|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.16
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: ASR ASR |
$4.48
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.48
|
| Rate for Payer: Healthscope Whirlpool |
$4.62
|
| Rate for Payer: Mclaren Commercial |
$4.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.05
|
| Rate for Payer: Priority Health Narrow Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.16 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: BCBS Trust/PPO |
$199.45
|
| Rate for Payer: BCN Commercial |
$199.45
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$235.59
|
| Rate for Payer: Healthscope Whirlpool |
$242.88
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.14 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: BCBS Trust/PPO |
$189.57
|
| Rate for Payer: BCN Commercial |
$189.57
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Healthscope Whirlpool |
$230.85
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: Aetna Medicare |
$85.41
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$190.34
|
| Rate for Payer: BCN Commercial |
$190.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Healthscope Whirlpool |
$230.85
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$202.27
|
| Rate for Payer: Priority Health Narrow Network |
$161.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$242.88
|
|
|
Service Code
|
NDC 904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$218.59
|
| Rate for Payer: Aetna Medicare |
$89.87
|
| Rate for Payer: ASR ASR |
$235.59
|
| Rate for Payer: BCBS Complete |
$97.15
|
| Rate for Payer: BCBS Trust/PPO |
$200.25
|
| Rate for Payer: BCN Commercial |
$200.25
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$235.59
|
| Rate for Payer: Healthscope Whirlpool |
$242.88
|
| Rate for Payer: Mclaren Commercial |
$218.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.45
|
| Rate for Payer: Nomi Health Commercial |
$199.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$212.81
|
| Rate for Payer: Priority Health Narrow Network |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.73
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.16
|
| Rate for Payer: ASR ASR |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.48
|
| Rate for Payer: Healthscope Whirlpool |
$4.62
|
| Rate for Payer: Mclaren Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$99.10
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.32 |
| Max. Negotiated Rate |
$99.10 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: ASR ASR |
$96.13
|
| Rate for Payer: ASR ASR |
$96.13
|
| Rate for Payer: BCBS Trust/PPO |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$81.38
|
| Rate for Payer: BCN Commercial |
$81.38
|
| Rate for Payer: BCN Commercial |
$81.38
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cofinity Commercial |
$93.15
|
| Rate for Payer: Cofinity Commercial |
$93.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Healthscope Commercial |
$96.13
|
| Rate for Payer: Healthscope Commercial |
$96.13
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Mclaren Commercial |
$89.19
|
| Rate for Payer: Mclaren Commercial |
$89.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Nomi Health Commercial |
$81.26
|
| Rate for Payer: Nomi Health Commercial |
$81.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.21
|
|
|
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.10
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$99.10 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$36.67
|
| Rate for Payer: Aetna Medicare |
$36.67
|
| Rate for Payer: ASR ASR |
$96.13
|
| Rate for Payer: ASR ASR |
$96.13
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Complete |
$39.64
|
| Rate for Payer: BCBS Trust/PPO |
$81.71
|
| Rate for Payer: BCBS Trust/PPO |
$81.71
|
| Rate for Payer: BCN Commercial |
$81.71
|
| Rate for Payer: BCN Commercial |
$81.71
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cofinity Commercial |
$93.15
|
| Rate for Payer: Cofinity Commercial |
$93.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.28
|
| Rate for Payer: Healthscope Commercial |
$96.13
|
| Rate for Payer: Healthscope Commercial |
$96.13
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Mclaren Commercial |
$89.19
|
| Rate for Payer: Mclaren Commercial |
$89.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.24
|
| Rate for Payer: Nomi Health Commercial |
$81.26
|
| Rate for Payer: Nomi Health Commercial |
$81.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.21
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$7.58
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Healthscope Whirlpool |
$9.20
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.06
|
| Rate for Payer: Priority Health Narrow Network |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$13.58
|
| Rate for Payer: BCN Commercial |
$13.58
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.43
|
| Rate for Payer: Priority Health Narrow Network |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$22.74
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Healthscope Whirlpool |
$9.20
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$44.49 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: ASR ASR |
$43.15
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.68
|
| Rate for Payer: BCN Commercial |
$36.68
|
| Rate for Payer: Cash Price |
$35.59
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Healthscope Whirlpool |
$44.49
|
| Rate for Payer: Mclaren Commercial |
$40.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Nomi Health Commercial |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.98
|
| Rate for Payer: Priority Health Narrow Network |
$31.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.15
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna Medicare |
$8.85
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: BCBS Trust/PPO |
$19.72
|
| Rate for Payer: BCN Commercial |
$19.72
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.19
|
| Rate for Payer: Healthscope Whirlpool |
$23.91
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$44.49
|
|
|
Service Code
|
NDC 16864004002
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$44.49 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: ASR ASR |
$43.15
|
| Rate for Payer: BCBS Trust/PPO |
$36.53
|
| Rate for Payer: BCN Commercial |
$36.53
|
| Rate for Payer: Cash Price |
$35.59
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Healthscope Whirlpool |
$44.49
|
| Rate for Payer: Mclaren Commercial |
$40.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.82
|
| Rate for Payer: Nomi Health Commercial |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.15
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$28.33 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: ASR ASR |
$27.48
|
| Rate for Payer: BCBS Complete |
$11.33
|
| Rate for Payer: BCBS Trust/PPO |
$23.36
|
| Rate for Payer: BCN Commercial |
$23.36
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$26.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Whirlpool |
$28.33
|
| Rate for Payer: Mclaren Commercial |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$23.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.82
|
| Rate for Payer: Priority Health Narrow Network |
$19.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.93
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.64
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.19
|
| Rate for Payer: Healthscope Whirlpool |
$23.91
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.33
|
|
|
Service Code
|
NDC 11701006723
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$28.33 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: ASR ASR |
$27.48
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$26.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Whirlpool |
$28.33
|
| Rate for Payer: Mclaren Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$23.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.93
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$13.10
|
|
|
Service Code
|
NDC 96295013276
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.13
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.48
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$13.10
|
|
|
Service Code
|
NDC 96295013276
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCN Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$11.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.13
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: ASR ASR |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$20.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Whirlpool |
$22.18
|
| Rate for Payer: Mclaren Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$25.17
|
| Rate for Payer: ASR ASR |
$27.13
|
| Rate for Payer: BCBS Trust/PPO |
$22.96
|
| Rate for Payer: BCN Commercial |
$22.96
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$27.13
|
| Rate for Payer: Healthscope Whirlpool |
$27.96
|
| Rate for Payer: Mclaren Commercial |
$25.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.61
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
NDC 9629514350
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$16.93 |
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: ASR ASR |
$16.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.91
|
| Rate for Payer: BCN Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$15.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Mclaren Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.39
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.90
|
|
