$4,188.75
|
| Rate for Payer: Cofinity Commercial |
$5,146.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,787.14
|
| Rate for Payer: Healthscope Commercial |
$5,385.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,188.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,487.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,086.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,487.95
|
| Rate for Payer: PHP Commercial |
$5,086.34
|
| Rate for Payer: Priority Health SBD |
$3,769.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,632.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,487.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$2,417.27
|
|
|
Service Code
|
NDC 64980052621
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,063.60 |
| Max. Negotiated Rate |
$2,175.54 |
| Rate for Payer: Aetna American Axle |
$1,571.23
|
| Rate for Payer: Aetna Commercial |
$2,054.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.23
|
| Rate for Payer: Cash Price |
$1,933.82
|
| Rate for Payer: Cofinity Advantage |
$1,692.09
|
| Rate for Payer: Cofinity Commercial |
$2,078.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,933.82
|
| Rate for Payer: Healthscope Commercial |
$2,175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,692.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,812.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,812.95
|
| Rate for Payer: PHP Commercial |
$2,054.68
|
| Rate for Payer: Priority Health SBD |
$1,522.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,063.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,812.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
OP
|
$2,417.27
|
|
|
Service Code
|
NDC 64980052621
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$2,175.54 |
| Rate for Payer: Aetna American Axle |
$1,571.23
|
| Rate for Payer: Aetna Commercial |
$2,054.68
|
| Rate for Payer: Aetna Medicare |
$1,208.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.23
|
| Rate for Payer: BCBS Complete |
$966.91
|
| Rate for Payer: Cash Price |
$1,933.82
|
| Rate for Payer: Cofinity Advantage |
$1,692.09
|
| Rate for Payer: Cofinity Commercial |
$2,078.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,933.82
|
| Rate for Payer: Healthscope Commercial |
$2,175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,692.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,812.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,933.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,812.95
|
| Rate for Payer: PHP Commercial |
$2,054.68
|
| Rate for Payer: Priority Health SBD |
$1,522.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,571.23
|
| Rate for Payer: UHC Core |
$1,259.40
|
| Rate for Payer: UHC Exchange |
$949.99
|
| Rate for Payer: UMR Bronson Commercial |
$894.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,812.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
OP
|
$5,983.93
|
|
|
Service Code
|
NDC 67546011114
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,214.05 |
| Max. Negotiated Rate |
$5,385.54 |
| Rate for Payer: Aetna American Axle |
$3,889.55
|
| Rate for Payer: Aetna Commercial |
$5,086.34
|
| Rate for Payer: Aetna Medicare |
$2,991.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,889.55
|
| Rate for Payer: BCBS Complete |
$2,393.57
|
| Rate for Payer: Cash Price |
$4,787.14
|
| Rate for Payer: Cofinity Advantage |
$4,188.75
|
| Rate for Payer: Cofinity Commercial |
$5,146.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,787.14
|
| Rate for Payer: Healthscope Commercial |
$5,385.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,188.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,487.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,787.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,086.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,487.95
|
| Rate for Payer: PHP Commercial |
$5,086.34
|
| Rate for Payer: Priority Health SBD |
$3,769.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,889.55
|
| Rate for Payer: UHC Core |
$3,117.63
|
| Rate for Payer: UHC Exchange |
$2,351.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,214.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,487.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
OP
|
$13,935.61
|
|
|
Service Code
|
NDC 67546011112
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,156.18 |
| Max. Negotiated Rate |
$12,542.05 |
| Rate for Payer: Aetna American Axle |
$9,058.15
|
| Rate for Payer: Aetna Commercial |
$11,845.27
|
| Rate for Payer: Aetna Medicare |
$6,967.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,058.15
|
| Rate for Payer: BCBS Complete |
$5,574.24
|
| Rate for Payer: Cash Price |
$11,148.49
|
| Rate for Payer: Cofinity Advantage |
$9,754.93
|
| Rate for Payer: Cofinity Commercial |
$11,984.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,148.49
|
| Rate for Payer: Healthscope Commercial |
$12,542.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,754.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,451.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,148.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,845.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,451.71
|
| Rate for Payer: PHP Commercial |
$11,845.27
|
| Rate for Payer: Priority Health SBD |
$8,779.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,058.15
|
| Rate for Payer: UHC Core |
$7,260.45
|
| Rate for Payer: UHC Exchange |
$5,476.69
|
| Rate for Payer: UMR Bronson Commercial |
$5,156.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,451.71
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
OP
|
$2,311.20
|
|
|
Service Code
|
NDC 64980052660
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$855.14 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna American Axle |
$1,502.28
|
| Rate for Payer: Aetna Commercial |
$1,964.52
|
| Rate for Payer: Aetna Medicare |
$1,155.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,502.28
|
| Rate for Payer: BCBS Complete |
$924.48
|
| Rate for Payer: Cash Price |
$1,848.96
|
| Rate for Payer: Cofinity Advantage |
$1,617.84
|
| Rate for Payer: Cofinity Commercial |
$1,987.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.96
|
| Rate for Payer: Healthscope Commercial |
$2,080.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,733.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,848.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,964.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,733.40
|
| Rate for Payer: PHP Commercial |
$1,964.52
|
| Rate for Payer: Priority Health SBD |
$1,456.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,502.28
|
| Rate for Payer: UHC Core |
$1,204.14
|
| Rate for Payer: UHC Exchange |
$908.30
|
| Rate for Payer: UMR Bronson Commercial |
$855.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,733.40
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$13,935.61
|
|
|
Service Code
|
NDC 67546011112
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,131.67 |
| Max. Negotiated Rate |
$12,542.05 |
| Rate for Payer: Aetna American Axle |
$9,058.15
|
| Rate for Payer: Aetna Commercial |
$11,845.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,058.15
|
| Rate for Payer: Cash Price |
$11,148.49
|
| Rate for Payer: Cofinity Advantage |
$9,754.93
|
| Rate for Payer: Cofinity Commercial |
$11,984.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,148.49
|
| Rate for Payer: Healthscope Commercial |
$12,542.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,754.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,451.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,845.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,451.71
|
| Rate for Payer: PHP Commercial |
$11,845.27
|
| Rate for Payer: Priority Health SBD |
$8,779.43
|
| Rate for Payer: UMR Bronson Commercial |
$6,131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,451.71
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4,092.46
|
|
|
Service Code
|
NDC 70954049610
|
| Hospital Charge Code |
10723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,800.68 |
| Max. Negotiated Rate |
$3,683.21 |
| Rate for Payer: Aetna American Axle |
$2,660.10
|
| Rate for Payer: Aetna Commercial |
$3,478.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.10
|
| Rate for Payer: Cash Price |
$3,273.97
|
| Rate for Payer: Cofinity Advantage |
$2,864.72
|
| Rate for Payer: Cofinity Commercial |
$3,519.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.97
|
| Rate for Payer: Healthscope Commercial |
$3,683.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,864.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,069.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,069.34
|
| Rate for Payer: PHP Commercial |
$3,478.59
|
| Rate for Payer: Priority Health SBD |
$2,578.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,800.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,069.34
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4,092.46
|
|
|
Service Code
|
NDC 70954049610
|
| Hospital Charge Code |
10723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,514.21 |
| Max. Negotiated Rate |
$3,683.21 |
| Rate for Payer: Aetna American Axle |
$2,660.10
|
| Rate for Payer: Aetna Commercial |
$3,478.59
|
| Rate for Payer: Aetna Medicare |
$2,046.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.10
|
| Rate for Payer: BCBS Complete |
$1,636.98
|
| Rate for Payer: Cash Price |
$3,273.97
|
| Rate for Payer: Cofinity Advantage |
$2,864.72
|
| Rate for Payer: Cofinity Commercial |
$3,519.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.97
|
| Rate for Payer: Healthscope Commercial |
$3,683.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,864.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,069.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,273.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,069.34
|
| Rate for Payer: PHP Commercial |
$3,478.59
|
| Rate for Payer: Priority Health SBD |
$2,578.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,660.10
|
| Rate for Payer: UHC Core |
$2,132.17
|
| Rate for Payer: UHC Exchange |
$1,608.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,514.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,069.34
|
|
