|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$68.36
|
|
|
Service Code
|
NDC 45802004811
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$61.52 |
| Rate for Payer: Aetna American Axle |
$44.43
|
| Rate for Payer: Aetna Commercial |
$58.11
|
| Rate for Payer: Aetna Medicare |
$34.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.43
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: Cash Price |
$54.69
|
| Rate for Payer: Cofinity Advantage |
$47.85
|
| Rate for Payer: Cofinity Commercial |
$58.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.69
|
| Rate for Payer: Healthscope Commercial |
$61.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.27
|
| Rate for Payer: PHP Commercial |
$58.11
|
| Rate for Payer: Priority Health SBD |
$43.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.43
|
| Rate for Payer: UHC Core |
$35.62
|
| Rate for Payer: UHC Exchange |
$26.87
|
| Rate for Payer: UMR Bronson Commercial |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.27
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$45.57
|
|
|
Service Code
|
NDC 45802004835
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$41.01 |
| Rate for Payer: Aetna American Axle |
$29.62
|
| Rate for Payer: Aetna Commercial |
$38.73
|
| Rate for Payer: Aetna Medicare |
$22.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.62
|
| Rate for Payer: BCBS Complete |
$18.23
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cofinity Advantage |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.46
|
| Rate for Payer: Healthscope Commercial |
$41.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.18
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health SBD |
$28.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$23.74
|
| Rate for Payer: UHC Exchange |
$17.91
|
| Rate for Payer: UMR Bronson Commercial |
$16.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.18
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$291.37
|
|
|
Service Code
|
NDC 00121104516
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$262.23 |
| Rate for Payer: Aetna American Axle |
$189.39
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cofinity Advantage |
$203.96
|
| Rate for Payer: Cofinity Commercial |
$250.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.10
|
| Rate for Payer: Healthscope Commercial |
$262.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.53
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UMR Bronson Commercial |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$291.37
|
|
|
Service Code
|
NDC 00121104516
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.81 |
| Max. Negotiated Rate |
$262.23 |
| Rate for Payer: Aetna American Axle |
$189.39
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna Medicare |
$145.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.39
|
| Rate for Payer: BCBS Complete |
$116.55
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cofinity Advantage |
$203.96
|
| Rate for Payer: Cofinity Commercial |
$250.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.10
|
| Rate for Payer: Healthscope Commercial |
$262.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.53
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.39
|
| Rate for Payer: UHC Core |
$151.80
|
| Rate for Payer: UHC Exchange |
$114.51
|
| Rate for Payer: UMR Bronson Commercial |
$107.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.92
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna American Axle |
$7.10
|
| Rate for Payer: Aetna Commercial |
$9.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.10
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$9.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health SBD |
$6.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.19
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$142.38
|
|
|
Service Code
|
NDC 00121086816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$128.14 |
| Rate for Payer: Aetna American Axle |
$92.55
|
| Rate for Payer: Aetna Commercial |
$121.02
|
| Rate for Payer: Aetna Medicare |
$71.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.55
|
| Rate for Payer: BCBS Complete |
$56.95
|
| Rate for Payer: Cash Price |
$113.90
|
| Rate for Payer: Cofinity Advantage |
$99.67
|
| Rate for Payer: Cofinity Commercial |
$122.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.90
|
| Rate for Payer: Healthscope Commercial |
$128.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.78
|
| Rate for Payer: PHP Commercial |
$121.02
|
| Rate for Payer: Priority Health SBD |
$89.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.55
|
| Rate for Payer: UHC Core |
$74.18
|
| Rate for Payer: UHC Exchange |
$55.96
|
| Rate for Payer: UMR Bronson Commercial |
$52.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.78
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Advantage |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.31
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$2.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna American Axle |
$4.66
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.66
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Advantage |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.66
|
| Rate for Payer: UHC Core |
$3.74
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,627.36
|
|
|
Service Code
|
NDC 62135081347
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$716.04 |
| Max. Negotiated Rate |
$1,464.62 |
| Rate for Payer: Aetna American Axle |
$1,057.78
|
| Rate for Payer: Aetna Commercial |
$1,383.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,057.78
|
| Rate for Payer: Cash Price |
$1,301.89
|
| Rate for Payer: Cofinity Advantage |
$1,139.15
|
| Rate for Payer: Cofinity Commercial |
$1,399.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,301.89
|
| Rate for Payer: Healthscope Commercial |
$1,464.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,139.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,220.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,383.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,220.52
|
| Rate for Payer: PHP Commercial |
$1,383.26
|
| Rate for Payer: Priority Health SBD |
$1,025.24
|
| Rate for Payer: UMR Bronson Commercial |
$716.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,220.52
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$142.38
|
|
|
Service Code
|
NDC 00121086816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.65 |
| Max. Negotiated Rate |
$128.14 |
| Rate for Payer: Aetna American Axle |
$92.55
|
| Rate for Payer: Aetna Commercial |
$121.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.55
|
| Rate for Payer: Cash Price |
$113.90
|
| Rate for Payer: Cofinity Advantage |
$99.67
|
| Rate for Payer: Cofinity Commercial |
$122.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.90
|
| Rate for Payer: Healthscope Commercial |
$128.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.78
|
| Rate for Payer: PHP Commercial |
$121.02
|
| Rate for Payer: Priority Health SBD |
$89.70
|
| Rate for Payer: UMR Bronson Commercial |
$62.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.78
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Advantage |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna American Axle |
$4.66
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.66
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Advantage |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$110.88
|
|
|
Service Code
|
NDC 66689000816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna American Axle |
$72.07
|
| Rate for Payer: Aetna Commercial |
$94.25
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.07
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cofinity Advantage |
$77.62
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.70
|
| Rate for Payer: Healthscope Commercial |
$99.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.16
|
| Rate for Payer: PHP Commercial |
$94.25
|
| Rate for Payer: Priority Health SBD |
$69.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.07
|
| Rate for Payer: UHC Core |
$57.77
|
| Rate for Payer: UHC Exchange |
$43.58
|
| Rate for Payer: UMR Bronson Commercial |
$41.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.16
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$102.65
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Aetna American Axle |
$66.72
|
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Aetna Medicare |
$51.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.72
|
| Rate for Payer: BCBS Complete |
$41.06
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cofinity Advantage |
$71.86
|
| Rate for Payer: Cofinity Commercial |
$88.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.12
|
| Rate for Payer: Healthscope Commercial |
$92.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.99
|
| Rate for Payer: PHP Commercial |
$87.25
|
| Rate for Payer: Priority Health SBD |
$64.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.72
|
| Rate for Payer: UHC Core |
$53.48
|
| Rate for Payer: UHC Exchange |
$40.34
|
| Rate for Payer: UMR Bronson Commercial |
$37.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.99
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$289.72
|
|
|
Service Code
|
NDC 60432053716
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.48 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna American Axle |
$188.32
|
| Rate for Payer: Aetna Commercial |
$246.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.32
|
| Rate for Payer: Cash Price |
$231.78
|
| Rate for Payer: Cofinity Advantage |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$260.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.29
|
| Rate for Payer: PHP Commercial |
$246.26
|
| Rate for Payer: Priority Health SBD |
$182.52
|
| Rate for Payer: UMR Bronson Commercial |
$127.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.29
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.92
|
|
|
Service Code
|
NDC 68094059959
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna American Axle |
$7.10
|
| Rate for Payer: Aetna Commercial |
$9.28
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.10
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$9.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health SBD |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.10
|
| Rate for Payer: UHC Core |
$5.69
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.19
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$110.88
|
|
|
Service Code
|
NDC 66689000816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna American Axle |
$72.07
|
| Rate for Payer: Aetna Commercial |
$94.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.07
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cofinity Advantage |
$77.62
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.70
|
| Rate for Payer: Healthscope Commercial |
$99.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.16
|
| Rate for Payer: PHP Commercial |
$94.25
|
| Rate for Payer: Priority Health SBD |
$69.85
|
| Rate for Payer: UMR Bronson Commercial |
$48.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.16
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.17
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna American Axle |
$4.66
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.66
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Advantage |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.66
|
| Rate for Payer: UHC Core |
$3.74
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$289.72
|
|
|
Service Code
|
NDC 60432053716
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna American Axle |
$188.32
|
| Rate for Payer: Aetna Commercial |
$246.26
|
| Rate for Payer: Aetna Medicare |
$144.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.32
|
| Rate for Payer: BCBS Complete |
$115.89
|
| Rate for Payer: Cash Price |
$231.78
|
| Rate for Payer: Cofinity Advantage |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$260.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.29
|
| Rate for Payer: PHP Commercial |
$246.26
|
| Rate for Payer: Priority Health SBD |
$182.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.32
|
| Rate for Payer: UHC Core |
$150.94
|
| Rate for Payer: UHC Exchange |
$113.86
|
| Rate for Payer: UMR Bronson Commercial |
$107.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.29
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$7.17
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna American Axle |
$4.66
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.66
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Advantage |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.38
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,627.36
|
|
|
Service Code
|
NDC 62135081347
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.12 |
| Max. Negotiated Rate |
$1,464.62 |
| Rate for Payer: Aetna American Axle |
$1,057.78
|
| Rate for Payer: Aetna Commercial |
$1,383.26
|
| Rate for Payer: Aetna Medicare |
$813.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,057.78
|
| Rate for Payer: BCBS Complete |
$650.94
|
| Rate for Payer: Cash Price |
$1,301.89
|
| Rate for Payer: Cofinity Advantage |
$1,139.15
|
| Rate for Payer: Cofinity Commercial |
$1,399.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,301.89
|
| Rate for Payer: Healthscope Commercial |
$1,464.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,139.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,220.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,301.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,383.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,220.52
|
| Rate for Payer: PHP Commercial |
$1,383.26
|
| Rate for Payer: Priority Health SBD |
$1,025.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,057.78
|
| Rate for Payer: UHC Core |
$847.85
|
| Rate for Payer: UHC Exchange |
$639.55
|
| Rate for Payer: UMR Bronson Commercial |
$602.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,220.52
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna American Axle |
$3.55
|
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Advantage |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.09
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health SBD |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.55
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: UHC Exchange |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.09
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$102.65
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.17 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Aetna American Axle |
$66.72
|
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.72
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cofinity Advantage |
$71.86
|
| Rate for Payer: Cofinity Commercial |
$88.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.12
|
| Rate for Payer: Healthscope Commercial |
$92.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.99
|
| Rate for Payer: PHP Commercial |
$87.25
|
| Rate for Payer: Priority Health SBD |
$64.67
|
| Rate for Payer: UMR Bronson Commercial |
$45.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.99
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna American Axle |
$3.55
|
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Advantage |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.09
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health SBD |
$3.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.09
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$446.25
|
|
|
Service Code
|
NDC 09900001984
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
