|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,017.99
|
|
|
Service Code
|
NDC 42806050209
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$641.33 |
| Max. Negotiated Rate |
$916.19 |
| Rate for Payer: Aetna Commercial |
$865.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.69
|
| Rate for Payer: Cash Price |
$814.39
|
| Rate for Payer: Cofinity Advantage |
$712.59
|
| Rate for Payer: Cofinity Commercial |
$875.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.39
|
| Rate for Payer: Healthscope Commercial |
$916.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$763.49
|
| Rate for Payer: PHP Commercial |
$865.29
|
| Rate for Payer: Priority Health SBD |
$641.33
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$1,017.99
|
|
|
Service Code
|
NDC 42806050209
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.07 |
| Max. Negotiated Rate |
$916.19 |
| Rate for Payer: Aetna Commercial |
$865.29
|
| Rate for Payer: Aetna Medicare |
$509.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.69
|
| Rate for Payer: BCBS Complete |
$407.20
|
| Rate for Payer: Cash Price |
$814.39
|
| Rate for Payer: Cofinity Advantage |
$712.59
|
| Rate for Payer: Cofinity Commercial |
$875.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.39
|
| Rate for Payer: Healthscope Commercial |
$916.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$814.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$763.49
|
| Rate for Payer: PHP Commercial |
$865.29
|
| Rate for Payer: Priority Health SBD |
$641.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.69
|
| Rate for Payer: UHC Core |
$530.37
|
| Rate for Payer: UHC Exchange |
$400.07
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$789.55
|
|
|
Service Code
|
NDC 00378143077
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.42 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Advantage |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.16
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health SBD |
$497.42
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$789.55
|
|
|
Service Code
|
NDC 00378143077
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.29 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna Medicare |
$394.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: BCBS Complete |
$315.82
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Advantage |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$631.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.16
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health SBD |
$497.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.21
|
| Rate for Payer: UHC Core |
$411.36
|
| Rate for Payer: UHC Exchange |
$310.29
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$270.98
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$243.88 |
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: Aetna Commercial |
$268.19
|
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Medicare |
$135.49
|
| Rate for Payer: Aetna Medicare |
$157.76
|
| Rate for Payer: Aetna Medicare |
$172.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.39
|
| Rate for Payer: BCBS Complete |
$138.09
|
| Rate for Payer: BCBS Complete |
$108.39
|
| Rate for Payer: BCBS Complete |
$126.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$276.18
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$276.18
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cofinity Advantage |
$220.86
|
| Rate for Payer: Cofinity Advantage |
$189.69
|
| Rate for Payer: Cofinity Advantage |
$241.65
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$271.35
|
| Rate for Payer: Cofinity Commercial |
$296.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$310.70
|
| Rate for Payer: Healthscope Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.92
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: PHP Commercial |
$268.19
|
| Rate for Payer: PHP Commercial |
$293.44
|
| Rate for Payer: Priority Health SBD |
$170.72
|
| Rate for Payer: Priority Health SBD |
$217.49
|
| Rate for Payer: Priority Health SBD |
$198.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$315.52
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.78 |
| Max. Negotiated Rate |
$283.97 |
| Rate for Payer: Aetna Commercial |
$268.19
|
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.14
|
| Rate for Payer: Cash Price |
$276.18
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Advantage |
$220.86
|
| Rate for Payer: Cofinity Advantage |
$189.69
|
| Rate for Payer: Cofinity Advantage |
$241.65
|
| Rate for Payer: Cofinity Commercial |
$296.89
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$271.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.18
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: Healthscope Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$310.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.64
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: PHP Commercial |
$293.44
|
| Rate for Payer: PHP Commercial |
$268.19
|
| Rate for Payer: Priority Health SBD |
$217.49
|
| Rate for Payer: Priority Health SBD |
$170.72
|
| Rate for Payer: Priority Health SBD |
$198.78
|
|
|
NICARDIPINE 50 MG/250 ML NS (IV PREMIX)
|
Facility
|
OP
|
$193.50
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
180442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$174.15 |
| Rate for Payer: Aetna Commercial |
$164.47
|
| Rate for Payer: Aetna Medicare |
$96.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: BCBS Complete |
$77.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cofinity Advantage |
$135.45
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$174.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.12
|
| Rate for Payer: PHP Commercial |
$164.47
|
| Rate for Payer: Priority Health SBD |
$121.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
|
|
NICARDIPINE 50 MG/250 ML NS (IV PREMIX)
|
Facility
|
IP
|
$193.50
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
180442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.91 |
| Max. Negotiated Rate |
$174.15 |
| Rate for Payer: Aetna Commercial |
$164.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cofinity Advantage |
$135.45
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$174.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.12
|
| Rate for Payer: PHP Commercial |
$164.47
|
| Rate for Payer: Priority Health SBD |
$121.91
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$64.32
|
|
|
Service Code
|
NDC 00536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Aetna Medicare |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.81
|
| Rate for Payer: BCBS Complete |
$25.73
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Advantage |
$45.02
|
| Rate for Payer: Cofinity Commercial |
$55.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.24
|
| Rate for Payer: PHP Commercial |
$54.67
|
| Rate for Payer: Priority Health SBD |
$40.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.81
|
| Rate for Payer: UHC Core |
$33.51
|
| Rate for Payer: UHC Exchange |
$25.28
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$111.15
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.25
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Advantage |
$77.81
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health SBD |
$70.02
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$64.32
|
|
|
Service Code
|
NDC 00536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.81
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Advantage |
$45.02
|
| Rate for Payer: Cofinity Commercial |
$55.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.24
|
| Rate for Payer: PHP Commercial |
$54.67
|
| Rate for Payer: Priority Health SBD |
$40.52
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$7.66
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.98
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cofinity Advantage |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.13
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: Priority Health SBD |
$4.83
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: BCBS Complete |
$42.85
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.63
|
| Rate for Payer: UHC Core |
$55.81
|
| Rate for Payer: UHC Exchange |
$42.10
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.93
|
|
|
Service Code
|
NDC 48985000150
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna Commercial |
$91.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.15
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cofinity Advantage |
$75.55
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.34
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.95
|
| Rate for Payer: PHP Commercial |
$91.74
|
| Rate for Payer: Priority Health SBD |
$68.00
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$111.15
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna Medicare |
$55.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.25
|
| Rate for Payer: BCBS Complete |
$44.46
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Advantage |
$77.81
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health SBD |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.25
|
| Rate for Payer: UHC Core |
$57.91
|
| Rate for Payer: UHC Exchange |
$43.68
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$89.31
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$80.38 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.45
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$76.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.45
|
| Rate for Payer: Healthscope Commercial |
$80.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.27
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$89.31
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$80.38 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.45
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$76.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.45
|
| Rate for Payer: Healthscope Commercial |
$80.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.10
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.93
|
|
|
Service Code
|
NDC 48985000150
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna Commercial |
$91.74
|
| Rate for Payer: Aetna Medicare |
$53.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.15
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cofinity Advantage |
$75.55
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.34
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.95
|
| Rate for Payer: PHP Commercial |
$91.74
|
| Rate for Payer: Priority Health SBD |
$68.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.15
|
| Rate for Payer: UHC Core |
$56.23
|
| Rate for Payer: UHC Exchange |
$42.42
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$7.66
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.98
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cofinity Advantage |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.13
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: Priority Health SBD |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$3.99
|
| Rate for Payer: UHC Exchange |
$3.01
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$121.91
|
|
|
Service Code
|
NDC 48985000152
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$103.62
|
| Rate for Payer: Aetna Medicare |
$60.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.24
|
| Rate for Payer: BCBS Complete |
$48.76
|
| Rate for Payer: Cash Price |
$97.53
|
| Rate for Payer: Cofinity Advantage |
$85.34
|
| Rate for Payer: Cofinity Commercial |
$104.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.53
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.43
|
| Rate for Payer: PHP Commercial |
$103.62
|
| Rate for Payer: Priority Health SBD |
$76.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.24
|
| Rate for Payer: UHC Core |
$63.52
|
| Rate for Payer: UHC Exchange |
$47.91
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: BCBS Complete |
$42.85
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.63
|
| Rate for Payer: UHC Core |
$55.81
|
| Rate for Payer: UHC Exchange |
$42.10
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$86.49
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$77.84 |
| Rate for Payer: Aetna Commercial |
$73.52
|
| Rate for Payer: Aetna Medicare |
$43.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.22
|
| Rate for Payer: BCBS Complete |
$34.60
|
| Rate for Payer: Cash Price |
$69.19
|
| Rate for Payer: Cofinity Advantage |
$60.54
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.19
|
| Rate for Payer: Healthscope Commercial |
$77.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.87
|
| Rate for Payer: PHP Commercial |
$73.52
|
| Rate for Payer: Priority Health SBD |
$54.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.22
|
| Rate for Payer: UHC Core |
$45.06
|
| Rate for Payer: UHC Exchange |
$33.99
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$111.15
|
|
|
Service Code
|
NDC 43598044874
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna Medicare |
$55.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.25
|
| Rate for Payer: BCBS Complete |
$44.46
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Advantage |
$77.81
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health SBD |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.25
|
| Rate for Payer: UHC Core |
$57.91
|
| Rate for Payer: UHC Exchange |
$43.68
|
|
