Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$95.09

Service Code	NDC 00536589688
Hospital Charge Code	27863
Hospital Revenue Code	637
Min. Negotiated Rate	$59.91
Max. Negotiated Rate	$85.58
Rate for Payer: Aetna Commercial	$80.83
Rate for Payer: Aetna New Business (MI Preferred)	$61.81
Rate for Payer: Cash Price	$76.07
Rate for Payer: Cofinity Commercial	$66.56
Rate for Payer: Cofinity Commercial	$81.78
Rate for Payer: Cofinity Medicare Advantage	$66.56
Rate for Payer: Encore Health Key Benefits Commercial	$76.07
Rate for Payer: Healthscope Commercial	$85.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.83
Rate for Payer: PHP Commercial	$80.83
Rate for Payer: Priority Health Cigna Priority Health	$61.81
Rate for Payer: Priority Health SBD	$59.91

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$115.12

Service Code	NDC 00536110888
Hospital Charge Code	27863
Hospital Revenue Code	637
Min. Negotiated Rate	$46.05
Max. Negotiated Rate	$103.61
Rate for Payer: Aetna Commercial	$97.85
Rate for Payer: Aetna Medicare	$57.56
Rate for Payer: Aetna New Business (MI Preferred)	$74.83
Rate for Payer: BCBS Complete	$46.05
Rate for Payer: Cash Price	$92.10
Rate for Payer: Cofinity Commercial	$80.58
Rate for Payer: Cofinity Commercial	$99.00
Rate for Payer: Cofinity Medicare Advantage	$80.58
Rate for Payer: Encore Health Key Benefits Commercial	$92.10
Rate for Payer: Healthscope Commercial	$103.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.85
Rate for Payer: PHP Commercial	$97.85
Rate for Payer: Priority Health Cigna Priority Health	$74.83
Rate for Payer: Priority Health SBD	$72.53

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$115.12

Service Code	NDC 00536110888
Hospital Charge Code	27863
Hospital Revenue Code	637
Min. Negotiated Rate	$72.53
Max. Negotiated Rate	$103.61
Rate for Payer: Aetna Commercial	$97.85
Rate for Payer: Aetna New Business (MI Preferred)	$74.83
Rate for Payer: Cash Price	$92.10
Rate for Payer: Cofinity Commercial	$80.58
Rate for Payer: Cofinity Commercial	$99.00
Rate for Payer: Cofinity Medicare Advantage	$80.58
Rate for Payer: Encore Health Key Benefits Commercial	$92.10
Rate for Payer: Healthscope Commercial	$103.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.85
Rate for Payer: PHP Commercial	$97.85
Rate for Payer: Priority Health Cigna Priority Health	$74.83
Rate for Payer: Priority Health SBD	$72.53

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$111.15

Service Code	NDC 43598044874
Hospital Charge Code	27863
Hospital Revenue Code	637
Min. Negotiated Rate	$44.46
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 Commercial	$77.81
Rate for Payer: Cofinity Commercial	$95.59
Rate for Payer: Cofinity Medicare Advantage	$77.81
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: PHP Commercial	$94.48
Rate for Payer: Priority Health Cigna Priority Health	$72.25
Rate for Payer: Priority Health SBD	$70.02

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$65.56

Service Code	NDC 43598044670
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$55.73
Rate for Payer: Aetna New Business (MI Preferred)	$42.61
Rate for Payer: Cash Price	$52.45
Rate for Payer: Cofinity Commercial	$45.89
Rate for Payer: Cofinity Commercial	$56.38
Rate for Payer: Cofinity Medicare Advantage	$45.89
Rate for Payer: Encore Health Key Benefits Commercial	$52.45
Rate for Payer: Healthscope Commercial	$59.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.73
Rate for Payer: PHP Commercial	$55.73
Rate for Payer: Priority Health Cigna Priority Health	$42.61
Rate for Payer: Priority Health SBD	$41.30

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$65.56

Service Code	NDC 43598044670
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$26.22
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$55.73
Rate for Payer: Aetna Medicare	$32.78
Rate for Payer: Aetna New Business (MI Preferred)	$42.61
Rate for Payer: BCBS Complete	$26.22
Rate for Payer: Cash Price	$52.45
Rate for Payer: Cofinity Commercial	$45.89
Rate for Payer: Cofinity Commercial	$56.38
Rate for Payer: Cofinity Medicare Advantage	$45.89
Rate for Payer: Encore Health Key Benefits Commercial	$52.45
Rate for Payer: Healthscope Commercial	$59.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.73
Rate for Payer: PHP Commercial	$55.73
Rate for Payer: Priority Health Cigna Priority Health	$42.61
Rate for Payer: Priority Health SBD	$41.30

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$8.04

Service Code	NDC 43598044671
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$6.83
Rate for Payer: Aetna New Business (MI Preferred)	$5.23
Rate for Payer: Cash Price	$6.43
Rate for Payer: Cofinity Commercial	$5.63
Rate for Payer: Cofinity Commercial	$6.91
Rate for Payer: Cofinity Medicare Advantage	$5.63
Rate for Payer: Encore Health Key Benefits Commercial	$6.43
Rate for Payer: Healthscope Commercial	$7.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.83
Rate for Payer: PHP Commercial	$6.83
Rate for Payer: Priority Health Cigna Priority Health	$5.23
Rate for Payer: Priority Health SBD	$5.07

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$8.04

Service Code	NDC 43598044671
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$6.83
Rate for Payer: Aetna Medicare	$4.02
Rate for Payer: Aetna New Business (MI Preferred)	$5.23
Rate for Payer: BCBS Complete	$3.22
Rate for Payer: Cash Price	$6.43
Rate for Payer: Cofinity Commercial	$5.63
Rate for Payer: Cofinity Commercial	$6.91
Rate for Payer: Cofinity Medicare Advantage	$5.63
Rate for Payer: Encore Health Key Benefits Commercial	$6.43
Rate for Payer: Healthscope Commercial	$7.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.83
Rate for Payer: PHP Commercial	$6.83
Rate for Payer: Priority Health Cigna Priority Health	$5.23
Rate for Payer: Priority Health SBD	$5.07

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$112.50

Service Code	NDC 00536110688
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$95.62
Rate for Payer: Aetna New Business (MI Preferred)	$73.12
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cofinity Commercial	$78.75
Rate for Payer: Cofinity Commercial	$96.75
Rate for Payer: Cofinity Medicare Advantage	$78.75
Rate for Payer: Encore Health Key Benefits Commercial	$90.00
Rate for Payer: Healthscope Commercial	$101.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.62
Rate for Payer: PHP Commercial	$95.62
Rate for Payer: Priority Health Cigna Priority Health	$73.12
Rate for Payer: Priority Health SBD	$70.88

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$112.50

Service Code	NDC 00536110688
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$95.62
Rate for Payer: Aetna Medicare	$56.25
Rate for Payer: Aetna New Business (MI Preferred)	$73.12
Rate for Payer: BCBS Complete	$45.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cofinity Commercial	$78.75
Rate for Payer: Cofinity Commercial	$96.75
Rate for Payer: Cofinity Medicare Advantage	$78.75
Rate for Payer: Encore Health Key Benefits Commercial	$90.00
Rate for Payer: Healthscope Commercial	$101.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.62
Rate for Payer: PHP Commercial	$95.62
Rate for Payer: Priority Health Cigna Priority Health	$73.12
Rate for Payer: Priority Health SBD	$70.88

NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE

Facility

$247.61

Service Code	NDC 45802034405
Hospital Charge Code	34769
Hospital Revenue Code	637
Min. Negotiated Rate	$99.04
Max. Negotiated Rate	$222.85
Rate for Payer: Aetna Commercial	$210.47
Rate for Payer: Aetna Medicare	$123.81
Rate for Payer: Aetna New Business (MI Preferred)	$160.95
Rate for Payer: BCBS Complete	$99.04
Rate for Payer: Cash Price	$198.09
Rate for Payer: Cofinity Commercial	$173.33
Rate for Payer: Cofinity Commercial	$212.94
Rate for Payer: Cofinity Medicare Advantage	$173.33
Rate for Payer: Encore Health Key Benefits Commercial	$198.09
Rate for Payer: Healthscope Commercial	$222.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.47
Rate for Payer: PHP Commercial	$210.47
Rate for Payer: Priority Health Cigna Priority Health	$160.95
Rate for Payer: Priority Health SBD	$155.99

NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE

Facility

$247.61

Service Code	NDC 45802034405
Hospital Charge Code	34769
Hospital Revenue Code	637
Min. Negotiated Rate	$155.99
Max. Negotiated Rate	$222.85
Rate for Payer: Aetna Commercial	$210.47
Rate for Payer: Aetna New Business (MI Preferred)	$160.95
Rate for Payer: Cash Price	$198.09
Rate for Payer: Cofinity Commercial	$173.33
Rate for Payer: Cofinity Commercial	$212.94
Rate for Payer: Cofinity Medicare Advantage	$173.33
Rate for Payer: Encore Health Key Benefits Commercial	$198.09
Rate for Payer: Healthscope Commercial	$222.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.47
Rate for Payer: PHP Commercial	$210.47
Rate for Payer: Priority Health Cigna Priority Health	$160.95
Rate for Payer: Priority Health SBD	$155.99

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$289.34

Service Code	NDC 45802008902
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$115.74
Max. Negotiated Rate	$260.41
Rate for Payer: Aetna Commercial	$245.94
Rate for Payer: Aetna Medicare	$144.67
Rate for Payer: Aetna New Business (MI Preferred)	$188.07
Rate for Payer: BCBS Complete	$115.74
Rate for Payer: Cash Price	$231.47
Rate for Payer: Cofinity Commercial	$202.54
Rate for Payer: Cofinity Commercial	$248.83
Rate for Payer: Cofinity Medicare Advantage	$202.54
Rate for Payer: Encore Health Key Benefits Commercial	$231.47
Rate for Payer: Healthscope Commercial	$260.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.94
Rate for Payer: PHP Commercial	$245.94
Rate for Payer: Priority Health Cigna Priority Health	$188.07
Rate for Payer: Priority Health SBD	$182.28

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$289.34

Service Code	NDC 45802008902
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$182.28
Max. Negotiated Rate	$260.41
Rate for Payer: Aetna Commercial	$245.94
Rate for Payer: Aetna New Business (MI Preferred)	$188.07
Rate for Payer: Cash Price	$231.47
Rate for Payer: Cofinity Commercial	$202.54
Rate for Payer: Cofinity Commercial	$248.83
Rate for Payer: Cofinity Medicare Advantage	$202.54
Rate for Payer: Encore Health Key Benefits Commercial	$231.47
Rate for Payer: Healthscope Commercial	$260.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.94
Rate for Payer: PHP Commercial	$245.94
Rate for Payer: Priority Health Cigna Priority Health	$188.07
Rate for Payer: Priority Health SBD	$182.28

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$96.45

Service Code	NDC 45802008901
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$60.76
Max. Negotiated Rate	$86.81
Rate for Payer: Aetna Commercial	$81.98
Rate for Payer: Aetna New Business (MI Preferred)	$62.69
Rate for Payer: Cash Price	$77.16
Rate for Payer: Cofinity Commercial	$67.52
Rate for Payer: Cofinity Commercial	$82.95
Rate for Payer: Cofinity Medicare Advantage	$67.52
Rate for Payer: Encore Health Key Benefits Commercial	$77.16
Rate for Payer: Healthscope Commercial	$86.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.98
Rate for Payer: PHP Commercial	$81.98
Rate for Payer: Priority Health Cigna Priority Health	$62.69
Rate for Payer: Priority Health SBD	$60.76

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$96.45

Service Code	NDC 45802008901
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$38.58
Max. Negotiated Rate	$86.81
Rate for Payer: Aetna Commercial	$81.98
Rate for Payer: Aetna Medicare	$48.23
Rate for Payer: Aetna New Business (MI Preferred)	$62.69
Rate for Payer: BCBS Complete	$38.58
Rate for Payer: Cash Price	$77.16
Rate for Payer: Cofinity Commercial	$67.52
Rate for Payer: Cofinity Commercial	$82.95
Rate for Payer: Cofinity Medicare Advantage	$67.52
Rate for Payer: Encore Health Key Benefits Commercial	$77.16
Rate for Payer: Healthscope Commercial	$86.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.98
Rate for Payer: PHP Commercial	$81.98
Rate for Payer: Priority Health Cigna Priority Health	$62.69
Rate for Payer: Priority Health SBD	$60.76

NIFEDIPINE 10 MG CAPSULE

Facility

$326.80

Service Code	NDC 23155019401
Hospital Charge Code	5558
Hospital Revenue Code	637
Min. Negotiated Rate	$130.72
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna Medicare	$163.40
Rate for Payer: Aetna New Business (MI Preferred)	$212.42
Rate for Payer: BCBS Complete	$130.72
Rate for Payer: Cash Price	$261.44
Rate for Payer: Cofinity Commercial	$228.76
Rate for Payer: Cofinity Commercial	$281.05
Rate for Payer: Cofinity Medicare Advantage	$228.76
Rate for Payer: Encore Health Key Benefits Commercial	$261.44
Rate for Payer: Healthscope Commercial	$294.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.78
Rate for Payer: PHP Commercial	$277.78
Rate for Payer: Priority Health Cigna Priority Health	$212.42
Rate for Payer: Priority Health SBD	$205.88

NIFEDIPINE 10 MG CAPSULE

Facility

$326.80

Service Code	NDC 23155019401
Hospital Charge Code	5558
Hospital Revenue Code	637
Min. Negotiated Rate	$205.88
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna New Business (MI Preferred)	$212.42
Rate for Payer: Cash Price	$261.44
Rate for Payer: Cofinity Commercial	$228.76
Rate for Payer: Cofinity Commercial	$281.05
Rate for Payer: Cofinity Medicare Advantage	$228.76
Rate for Payer: Encore Health Key Benefits Commercial	$261.44
Rate for Payer: Healthscope Commercial	$294.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.78
Rate for Payer: PHP Commercial	$277.78
Rate for Payer: Priority Health Cigna Priority Health	$212.42
Rate for Payer: Priority Health SBD	$205.88

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.91

Service Code	NDC 68084059711
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna Medicare	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: BCBS Complete	$1.56
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cofinity Commercial	$2.74
Rate for Payer: Cofinity Commercial	$3.36
Rate for Payer: Cofinity Medicare Advantage	$2.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.13
Rate for Payer: Healthscope Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.46

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$390.72

Service Code	NDC 68084059701
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$246.15
Max. Negotiated Rate	$351.65
Rate for Payer: Aetna Commercial	$332.11
Rate for Payer: Aetna New Business (MI Preferred)	$253.97
Rate for Payer: Cash Price	$312.58
Rate for Payer: Cofinity Commercial	$273.50
Rate for Payer: Cofinity Commercial	$336.02
Rate for Payer: Cofinity Medicare Advantage	$273.50
Rate for Payer: Encore Health Key Benefits Commercial	$312.58
Rate for Payer: Healthscope Commercial	$351.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.11
Rate for Payer: PHP Commercial	$332.11
Rate for Payer: Priority Health Cigna Priority Health	$253.97
Rate for Payer: Priority Health SBD	$246.15

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$390.72

Service Code	NDC 68084059701
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$156.29
Max. Negotiated Rate	$351.65
Rate for Payer: Aetna Commercial	$332.11
Rate for Payer: Aetna Medicare	$195.36
Rate for Payer: Aetna New Business (MI Preferred)	$253.97
Rate for Payer: BCBS Complete	$156.29
Rate for Payer: Cash Price	$312.58
Rate for Payer: Cofinity Commercial	$273.50
Rate for Payer: Cofinity Commercial	$336.02
Rate for Payer: Cofinity Medicare Advantage	$273.50
Rate for Payer: Encore Health Key Benefits Commercial	$312.58
Rate for Payer: Healthscope Commercial	$351.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.11
Rate for Payer: PHP Commercial	$332.11
Rate for Payer: Priority Health Cigna Priority Health	$253.97
Rate for Payer: Priority Health SBD	$246.15

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.91

Service Code	NDC 68084059711
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cofinity Commercial	$2.74
Rate for Payer: Cofinity Commercial	$3.36
Rate for Payer: Cofinity Medicare Advantage	$2.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.13
Rate for Payer: Healthscope Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.46

NIMODIPINE 30 MG CAPSULE

Facility

$185.67

Service Code	NDC 68084091232
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$74.27
Max. Negotiated Rate	$167.10
Rate for Payer: Aetna Commercial	$157.82
Rate for Payer: Aetna Medicare	$92.83
Rate for Payer: Aetna New Business (MI Preferred)	$120.69
Rate for Payer: BCBS Complete	$74.27
Rate for Payer: Cash Price	$148.54
Rate for Payer: Cofinity Commercial	$129.97
Rate for Payer: Cofinity Commercial	$159.68
Rate for Payer: Cofinity Medicare Advantage	$129.97
Rate for Payer: Encore Health Key Benefits Commercial	$148.54
Rate for Payer: Healthscope Commercial	$167.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.82
Rate for Payer: PHP Commercial	$157.82
Rate for Payer: Priority Health Cigna Priority Health	$120.69
Rate for Payer: Priority Health SBD	$116.97

NIMODIPINE 30 MG CAPSULE

Facility

$185.67

Service Code	NDC 68084091232
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$116.97
Max. Negotiated Rate	$167.10
Rate for Payer: Aetna Commercial	$157.82
Rate for Payer: Aetna New Business (MI Preferred)	$120.69
Rate for Payer: Cash Price	$148.54
Rate for Payer: Cofinity Commercial	$129.97
Rate for Payer: Cofinity Commercial	$159.68
Rate for Payer: Cofinity Medicare Advantage	$129.97
Rate for Payer: Encore Health Key Benefits Commercial	$148.54
Rate for Payer: Healthscope Commercial	$167.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.82
Rate for Payer: PHP Commercial	$157.82
Rate for Payer: Priority Health Cigna Priority Health	$120.69
Rate for Payer: Priority Health SBD	$116.97

NIMODIPINE 30 MG CAPSULE

Facility

$9.29

Service Code	NDC 68084091233
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.36
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna Medicare	$4.64
Rate for Payer: Aetna New Business (MI Preferred)	$6.04
Rate for Payer: BCBS Complete	$3.72
Rate for Payer: Cash Price	$7.43
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Cofinity Commercial	$7.99
Rate for Payer: Cofinity Medicare Advantage	$6.50
Rate for Payer: Encore Health Key Benefits Commercial	$7.43
Rate for Payer: Healthscope Commercial	$8.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.90
Rate for Payer: PHP Commercial	$7.90
Rate for Payer: Priority Health Cigna Priority Health	$6.04
Rate for Payer: Priority Health SBD	$5.85

Know your out-of-pocket cost for care.

All Charges