|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$44.70
|
|
|
Service Code
|
NDC 62559021052
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna American Axle |
$29.06
|
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.06
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Commercial |
$38.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$40.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.00
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.06
|
| Rate for Payer: Priority Health SBD |
$28.16
|
| Rate for Payer: UMR Bronson Commercial |
$19.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.52
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
NDC 23155051200
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$253.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$17.72
|
|
|
Service Code
|
NDC 57664013560
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Medicare |
$8.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.52
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$44.70
|
|
|
Service Code
|
NDC 62559021052
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna American Axle |
$29.06
|
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare |
$22.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.06
|
| Rate for Payer: BCBS Complete |
$17.88
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Commercial |
$38.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$40.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.00
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.06
|
| Rate for Payer: Priority Health SBD |
$28.16
|
| Rate for Payer: UMR Bronson Commercial |
$16.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.52
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 69452020907
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna American Axle |
$3.17
|
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.17
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$4.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.15
|
| Rate for Payer: PHP Commercial |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.17
|
| Rate for Payer: Priority Health SBD |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.66
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$146.16
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna Medicare |
$73.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: BCBS Complete |
$58.46
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.24
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.00
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
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
|
|
|
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
|
|
|
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS DUCT
|
Facility
|
OP
|
$11,792.02
|
|
|
Service Code
|
CPT 19110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,828.88
|
| Rate for Payer: BCCCP Commercial |
$467.47
|
| Rate for Payer: BCN Commercial |
$1,828.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.09
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$341.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
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 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 |
$474.02 |
| Max. Negotiated Rate |
$1,389.36 |
| 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: BCBS Trust/PPO |
$1,389.36
|
| Rate for Payer: BCN Commercial |
$1,389.36
|
| Rate for Payer: Cash Price |
$1,064.18
|
| 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 HMO/PPO/Tiered Network |
$592.52
|
| Rate for Payer: Priority Health Narrow Network |
$474.02
|
| 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 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 |
$474.02 |
| Max. Negotiated Rate |
$1,389.36 |
| 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: BCBS Trust/PPO |
$1,389.36
|
| Rate for Payer: BCN Commercial |
$1,389.36
|
| Rate for Payer: Cash Price |
$1,064.18
|
| 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 HMO/PPO/Tiered Network |
$592.52
|
| Rate for Payer: Priority Health Narrow Network |
$474.02
|
| 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 50 MG/0.5 ML VFC ELIGIBLE INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,389.36
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
301676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.02 |
| Max. Negotiated Rate |
$1,389.36 |
| Rate for Payer: BCBS Trust/PPO |
$1,389.36
|
| Rate for Payer: BCN Commercial |
$1,389.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.52
|
| Rate for Payer: Priority Health Narrow Network |
$474.02
|
|
|
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
|
$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 |
$1,208.64
|
| 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
|
|
|
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
|
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 |
$2,991.96
|
| 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
|
$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 |
$6,967.80
|
| 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
|
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
|
$2,417.27
|
|
|
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
|
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
|
|
|
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 |
$2,458.12
|
| 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 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 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
|
|
