|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$808.08
|
|
|
Service Code
|
NDC 47781030801
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.56 |
| Max. Negotiated Rate |
$727.27 |
| Rate for Payer: Aetna American Axle |
$525.25
|
| Rate for Payer: Aetna Commercial |
$686.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.25
|
| Rate for Payer: Cash Price |
$646.46
|
| Rate for Payer: Cofinity Advantage |
$565.66
|
| Rate for Payer: Cofinity Commercial |
$694.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.46
|
| Rate for Payer: Healthscope Commercial |
$727.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.06
|
| Rate for Payer: PHP Commercial |
$686.87
|
| Rate for Payer: Priority Health SBD |
$509.09
|
| Rate for Payer: UMR Bronson Commercial |
$355.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.06
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
OP
|
$808.08
|
|
|
Service Code
|
NDC 47781030801
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.99 |
| Max. Negotiated Rate |
$727.27 |
| Rate for Payer: Aetna American Axle |
$525.25
|
| Rate for Payer: Aetna Commercial |
$686.87
|
| Rate for Payer: Aetna Medicare |
$404.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.25
|
| Rate for Payer: BCBS Complete |
$323.23
|
| Rate for Payer: Cash Price |
$646.46
|
| Rate for Payer: Cofinity Advantage |
$565.66
|
| Rate for Payer: Cofinity Commercial |
$694.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.46
|
| Rate for Payer: Healthscope Commercial |
$727.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$646.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.06
|
| Rate for Payer: PHP Commercial |
$686.87
|
| Rate for Payer: Priority Health SBD |
$509.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.25
|
| Rate for Payer: UHC Core |
$421.01
|
| Rate for Payer: UHC Exchange |
$317.58
|
| Rate for Payer: UMR Bronson Commercial |
$298.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.06
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$8.20
|
|
|
Service Code
|
NDC 60687047211
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna American Axle |
$5.33
|
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.33
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cofinity Advantage |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.56
|
| Rate for Payer: Healthscope Commercial |
$7.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.15
|
| Rate for Payer: PHP Commercial |
$6.97
|
| Rate for Payer: Priority Health SBD |
$5.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.15
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$899.52
|
|
|
Service Code
|
NDC 00904702661
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.82 |
| Max. Negotiated Rate |
$809.57 |
| Rate for Payer: Aetna American Axle |
$584.69
|
| Rate for Payer: Aetna Commercial |
$764.59
|
| Rate for Payer: Aetna Medicare |
$449.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.69
|
| Rate for Payer: BCBS Complete |
$359.81
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Advantage |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Healthscope Commercial |
$809.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.64
|
| Rate for Payer: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health SBD |
$566.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.69
|
| Rate for Payer: UHC Core |
$468.65
|
| Rate for Payer: UHC Exchange |
$353.51
|
| Rate for Payer: UMR Bronson Commercial |
$332.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.64
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$819.84
|
|
|
Service Code
|
NDC 60687047201
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.73 |
| Max. Negotiated Rate |
$737.86 |
| Rate for Payer: Aetna American Axle |
$532.90
|
| Rate for Payer: Aetna Commercial |
$696.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.90
|
| Rate for Payer: Cash Price |
$655.87
|
| Rate for Payer: Cofinity Advantage |
$573.89
|
| Rate for Payer: Cofinity Commercial |
$705.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.87
|
| Rate for Payer: Healthscope Commercial |
$737.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.88
|
| Rate for Payer: PHP Commercial |
$696.86
|
| Rate for Payer: Priority Health SBD |
$516.50
|
| Rate for Payer: UMR Bronson Commercial |
$360.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.88
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$8.20
|
|
|
Service Code
|
NDC 60687047211
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna American Axle |
$5.33
|
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.33
|
| Rate for Payer: BCBS Complete |
$3.28
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cofinity Advantage |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.56
|
| Rate for Payer: Healthscope Commercial |
$7.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.15
|
| Rate for Payer: PHP Commercial |
$6.97
|
| Rate for Payer: Priority Health SBD |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.33
|
| Rate for Payer: UHC Core |
$4.27
|
| Rate for Payer: UHC Exchange |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.15
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
OP
|
$819.84
|
|
|
Service Code
|
NDC 60687047201
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.34 |
| Max. Negotiated Rate |
$737.86 |
| Rate for Payer: Aetna American Axle |
$532.90
|
| Rate for Payer: Aetna Commercial |
$696.86
|
| Rate for Payer: Aetna Medicare |
$409.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.90
|
| Rate for Payer: BCBS Complete |
$327.94
|
| Rate for Payer: Cash Price |
$655.87
|
| Rate for Payer: Cofinity Advantage |
$573.89
|
| Rate for Payer: Cofinity Commercial |
$705.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.87
|
| Rate for Payer: Healthscope Commercial |
$737.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$655.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.88
|
| Rate for Payer: PHP Commercial |
$696.86
|
| Rate for Payer: Priority Health SBD |
$516.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.90
|
| Rate for Payer: UHC Core |
$427.14
|
| Rate for Payer: UHC Exchange |
$322.20
|
| Rate for Payer: UMR Bronson Commercial |
$303.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.88
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$899.52
|
|
|
Service Code
|
NDC 00904702661
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.79 |
| Max. Negotiated Rate |
$809.57 |
| Rate for Payer: Aetna American Axle |
$584.69
|
| Rate for Payer: Aetna Commercial |
$764.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.69
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Advantage |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Healthscope Commercial |
$809.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.64
|
| Rate for Payer: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health SBD |
$566.70
|
| Rate for Payer: UMR Bronson Commercial |
$395.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.64
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$628.32
|
|
|
Service Code
|
NDC 65162047810
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.48 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna American Axle |
$408.41
|
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna Medicare |
$314.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: BCBS Complete |
$251.33
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Advantage |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$502.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.24
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health SBD |
$395.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.41
|
| Rate for Payer: UHC Core |
$327.35
|
| Rate for Payer: UHC Exchange |
$246.93
|
| Rate for Payer: UMR Bronson Commercial |
$232.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.24
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.36 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna American Axle |
$204.39
|
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Advantage |
$220.12
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health SBD |
$198.10
|
| Rate for Payer: UMR Bronson Commercial |
$138.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna American Axle |
$183.46
|
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna Medicare |
$141.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.46
|
| Rate for Payer: BCBS Complete |
$112.90
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Advantage |
$197.57
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health SBD |
$177.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.46
|
| Rate for Payer: UHC Core |
$147.05
|
| Rate for Payer: UHC Exchange |
$110.92
|
| Rate for Payer: UMR Bronson Commercial |
$104.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna American Axle |
$183.46
|
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.46
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Advantage |
$197.57
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health SBD |
$177.81
|
| Rate for Payer: UMR Bronson Commercial |
$124.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$1,111.85
|
|
|
Service Code
|
NDC 51079034820
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.21 |
| Max. Negotiated Rate |
$1,000.66 |
| Rate for Payer: Aetna American Axle |
$722.70
|
| Rate for Payer: Aetna Commercial |
$945.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.70
|
| Rate for Payer: Cash Price |
$889.48
|
| Rate for Payer: Cofinity Advantage |
$778.29
|
| Rate for Payer: Cofinity Commercial |
$956.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.48
|
| Rate for Payer: Healthscope Commercial |
$1,000.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.89
|
| Rate for Payer: PHP Commercial |
$945.07
|
| Rate for Payer: Priority Health SBD |
$700.47
|
| Rate for Payer: UMR Bronson Commercial |
$489.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.89
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$314.45
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna American Axle |
$204.39
|
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna Medicare |
$157.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
| Rate for Payer: BCBS Complete |
$125.78
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Advantage |
$220.12
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health SBD |
$198.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.39
|
| Rate for Payer: UHC Core |
$163.83
|
| Rate for Payer: UHC Exchange |
$123.58
|
| Rate for Payer: UMR Bronson Commercial |
$116.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$1,111.85
|
|
|
Service Code
|
NDC 51079034820
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.38 |
| Max. Negotiated Rate |
$1,000.66 |
| Rate for Payer: Aetna American Axle |
$722.70
|
| Rate for Payer: Aetna Commercial |
$945.07
|
| Rate for Payer: Aetna Medicare |
$555.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.70
|
| Rate for Payer: BCBS Complete |
$444.74
|
| Rate for Payer: Cash Price |
$889.48
|
| Rate for Payer: Cofinity Advantage |
$778.29
|
| Rate for Payer: Cofinity Commercial |
$956.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.48
|
| Rate for Payer: Healthscope Commercial |
$1,000.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.89
|
| Rate for Payer: PHP Commercial |
$945.07
|
| Rate for Payer: Priority Health SBD |
$700.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.70
|
| Rate for Payer: UHC Core |
$579.27
|
| Rate for Payer: UHC Exchange |
$436.96
|
| Rate for Payer: UMR Bronson Commercial |
$411.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.89
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Advantage |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.23
|
| Rate for Payer: UHC Core |
$5.79
|
| Rate for Payer: UHC Exchange |
$4.37
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$628.32
|
|
|
Service Code
|
NDC 65162047810
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.46 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna American Axle |
$408.41
|
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Advantage |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.24
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health SBD |
$395.84
|
| Rate for Payer: UMR Bronson Commercial |
$276.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.24
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Advantage |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 00378910216
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.03
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$139.65
|
|
|
Service Code
|
NDC 00378910293
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna American Axle |
$90.77
|
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna Medicare |
$69.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.77
|
| Rate for Payer: BCBS Complete |
$55.86
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Advantage |
$97.75
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health SBD |
$87.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.77
|
| Rate for Payer: UHC Core |
$72.76
|
| Rate for Payer: UHC Exchange |
$54.88
|
| Rate for Payer: UMR Bronson Commercial |
$51.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$139.65
|
|
|
Service Code
|
NDC 00378910293
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna American Axle |
$90.77
|
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.77
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Advantage |
$97.75
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health SBD |
$87.98
|
| Rate for Payer: UMR Bronson Commercial |
$61.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 00378910216
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$5,470.31
|
|
|
Service Code
|
NDC 50742051530
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,406.94 |
| Max. Negotiated Rate |
$4,923.28 |
| Rate for Payer: Aetna American Axle |
$3,555.70
|
| Rate for Payer: Aetna Commercial |
$4,649.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,555.70
|
| Rate for Payer: Cash Price |
$4,376.25
|
| Rate for Payer: Cofinity Advantage |
$3,829.22
|
| Rate for Payer: Cofinity Commercial |
$4,704.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,376.25
|
| Rate for Payer: Healthscope Commercial |
$4,923.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,829.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,102.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,649.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,102.73
|
| Rate for Payer: PHP Commercial |
$4,649.76
|
| Rate for Payer: Priority Health SBD |
$3,446.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,406.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,102.73
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$5,470.31
|
|
|
Service Code
|
NDC 50742051530
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,024.01 |
| Max. Negotiated Rate |
$4,923.28 |
| Rate for Payer: Aetna American Axle |
$3,555.70
|
| Rate for Payer: Aetna Commercial |
$4,649.76
|
| Rate for Payer: Aetna Medicare |
$2,735.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,555.70
|
| Rate for Payer: BCBS Complete |
$2,188.12
|
| Rate for Payer: Cash Price |
$4,376.25
|
| Rate for Payer: Cofinity Advantage |
$3,829.22
|
| Rate for Payer: Cofinity Commercial |
$4,704.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,376.25
|
| Rate for Payer: Healthscope Commercial |
$4,923.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,829.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,102.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,376.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,649.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,102.73
|
| Rate for Payer: PHP Commercial |
$4,649.76
|
| Rate for Payer: Priority Health SBD |
$3,446.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,555.70
|
| Rate for Payer: UHC Core |
$2,850.03
|
| Rate for Payer: UHC Exchange |
$2,149.83
|
| Rate for Payer: UMR Bronson Commercial |
$2,024.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,102.73
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$182.35
|
|
|
Service Code
|
NDC 50742051501
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$164.12 |
| Rate for Payer: Aetna American Axle |
$118.53
|
| Rate for Payer: Aetna Commercial |
$155.00
|
| Rate for Payer: Aetna Medicare |
$91.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.53
|
| Rate for Payer: BCBS Complete |
$72.94
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Cofinity Advantage |
$127.64
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.88
|
| Rate for Payer: Healthscope Commercial |
$164.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.76
|
| Rate for Payer: PHP Commercial |
$155.00
|
| Rate for Payer: Priority Health SBD |
$114.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.53
|
| Rate for Payer: UHC Core |
$95.00
|
| Rate for Payer: UHC Exchange |
$71.66
|
| Rate for Payer: UMR Bronson Commercial |
$67.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.76
|
|
