Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NIMODIPINE 30 MG CAPSULE

Facility

$9.29

Service Code	NDC 68084091233
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$8.36
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna New Business (MI Preferred)	$6.04
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

NITAZOXANIDE 500 MG TABLET

Facility

$2,685.81

Service Code	NDC 64980052660
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$1,074.32
Max. Negotiated Rate	$2,417.23
Rate for Payer: Aetna Commercial	$2,282.94
Rate for Payer: Aetna Medicare	$1,342.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,745.78
Rate for Payer: BCBS Complete	$1,074.32
Rate for Payer: Cash Price	$2,148.65
Rate for Payer: Cofinity Commercial	$1,880.07
Rate for Payer: Cofinity Commercial	$2,309.80
Rate for Payer: Cofinity Medicare Advantage	$1,880.07
Rate for Payer: Encore Health Key Benefits Commercial	$2,148.65
Rate for Payer: Healthscope Commercial	$2,417.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,282.94
Rate for Payer: PHP Commercial	$2,282.94
Rate for Payer: Priority Health Cigna Priority Health	$1,745.78
Rate for Payer: Priority Health SBD	$1,692.06

NITAZOXANIDE 500 MG TABLET

Facility

$2,417.27

Service Code	NDC 64980052621
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$966.91
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 Commercial	$1,692.09
Rate for Payer: Cofinity Commercial	$2,078.85
Rate for Payer: Cofinity Medicare Advantage	$1,692.09
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: PHP Commercial	$2,054.68
Rate for Payer: Priority Health Cigna Priority Health	$1,571.23
Rate for Payer: Priority Health SBD	$1,522.88

NITAZOXANIDE 500 MG TABLET

Facility

$2,685.81

Service Code	NDC 64980052660
Hospital Charge Code	39254
Hospital Revenue Code	637
Min. Negotiated Rate	$1,692.06
Max. Negotiated Rate	$2,417.23
Rate for Payer: Aetna Commercial	$2,282.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,745.78
Rate for Payer: Cash Price	$2,148.65
Rate for Payer: Cofinity Commercial	$1,880.07
Rate for Payer: Cofinity Commercial	$2,309.80
Rate for Payer: Cofinity Medicare Advantage	$1,880.07
Rate for Payer: Encore Health Key Benefits Commercial	$2,148.65
Rate for Payer: Healthscope Commercial	$2,417.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,282.94
Rate for Payer: PHP Commercial	$2,282.94
Rate for Payer: Priority Health Cigna Priority Health	$1,745.78
Rate for Payer: Priority Health SBD	$1,692.06

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 Commercial	$1,692.09
Rate for Payer: Cofinity Commercial	$2,078.85
Rate for Payer: Cofinity Medicare Advantage	$1,692.09
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: PHP Commercial	$2,054.68
Rate for Payer: Priority Health Cigna Priority Health	$1,571.23
Rate for Payer: Priority Health SBD	$1,522.88

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044601
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$352.54
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 Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Cofinity Medicare Advantage	$616.94
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: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$572.87
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 Commercial	$555.81
Rate for Payer: Cofinity Commercial	$682.86
Rate for Payer: Cofinity Medicare Advantage	$555.81
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: PHP Commercial	$674.92
Rate for Payer: Priority Health Cigna Priority Health	$516.11
Rate for Payer: Priority Health SBD	$500.23

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$794.02

Service Code	NDC 00904713761
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$317.61
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 Commercial	$555.81
Rate for Payer: Cofinity Commercial	$682.86
Rate for Payer: Cofinity Medicare Advantage	$555.81
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: PHP Commercial	$674.92
Rate for Payer: Priority Health Cigna Priority Health	$516.11
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	$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 Commercial	$197.57
Rate for Payer: Cofinity Commercial	$242.73
Rate for Payer: Cofinity Medicare Advantage	$197.57
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: PHP Commercial	$239.90
Rate for Payer: Priority Health Cigna Priority Health	$183.46
Rate for Payer: Priority Health SBD	$177.81

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$282.24

Service Code	NDC 47781030301
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$112.90
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 Commercial	$197.57
Rate for Payer: Cofinity Commercial	$242.73
Rate for Payer: Cofinity Medicare Advantage	$197.57
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: PHP Commercial	$239.90
Rate for Payer: Priority Health Cigna Priority Health	$183.46
Rate for Payer: Priority Health SBD	$177.81

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 Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Cofinity Medicare Advantage	$616.94
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: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$572.87
Rate for Payer: Priority Health SBD	$555.24

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 Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Cofinity Medicare Advantage	$616.94
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: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$572.87
Rate for Payer: Priority Health SBD	$555.24

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084044611
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$352.54
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 Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Cofinity Medicare Advantage	$616.94
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: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$572.87
Rate for Payer: Priority Health SBD	$555.24

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$72.58

Service Code	NDC 00378910293
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$65.32
Rate for Payer: Aetna Commercial	$61.69
Rate for Payer: Aetna New Business (MI Preferred)	$47.18
Rate for Payer: Cash Price	$58.06
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Cofinity Commercial	$62.42
Rate for Payer: Cofinity Medicare Advantage	$50.81
Rate for Payer: Encore Health Key Benefits Commercial	$58.06
Rate for Payer: Healthscope Commercial	$65.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.69
Rate for Payer: PHP Commercial	$61.69
Rate for Payer: Priority Health Cigna Priority Health	$47.18
Rate for Payer: Priority Health SBD	$45.73

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$72.58

Service Code	NDC 00378910293
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$29.03
Max. Negotiated Rate	$65.32
Rate for Payer: Aetna Commercial	$61.69
Rate for Payer: Aetna Medicare	$36.29
Rate for Payer: Aetna New Business (MI Preferred)	$47.18
Rate for Payer: BCBS Complete	$29.03
Rate for Payer: Cash Price	$58.06
Rate for Payer: Cofinity Commercial	$50.81
Rate for Payer: Cofinity Commercial	$62.42
Rate for Payer: Cofinity Medicare Advantage	$50.81
Rate for Payer: Encore Health Key Benefits Commercial	$58.06
Rate for Payer: Healthscope Commercial	$65.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.69
Rate for Payer: PHP Commercial	$61.69
Rate for Payer: Priority Health Cigna Priority Health	$47.18
Rate for Payer: Priority Health SBD	$45.73

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$2.42

Service Code	NDC 00378910216
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$2.42

Service Code	NDC 00378910216
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare	$1.21
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: BCBS Complete	$0.97
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$107.45

Service Code	NDC 49730011130
Hospital Charge Code	27472
Hospital Revenue Code	637
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$96.70
Rate for Payer: Aetna Commercial	$91.33
Rate for Payer: Aetna Medicare	$53.73
Rate for Payer: Aetna New Business (MI Preferred)	$69.84
Rate for Payer: BCBS Complete	$42.98
Rate for Payer: Cash Price	$85.96
Rate for Payer: Cofinity Commercial	$75.22
Rate for Payer: Cofinity Commercial	$92.41
Rate for Payer: Cofinity Medicare Advantage	$75.22
Rate for Payer: Encore Health Key Benefits Commercial	$85.96
Rate for Payer: Healthscope Commercial	$96.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.33
Rate for Payer: PHP Commercial	$91.33
Rate for Payer: Priority Health Cigna Priority Health	$69.84
Rate for Payer: Priority Health SBD	$67.69

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$107.45

Service Code	NDC 49730011130
Hospital Charge Code	27472
Hospital Revenue Code	637
Min. Negotiated Rate	$67.69
Max. Negotiated Rate	$96.70
Rate for Payer: Aetna Commercial	$91.33
Rate for Payer: Aetna New Business (MI Preferred)	$69.84
Rate for Payer: Cash Price	$85.96
Rate for Payer: Cofinity Commercial	$75.22
Rate for Payer: Cofinity Commercial	$92.41
Rate for Payer: Cofinity Medicare Advantage	$75.22
Rate for Payer: Encore Health Key Benefits Commercial	$85.96
Rate for Payer: Healthscope Commercial	$96.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.33
Rate for Payer: PHP Commercial	$91.33
Rate for Payer: Priority Health Cigna Priority Health	$69.84
Rate for Payer: Priority Health SBD	$67.69

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	$43.44
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 Commercial	$76.01
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Cofinity Medicare Advantage	$76.01
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: PHP Commercial	$92.30
Rate for Payer: Priority Health Cigna Priority Health	$70.58
Rate for Payer: Priority Health SBD	$68.41

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.67

Service Code	NDC 68382031001
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.57
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.12
Rate for Payer: PHP Commercial	$3.12
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.31

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.67

Service Code	NDC 68382031001
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna Medicare	$1.83
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: BCBS Complete	$1.47
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.57
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.12
Rate for Payer: PHP Commercial	$3.12
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.31

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$110.02

Service Code	NDC 68382031030
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$44.01
Max. Negotiated Rate	$99.02
Rate for Payer: Aetna Commercial	$93.52
Rate for Payer: Aetna Medicare	$55.01
Rate for Payer: Aetna New Business (MI Preferred)	$71.51
Rate for Payer: BCBS Complete	$44.01
Rate for Payer: Cash Price	$88.02
Rate for Payer: Cofinity Commercial	$77.01
Rate for Payer: Cofinity Commercial	$94.62
Rate for Payer: Cofinity Medicare Advantage	$77.01
Rate for Payer: Encore Health Key Benefits Commercial	$88.02
Rate for Payer: Healthscope Commercial	$99.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.52
Rate for Payer: PHP Commercial	$93.52
Rate for Payer: Priority Health Cigna Priority Health	$71.51
Rate for Payer: Priority Health SBD	$69.31

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$110.02

Service Code	NDC 68382031030
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$69.31
Max. Negotiated Rate	$99.02
Rate for Payer: Aetna Commercial	$93.52
Rate for Payer: Aetna New Business (MI Preferred)	$71.51
Rate for Payer: Cash Price	$88.02
Rate for Payer: Cofinity Commercial	$77.01
Rate for Payer: Cofinity Commercial	$94.62
Rate for Payer: Cofinity Medicare Advantage	$77.01
Rate for Payer: Encore Health Key Benefits Commercial	$88.02
Rate for Payer: Healthscope Commercial	$99.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.52
Rate for Payer: PHP Commercial	$93.52
Rate for Payer: Priority Health Cigna Priority Health	$71.51
Rate for Payer: Priority Health SBD	$69.31

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 Commercial	$76.01
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Cofinity Medicare Advantage	$76.01
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: PHP Commercial	$92.30
Rate for Payer: Priority Health Cigna Priority Health	$70.58
Rate for Payer: Priority Health SBD	$68.41

Know your out-of-pocket cost for care.

All Charges