|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$347.77
|
|
|
Service Code
|
NDC 24338026010
|
| Hospital Charge Code |
193497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.67 |
| Max. Negotiated Rate |
$312.99 |
| Rate for Payer: Aetna American Axle |
$226.05
|
| Rate for Payer: Aetna Commercial |
$295.60
|
| Rate for Payer: Aetna Medicare |
$173.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.05
|
| Rate for Payer: BCBS Complete |
$139.11
|
| Rate for Payer: Cash Price |
$278.22
|
| Rate for Payer: Cofinity Commercial |
$243.44
|
| Rate for Payer: Cofinity Commercial |
$299.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.22
|
| Rate for Payer: Healthscope Commercial |
$312.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.60
|
| Rate for Payer: PHP Commercial |
$295.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.05
|
| Rate for Payer: Priority Health SBD |
$219.10
|
| Rate for Payer: UMR Bronson Commercial |
$128.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.83
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$347.77
|
|
|
Service Code
|
NDC 24338026010
|
| Hospital Charge Code |
193497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.02 |
| Max. Negotiated Rate |
$312.99 |
| Rate for Payer: Aetna American Axle |
$226.05
|
| Rate for Payer: Aetna Commercial |
$295.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.05
|
| Rate for Payer: Cash Price |
$278.22
|
| Rate for Payer: Cofinity Commercial |
$243.44
|
| Rate for Payer: Cofinity Commercial |
$299.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.22
|
| Rate for Payer: Healthscope Commercial |
$312.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.60
|
| Rate for Payer: PHP Commercial |
$295.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.05
|
| Rate for Payer: Priority Health SBD |
$219.10
|
| Rate for Payer: UMR Bronson Commercial |
$153.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.83
|
|
|
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS DUCT
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 19110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,330.23
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
204885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.19 |
| Max. Negotiated Rate |
$1,197.21 |
| Rate for Payer: Aetna American Axle |
$864.65
|
| Rate for Payer: Aetna Commercial |
$1,130.70
|
| Rate for Payer: Aetna Medicare |
$665.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.65
|
| Rate for Payer: BCBS Complete |
$532.09
|
| Rate for Payer: Cash Price |
$1,064.18
|
| Rate for Payer: Cofinity Commercial |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$931.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.18
|
| Rate for Payer: Healthscope Commercial |
$1,197.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$931.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.70
|
| Rate for Payer: PHP Commercial |
$1,130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.65
|
| Rate for Payer: Priority Health SBD |
$838.04
|
| Rate for Payer: UMR Bronson Commercial |
$492.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.67
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,330.23
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
204885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.30 |
| Max. Negotiated Rate |
$1,197.21 |
| Rate for Payer: Aetna American Axle |
$864.65
|
| Rate for Payer: Aetna Commercial |
$1,130.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.65
|
| Rate for Payer: Cash Price |
$1,064.18
|
| Rate for Payer: Cofinity Commercial |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$931.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.18
|
| Rate for Payer: Healthscope Commercial |
$1,197.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$931.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.70
|
| Rate for Payer: PHP Commercial |
$1,130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.65
|
| Rate for Payer: Priority Health SBD |
$838.04
|
| Rate for Payer: UMR Bronson Commercial |
$585.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.67
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,330.23
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
204884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.30 |
| Max. Negotiated Rate |
$1,197.21 |
| Rate for Payer: Aetna American Axle |
$864.65
|
| Rate for Payer: Aetna Commercial |
$1,130.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.65
|
| Rate for Payer: Cash Price |
$1,064.18
|
| Rate for Payer: Cofinity Commercial |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$931.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.18
|
| Rate for Payer: Healthscope Commercial |
$1,197.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$931.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.70
|
| Rate for Payer: PHP Commercial |
$1,130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.65
|
| Rate for Payer: Priority Health SBD |
$838.04
|
| Rate for Payer: UMR Bronson Commercial |
$585.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.67
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,330.23
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
204884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.19 |
| Max. Negotiated Rate |
$1,197.21 |
| Rate for Payer: Aetna American Axle |
$864.65
|
| Rate for Payer: Aetna Commercial |
$1,130.70
|
| Rate for Payer: Aetna Medicare |
$665.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.65
|
| Rate for Payer: BCBS Complete |
$532.09
|
| Rate for Payer: Cash Price |
$1,064.18
|
| Rate for Payer: Cofinity Commercial |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$931.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.18
|
| Rate for Payer: Healthscope Commercial |
$1,197.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$931.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.70
|
| Rate for Payer: PHP Commercial |
$1,130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.65
|
| Rate for Payer: Priority Health SBD |
$838.04
|
| Rate for Payer: UMR Bronson Commercial |
$492.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.67
|
|
|
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 Commercial |
$11,984.62
|
| Rate for Payer: Cofinity Commercial |
$9,754.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,754.93
|
| 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: PHP Commercial |
$11,845.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,058.15
|
| Rate for Payer: Priority Health SBD |
$8,779.43
|
| 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
|
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 Commercial |
$11,984.62
|
| Rate for Payer: Cofinity Commercial |
$9,754.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,754.93
|
| 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: PHP Commercial |
$11,845.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,058.15
|
| 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
|
|
|
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 Commercial |
$4,188.75
|
| Rate for Payer: Cofinity Commercial |
$5,146.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,188.75
|
| 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: PHP Commercial |
$5,086.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,889.55
|
| 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
|
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 Commercial |
$4,188.75
|
| Rate for Payer: Cofinity Commercial |
$5,146.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,188.75
|
| 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: PHP Commercial |
$5,086.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,889.55
|
| Rate for Payer: Priority Health SBD |
$3,769.88
|
| 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
|
$2,685.81
|
|
|
Service Code
|
NDC 64980052660
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$2,417.23 |
| Rate for Payer: Aetna American Axle |
$1,745.78
|
| Rate for Payer: Aetna Commercial |
$2,282.94
|
| Rate for Payer: Aetna Medicare |
$1,342.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,745.78
|
| Rate for Payer: BCBS Complete |
$1,074.32
|
| Rate for Payer: Cash Price |
$2,148.65
|
| Rate for Payer: Cofinity Commercial |
$1,880.07
|
| Rate for Payer: Cofinity Commercial |
$2,309.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,880.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.65
|
| Rate for Payer: Healthscope Commercial |
$2,417.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,880.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,014.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,282.94
|
| Rate for Payer: PHP Commercial |
$2,282.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,745.78
|
| Rate for Payer: Priority Health SBD |
$1,692.06
|
| Rate for Payer: UMR Bronson Commercial |
$993.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,014.36
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$2,685.81
|
|
|
Service Code
|
NDC 64980052660
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,181.76 |
| Max. Negotiated Rate |
$2,417.23 |
| Rate for Payer: Aetna American Axle |
$1,745.78
|
| Rate for Payer: Aetna Commercial |
$2,282.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,745.78
|
| Rate for Payer: Cash Price |
$2,148.65
|
| Rate for Payer: Cofinity Commercial |
$1,880.07
|
| Rate for Payer: Cofinity Commercial |
$2,309.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,880.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.65
|
| Rate for Payer: Healthscope Commercial |
$2,417.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,880.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,014.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,282.94
|
| Rate for Payer: PHP Commercial |
$2,282.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,745.78
|
| Rate for Payer: Priority Health SBD |
$1,692.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,181.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,014.36
|
|
|
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 Commercial |
$1,692.09
|
| Rate for Payer: Cofinity Commercial |
$2,078.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,692.09
|
| 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: PHP Commercial |
$2,054.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.23
|
| 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 Commercial |
$1,692.09
|
| Rate for Payer: Cofinity Commercial |
$2,078.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,692.09
|
| 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: PHP Commercial |
$2,054.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.23
|
| Rate for Payer: Priority Health SBD |
$1,522.88
|
| Rate for Payer: UMR Bronson Commercial |
$894.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,812.95
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4,916.23
|
|
|
Service Code
|
NDC 70954049610
|
| Hospital Charge Code |
10723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,163.14 |
| Max. Negotiated Rate |
$4,424.61 |
| Rate for Payer: Aetna American Axle |
$3,195.55
|
| Rate for Payer: Aetna Commercial |
$4,178.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,195.55
|
| Rate for Payer: Cash Price |
$3,932.98
|
| Rate for Payer: Cofinity Commercial |
$3,441.36
|
| Rate for Payer: Cofinity Commercial |
$4,227.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,441.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,932.98
|
| Rate for Payer: Healthscope Commercial |
$4,424.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,441.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,687.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,178.80
|
| Rate for Payer: PHP Commercial |
$4,178.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,195.55
|
| Rate for Payer: Priority Health SBD |
$3,097.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,163.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,687.17
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4,916.23
|
|
|
Service Code
|
NDC 70954049610
|
| Hospital Charge Code |
10723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,819.01 |
| Max. Negotiated Rate |
$4,424.61 |
| Rate for Payer: Aetna American Axle |
$3,195.55
|
| Rate for Payer: Aetna Commercial |
$4,178.80
|
| Rate for Payer: Aetna Medicare |
$2,458.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,195.55
|
| Rate for Payer: BCBS Complete |
$1,966.49
|
| Rate for Payer: Cash Price |
$3,932.98
|
| Rate for Payer: Cofinity Commercial |
$3,441.36
|
| Rate for Payer: Cofinity Commercial |
$4,227.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,441.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,932.98
|
| Rate for Payer: Healthscope Commercial |
$4,424.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,441.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,687.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,178.80
|
| Rate for Payer: PHP Commercial |
$4,178.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,195.55
|
| Rate for Payer: Priority Health SBD |
$3,097.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,819.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,687.17
|
|
|
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 Commercial |
$565.66
|
| Rate for Payer: Cofinity Commercial |
$694.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.66
|
| 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: PHP Commercial |
$686.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.25
|
| 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 Commercial |
$565.66
|
| Rate for Payer: Cofinity Commercial |
$694.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.66
|
| 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: PHP Commercial |
$686.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.25
|
| Rate for Payer: Priority Health SBD |
$509.09
|
| 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
|
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 Commercial |
$573.89
|
| Rate for Payer: Cofinity Commercial |
$705.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$573.89
|
| 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: PHP Commercial |
$696.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.90
|
| Rate for Payer: Priority Health SBD |
$516.50
|
| 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
|
$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 Commercial |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.74
|
| 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: PHP Commercial |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.33
|
| 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
|
IP
|
$767.04
|
|
|
Service Code
|
NDC 00904702661
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$690.34 |
| Rate for Payer: Aetna American Axle |
$498.58
|
| Rate for Payer: Aetna Commercial |
$651.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.58
|
| Rate for Payer: Cash Price |
$613.63
|
| Rate for Payer: Cofinity Commercial |
$536.93
|
| Rate for Payer: Cofinity Commercial |
$659.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.63
|
| Rate for Payer: Healthscope Commercial |
$690.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.98
|
| Rate for Payer: PHP Commercial |
$651.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.58
|
| Rate for Payer: Priority Health SBD |
$483.24
|
| Rate for Payer: UMR Bronson Commercial |
$337.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.28
|
|
|
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 Commercial |
$573.89
|
| Rate for Payer: Cofinity Commercial |
$705.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$573.89
|
| 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: PHP Commercial |
$696.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.90
|
| 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
|
$767.04
|
|
|
Service Code
|
NDC 00904702661
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$690.34 |
| Rate for Payer: Aetna American Axle |
$498.58
|
| Rate for Payer: Aetna Commercial |
$651.98
|
| Rate for Payer: Aetna Medicare |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.58
|
| Rate for Payer: BCBS Complete |
$306.82
|
| Rate for Payer: Cash Price |
$613.63
|
| Rate for Payer: Cofinity Commercial |
$536.93
|
| Rate for Payer: Cofinity Commercial |
$659.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.63
|
| Rate for Payer: Healthscope Commercial |
$690.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.98
|
| Rate for Payer: PHP Commercial |
$651.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.58
|
| Rate for Payer: Priority Health SBD |
$483.24
|
| Rate for Payer: UMR Bronson Commercial |
$283.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.28
|
|
|
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 Commercial |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.74
|
| 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: PHP Commercial |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.33
|
| Rate for Payer: Priority Health SBD |
$5.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.15
|
|
