|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$45.57
|
|
|
Service Code
|
NDC 00168000715
|
| 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 |
$22.78
|
| 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 Commercial |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.90
|
| 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: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.62
|
| Rate for Payer: Priority Health SBD |
$28.71
|
| Rate for Payer: UMR Bronson Commercial |
$16.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.18
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$67.62
|
|
|
Service Code
|
NDC 45802004811
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Aetna American Axle |
$43.95
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.95
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$58.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.48
|
| Rate for Payer: PHP Commercial |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health SBD |
$42.60
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$67.62
|
|
|
Service Code
|
NDC 45802004811
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$60.86 |
| Rate for Payer: Aetna American Axle |
$43.95
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.95
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$58.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.48
|
| Rate for Payer: PHP Commercial |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health SBD |
$42.60
|
| Rate for Payer: UMR Bronson Commercial |
$25.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
NDC 45802004835
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna American Axle |
$29.32
|
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: Aetna Medicare |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: BCBS Complete |
$18.04
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$31.57
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.32
|
| Rate for Payer: Priority Health SBD |
$28.41
|
| Rate for Payer: UMR Bronson Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.82
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 00713068615
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna American Axle |
$8.38
|
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: PHP Commercial |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$5.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$45.57
|
|
|
Service Code
|
NDC 00168000715
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$41.01 |
| Rate for Payer: Aetna American Axle |
$29.62
|
| Rate for Payer: Aetna Commercial |
$38.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.62
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$31.90
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.90
|
| 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: Multiplan/Beech St/PHCS Commercial |
$38.73
|
| Rate for Payer: PHP Commercial |
$38.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.62
|
| Rate for Payer: Priority Health SBD |
$28.71
|
| Rate for Payer: UMR Bronson Commercial |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.18
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 00713068615
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna American Axle |
$8.38
|
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: PHP Commercial |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
NDC 45802004835
|
| Hospital Charge Code |
5750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna American Axle |
$29.32
|
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$31.57
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.32
|
| Rate for Payer: Priority Health SBD |
$28.41
|
| Rate for Payer: UMR Bronson Commercial |
$19.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.82
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$107.61
|
|
|
Service Code
|
NDC 00121086816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna American Axle |
$69.95
|
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.95
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.09
|
| Rate for Payer: Healthscope Commercial |
$96.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.47
|
| Rate for Payer: PHP Commercial |
$91.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.95
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: UMR Bronson Commercial |
$39.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.71
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 66689003750
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$120.86
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$108.77 |
| Rate for Payer: Aetna American Axle |
$78.56
|
| Rate for Payer: Aetna Commercial |
$102.73
|
| Rate for Payer: Aetna Medicare |
$60.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.56
|
| Rate for Payer: BCBS Complete |
$48.34
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cofinity Commercial |
$103.94
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.69
|
| Rate for Payer: Healthscope Commercial |
$108.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.73
|
| Rate for Payer: PHP Commercial |
$102.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.56
|
| Rate for Payer: Priority Health SBD |
$76.14
|
| Rate for Payer: UMR Bronson Commercial |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.64
|
|
|
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 Commercial |
$77.62
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.62
|
| 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: PHP Commercial |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.07
|
| 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
|
$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 Commercial |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.80
|
| 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: PHP Commercial |
$246.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.32
|
| Rate for Payer: Priority Health SBD |
$182.52
|
| 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
|
$120.86
|
|
|
Service Code
|
NDC 69315050447
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.18 |
| Max. Negotiated Rate |
$108.77 |
| Rate for Payer: Aetna American Axle |
$78.56
|
| Rate for Payer: Aetna Commercial |
$102.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.56
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cofinity Commercial |
$103.94
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.69
|
| Rate for Payer: Healthscope Commercial |
$108.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.73
|
| Rate for Payer: PHP Commercial |
$102.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.56
|
| Rate for Payer: Priority Health SBD |
$76.14
|
| Rate for Payer: UMR Bronson Commercial |
$53.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.64
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$107.61
|
|
|
Service Code
|
NDC 00121086816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna American Axle |
$69.95
|
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.95
|
| Rate for Payer: Cash Price |
$86.09
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.09
|
| Rate for Payer: Healthscope Commercial |
$96.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.47
|
| Rate for Payer: PHP Commercial |
$91.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.95
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: UMR Bronson Commercial |
$47.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.71
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
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 Commercial |
$1,139.15
|
| Rate for Payer: Cofinity Commercial |
$1,399.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,139.15
|
| 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: PHP Commercial |
$1,383.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.78
|
| 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
|
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 Commercial |
$1,139.15
|
| Rate for Payer: Cofinity Commercial |
$1,399.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,139.15
|
| 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: PHP Commercial |
$1,383.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.78
|
| Rate for Payer: Priority Health SBD |
$1,025.24
|
| 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
|
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 Commercial |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.64
|
| 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: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| 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
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727641
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
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 |
$145.68
|
| 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 Commercial |
$203.96
|
| Rate for Payer: Cofinity Commercial |
$250.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.96
|
| 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: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.39
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| 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
|
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 Commercial |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.64
|
| 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: PHP Commercial |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health SBD |
$6.88
|
| 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
|
$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 |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| 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 |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| 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 |
$3.82
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 00904727670
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
