|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| 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
|
$5.10
|
|
|
Service Code
|
NDC 00121478505
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: BCBS Complete |
$2.04
|
| 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 |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna American Axle |
$3.55
|
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.55
|
| Rate for Payer: Priority Health SBD |
$3.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$291.37
|
|
|
Service Code
|
NDC 00121104516
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$262.23 |
| Rate for Payer: Aetna American Axle |
$189.39
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cofinity 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 |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.53
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 68094059961
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna American Axle |
$3.55
|
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$4.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.64
|
| Rate for Payer: PHP Commercial |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.55
|
| Rate for Payer: Priority Health SBD |
$3.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$110.88
|
|
|
Service Code
|
NDC 66689000816
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna American Axle |
$72.07
|
| Rate for Payer: Aetna Commercial |
$94.25
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.07
|
| Rate for Payer: BCBS Complete |
$44.35
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cofinity 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 |
$41.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.16
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| 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 |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689003750
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| 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 |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$289.72
|
|
|
Service Code
|
NDC 60432053716
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.48 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna American Axle |
$188.32
|
| Rate for Payer: Aetna Commercial |
$246.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.32
|
| Rate for Payer: Cash Price |
$231.78
|
| Rate for Payer: Cofinity 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 |
$127.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.29
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$446.25
|
|
|
Service Code
|
NDC 09900001984
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
OP
|
$446.25
|
|
|
Service Code
|
NDC 09900001984
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna Medicare |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: BCBS Complete |
$178.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
NDC 62991278501
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
NYSTATIN (BULK) 100 MILLION UNIT POWDER
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
NDC 62991278501
|
| Hospital Charge Code |
120073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
NYSTATIN (BULK) 150 MILLION UNIT POWDER
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
NDC 51552004101
|
| Hospital Charge Code |
116152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.12
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.18
|
| Rate for Payer: UMR Bronson Commercial |
$53.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
NYSTATIN (BULK) 150 MILLION UNIT POWDER
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
NDC 51552004101
|
| Hospital Charge Code |
116152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: BCBS Complete |
$49.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.12
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.18
|
| Rate for Payer: UMR Bronson Commercial |
$45.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$35.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$42.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna American Axle |
$27.16
|
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: Aetna Medicare |
$20.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: BCBS Complete |
$16.72
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health SBD |
$26.33
|
| Rate for Payer: UMR Bronson Commercial |
$15.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$95.76
|
|
|
Service Code
|
NDC 68462031435
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$42.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 45802088014
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: UMR Bronson Commercial |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$41.79
|
|
|
Service Code
|
NDC 45802088094
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Aetna American Axle |
$27.16
|
| Rate for Payer: Aetna Commercial |
$35.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$35.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.43
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.52
|
| Rate for Payer: PHP Commercial |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health SBD |
$26.33
|
| Rate for Payer: UMR Bronson Commercial |
$18.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$95.76
|
|
|
Service Code
|
NDC 51672126302
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$86.18 |
| Rate for Payer: Aetna American Axle |
$62.24
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.24
|
| Rate for Payer: BCBS Complete |
$38.30
|
| Rate for Payer: Cash Price |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Cofinity Commercial |
$82.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$86.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: Priority Health SBD |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$35.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.82
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 45802088014
|
| Hospital Charge Code |
5754
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Medicare |
$19.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: BCBS Complete |
$15.25
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: UMR Bronson Commercial |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
|
|
OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00563
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38,671.12
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
168805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,015.29 |
| Max. Negotiated Rate |
$34,804.01 |
| Rate for Payer: Aetna American Axle |
$25,136.23
|
| Rate for Payer: Aetna Commercial |
$32,870.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,136.23
|
| Rate for Payer: Cash Price |
$30,936.90
|
| Rate for Payer: Cofinity Commercial |
$27,069.78
|
| Rate for Payer: Cofinity Commercial |
$33,257.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$27,069.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,936.90
|
| Rate for Payer: Healthscope Commercial |
$34,804.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,069.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29,003.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,870.45
|
| Rate for Payer: PHP Commercial |
$32,870.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25,136.23
|
| Rate for Payer: Priority Health SBD |
$24,362.81
|
| Rate for Payer: UMR Bronson Commercial |
$17,015.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29,003.34
|
|
