Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NITAZOXANIDE 500 MG TABLET

Facility

$2,417.27

Service Code	NDC 64980052621
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$1,522.88
Max. Negotiated Rate	$2,175.54
Rate for Payer: Aetna Commercial	$2,054.68
Rate for Payer: Aetna New Business (MI Preferred)	$1,571.23
Rate for Payer: Cash Price	$1,933.82
Rate for Payer: Cofinity Advantage	$1,692.09
Rate for Payer: Cofinity Commercial	$2,078.85
Rate for Payer: Encore Health Key Benefits Commercial	$1,933.82
Rate for Payer: Healthscope Commercial	$2,175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,054.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,812.95
Rate for Payer: PHP Commercial	$2,054.68
Rate for Payer: Priority Health SBD	$1,522.88

NITAZOXANIDE 500 MG TABLET

Facility

$2,311.20

Service Code	NDC 64980052660
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$908.30
Max. Negotiated Rate	$2,080.08
Rate for Payer: Aetna Commercial	$1,964.52
Rate for Payer: Aetna Medicare	$1,155.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.28
Rate for Payer: BCBS Complete	$924.48
Rate for Payer: Cash Price	$1,848.96
Rate for Payer: Cofinity Advantage	$1,617.84
Rate for Payer: Cofinity Commercial	$1,987.63
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.96
Rate for Payer: Healthscope Commercial	$2,080.08
Rate for Payer: MI Amish Medical Board Commercial	$1,848.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,733.40
Rate for Payer: PHP Commercial	$1,964.52
Rate for Payer: Priority Health SBD	$1,456.06
Rate for Payer: UHC All Payor (Choice/PPO)	$1,502.28
Rate for Payer: UHC Core	$1,204.14
Rate for Payer: UHC Exchange	$908.30

NITAZOXANIDE 500 MG TABLET

Facility

$2,311.20

Service Code	NDC 64980052660
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$1,456.06
Max. Negotiated Rate	$2,080.08
Rate for Payer: Aetna Commercial	$1,964.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.28
Rate for Payer: Cash Price	$1,848.96
Rate for Payer: Cofinity Advantage	$1,617.84
Rate for Payer: Cofinity Commercial	$1,987.63
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.96
Rate for Payer: Healthscope Commercial	$2,080.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,733.40
Rate for Payer: PHP Commercial	$1,964.52
Rate for Payer: Priority Health SBD	$1,456.06

NITAZOXANIDE 500 MG TABLET

Facility

$2,417.27

Service Code	NDC 64980052621
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$949.99
Max. Negotiated Rate	$2,175.54
Rate for Payer: Aetna Commercial	$2,054.68
Rate for Payer: Aetna Medicare	$1,208.63
Rate for Payer: Aetna New Business (MI Preferred)	$1,571.23
Rate for Payer: BCBS Complete	$966.91
Rate for Payer: Cash Price	$1,933.82
Rate for Payer: Cofinity Advantage	$1,692.09
Rate for Payer: Cofinity Commercial	$2,078.85
Rate for Payer: Encore Health Key Benefits Commercial	$1,933.82
Rate for Payer: Healthscope Commercial	$2,175.54
Rate for Payer: MI Amish Medical Board Commercial	$1,933.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,054.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,812.95
Rate for Payer: PHP Commercial	$2,054.68
Rate for Payer: Priority Health SBD	$1,522.88
Rate for Payer: UHC All Payor (Choice/PPO)	$1,571.23
Rate for Payer: UHC Core	$1,259.40
Rate for Payer: UHC Exchange	$949.99

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$794.02

Service Code	NDC 00904713761
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$312.05
Max. Negotiated Rate	$714.62
Rate for Payer: Aetna Commercial	$674.92
Rate for Payer: Aetna Medicare	$397.01
Rate for Payer: Aetna New Business (MI Preferred)	$516.11
Rate for Payer: BCBS Complete	$317.61
Rate for Payer: Cash Price	$635.22
Rate for Payer: Cofinity Advantage	$555.81
Rate for Payer: Cofinity Commercial	$682.86
Rate for Payer: Encore Health Key Benefits Commercial	$635.22
Rate for Payer: Healthscope Commercial	$714.62
Rate for Payer: MI Amish Medical Board Commercial	$635.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$595.51
Rate for Payer: PHP Commercial	$674.92
Rate for Payer: Priority Health SBD	$500.23
Rate for Payer: UHC All Payor (Choice/PPO)	$516.11
Rate for Payer: UHC Core	$413.68
Rate for Payer: UHC Exchange	$312.05

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$282.24

Service Code	NDC 47781030301
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$177.81
Max. Negotiated Rate	$254.02
Rate for Payer: Aetna Commercial	$239.90
Rate for Payer: Aetna New Business (MI Preferred)	$183.46
Rate for Payer: Cash Price	$225.79
Rate for Payer: Cofinity Advantage	$197.57
Rate for Payer: Cofinity Commercial	$242.73
Rate for Payer: Encore Health Key Benefits Commercial	$225.79
Rate for Payer: Healthscope Commercial	$254.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.68
Rate for Payer: PHP Commercial	$239.90
Rate for Payer: Priority Health SBD	$177.81

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$314.45

Service Code	NDC 70756040411
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$123.58
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$267.28
Rate for Payer: Aetna Medicare	$157.22
Rate for Payer: Aetna New Business (MI Preferred)	$204.39
Rate for Payer: BCBS Complete	$125.78
Rate for Payer: Cash Price	$251.56
Rate for Payer: Cofinity Advantage	$220.12
Rate for Payer: Cofinity Commercial	$270.43
Rate for Payer: Encore Health Key Benefits Commercial	$251.56
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: MI Amish Medical Board Commercial	$251.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.84
Rate for Payer: PHP Commercial	$267.28
Rate for Payer: Priority Health SBD	$198.10
Rate for Payer: UHC All Payor (Choice/PPO)	$204.39
Rate for Payer: UHC Core	$163.83
Rate for Payer: UHC Exchange	$123.58

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044611
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$346.37
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna Medicare	$440.67
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: BCBS Complete	$352.54
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Advantage	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Encore Health Key Benefits Commercial	$705.07
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: MI Amish Medical Board Commercial	$705.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.00
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health SBD	$555.24
Rate for Payer: UHC All Payor (Choice/PPO)	$572.87
Rate for Payer: UHC Core	$459.18
Rate for Payer: UHC Exchange	$346.37

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$421.25

Service Code	NDC 60687063365
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$265.39
Max. Negotiated Rate	$379.12
Rate for Payer: Aetna Commercial	$358.06
Rate for Payer: Aetna New Business (MI Preferred)	$273.81
Rate for Payer: Cash Price	$337.00
Rate for Payer: Cofinity Advantage	$294.88
Rate for Payer: Cofinity Commercial	$362.27
Rate for Payer: Encore Health Key Benefits Commercial	$337.00
Rate for Payer: Healthscope Commercial	$379.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.94
Rate for Payer: PHP Commercial	$358.06
Rate for Payer: Priority Health SBD	$265.39

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$314.45

Service Code	NDC 70756040411
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$267.28
Rate for Payer: Aetna New Business (MI Preferred)	$204.39
Rate for Payer: Cash Price	$251.56
Rate for Payer: Cofinity Advantage	$220.12
Rate for Payer: Cofinity Commercial	$270.43
Rate for Payer: Encore Health Key Benefits Commercial	$251.56
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$267.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.84
Rate for Payer: PHP Commercial	$267.28
Rate for Payer: Priority Health SBD	$198.10

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044601
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$555.24
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Advantage	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Encore Health Key Benefits Commercial	$705.07
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.00
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health SBD	$555.24

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$8.43

Service Code	NDC 60687063311
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna Medicare	$4.21
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: BCBS Complete	$3.37
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Advantage	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: MI Amish Medical Board Commercial	$6.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.32
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health SBD	$5.31
Rate for Payer: UHC All Payor (Choice/PPO)	$5.48
Rate for Payer: UHC Core	$4.39
Rate for Payer: UHC Exchange	$3.31

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044601
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$346.37
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna Medicare	$440.67
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: BCBS Complete	$352.54
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Advantage	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Encore Health Key Benefits Commercial	$705.07
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: MI Amish Medical Board Commercial	$705.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.00
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health SBD	$555.24
Rate for Payer: UHC All Payor (Choice/PPO)	$572.87
Rate for Payer: UHC Core	$459.18
Rate for Payer: UHC Exchange	$346.37

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044611
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$555.24
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Advantage	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Encore Health Key Benefits Commercial	$705.07
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.00
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health SBD	$555.24

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$794.02

Service Code	NDC 00904713761
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$500.23
Max. Negotiated Rate	$714.62
Rate for Payer: Aetna Commercial	$674.92
Rate for Payer: Aetna New Business (MI Preferred)	$516.11
Rate for Payer: Cash Price	$635.22
Rate for Payer: Cofinity Advantage	$555.81
Rate for Payer: Cofinity Commercial	$682.86
Rate for Payer: Encore Health Key Benefits Commercial	$635.22
Rate for Payer: Healthscope Commercial	$714.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$595.51
Rate for Payer: PHP Commercial	$674.92
Rate for Payer: Priority Health SBD	$500.23

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$282.24

Service Code	NDC 47781030301
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$110.92
Max. Negotiated Rate	$254.02
Rate for Payer: Aetna Commercial	$239.90
Rate for Payer: Aetna Medicare	$141.12
Rate for Payer: Aetna New Business (MI Preferred)	$183.46
Rate for Payer: BCBS Complete	$112.90
Rate for Payer: Cash Price	$225.79
Rate for Payer: Cofinity Advantage	$197.57
Rate for Payer: Cofinity Commercial	$242.73
Rate for Payer: Encore Health Key Benefits Commercial	$225.79
Rate for Payer: Healthscope Commercial	$254.02
Rate for Payer: MI Amish Medical Board Commercial	$225.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.68
Rate for Payer: PHP Commercial	$239.90
Rate for Payer: Priority Health SBD	$177.81
Rate for Payer: UHC All Payor (Choice/PPO)	$183.46
Rate for Payer: UHC Core	$147.05
Rate for Payer: UHC Exchange	$110.92

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$421.25

Service Code	NDC 60687063365
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$165.55
Max. Negotiated Rate	$379.12
Rate for Payer: Aetna Commercial	$358.06
Rate for Payer: Aetna Medicare	$210.62
Rate for Payer: Aetna New Business (MI Preferred)	$273.81
Rate for Payer: BCBS Complete	$168.50
Rate for Payer: Cash Price	$337.00
Rate for Payer: Cofinity Advantage	$294.88
Rate for Payer: Cofinity Commercial	$362.27
Rate for Payer: Encore Health Key Benefits Commercial	$337.00
Rate for Payer: Healthscope Commercial	$379.12
Rate for Payer: MI Amish Medical Board Commercial	$337.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.94
Rate for Payer: PHP Commercial	$358.06
Rate for Payer: Priority Health SBD	$265.39
Rate for Payer: UHC All Payor (Choice/PPO)	$273.81
Rate for Payer: UHC Core	$219.47
Rate for Payer: UHC Exchange	$165.55

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$8.43

Service Code	NDC 60687063311
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Advantage	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.32
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health SBD	$5.31

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$139.65

Service Code	NDC 00378910293
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$54.88
Max. Negotiated Rate	$125.69
Rate for Payer: Aetna Commercial	$118.70
Rate for Payer: Aetna Medicare	$69.83
Rate for Payer: Aetna New Business (MI Preferred)	$90.77
Rate for Payer: BCBS Complete	$55.86
Rate for Payer: Cash Price	$111.72
Rate for Payer: Cofinity Advantage	$97.75
Rate for Payer: Cofinity Commercial	$120.10
Rate for Payer: Encore Health Key Benefits Commercial	$111.72
Rate for Payer: Healthscope Commercial	$125.69
Rate for Payer: MI Amish Medical Board Commercial	$111.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.74
Rate for Payer: PHP Commercial	$118.70
Rate for Payer: Priority Health SBD	$87.98
Rate for Payer: UHC All Payor (Choice/PPO)	$90.77
Rate for Payer: UHC Core	$72.76
Rate for Payer: UHC Exchange	$54.88

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$4.66

Service Code	NDC 00378910216
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: MI Amish Medical Board Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94
Rate for Payer: UHC All Payor (Choice/PPO)	$3.03
Rate for Payer: UHC Core	$2.43
Rate for Payer: UHC Exchange	$1.83

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$139.65

Service Code	NDC 00378910293
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$87.98
Max. Negotiated Rate	$125.69
Rate for Payer: Aetna Commercial	$118.70
Rate for Payer: Aetna New Business (MI Preferred)	$90.77
Rate for Payer: Cash Price	$111.72
Rate for Payer: Cofinity Advantage	$97.75
Rate for Payer: Cofinity Commercial	$120.10
Rate for Payer: Encore Health Key Benefits Commercial	$111.72
Rate for Payer: Healthscope Commercial	$125.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.74
Rate for Payer: PHP Commercial	$118.70
Rate for Payer: Priority Health SBD	$87.98

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$4.66

Service Code	NDC 00378910216
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$108.59

Service Code	NDC 49730011230
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$97.73
Rate for Payer: Aetna Commercial	$92.30
Rate for Payer: Aetna Medicare	$54.30
Rate for Payer: Aetna New Business (MI Preferred)	$70.58
Rate for Payer: BCBS Complete	$43.44
Rate for Payer: Cash Price	$86.87
Rate for Payer: Cofinity Advantage	$76.01
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Encore Health Key Benefits Commercial	$86.87
Rate for Payer: Healthscope Commercial	$97.73
Rate for Payer: MI Amish Medical Board Commercial	$86.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.44
Rate for Payer: PHP Commercial	$92.30
Rate for Payer: Priority Health SBD	$68.41
Rate for Payer: UHC All Payor (Choice/PPO)	$70.58
Rate for Payer: UHC Core	$56.58
Rate for Payer: UHC Exchange	$42.68

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$108.59

Service Code	NDC 49730011230
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$68.41
Max. Negotiated Rate	$97.73
Rate for Payer: Aetna Commercial	$92.30
Rate for Payer: Aetna New Business (MI Preferred)	$70.58
Rate for Payer: Cash Price	$86.87
Rate for Payer: Cofinity Advantage	$76.01
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Encore Health Key Benefits Commercial	$86.87
Rate for Payer: Healthscope Commercial	$97.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.44
Rate for Payer: PHP Commercial	$92.30
Rate for Payer: Priority Health SBD	$68.41

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$32.38

Service Code	NDC 59762330403
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$29.14
Rate for Payer: Aetna Commercial	$27.52
Rate for Payer: Aetna New Business (MI Preferred)	$21.05
Rate for Payer: Cash Price	$25.90
Rate for Payer: Cofinity Advantage	$22.67
Rate for Payer: Cofinity Commercial	$27.85
Rate for Payer: Encore Health Key Benefits Commercial	$25.90
Rate for Payer: Healthscope Commercial	$29.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.29
Rate for Payer: PHP Commercial	$27.52
Rate for Payer: Priority Health SBD	$20.40

Know your out-of-pocket cost for care.

All Charges