|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$115.12
|
|
|
Service Code
|
NDC 0536-1108-88
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$103.61 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: BCBS Trust/PPO |
$88.96
|
| Rate for Payer: BCN Commercial |
$88.96
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$99.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$103.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.85
|
| Rate for Payer: PHP Commercial |
$97.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.34
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43598-448-71
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| Rate for Payer: BCN Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.01
|
| Rate for Payer: UHC Core |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 43598-446-71
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.21
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.83
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 43598-446-70
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: BCBS Trust/PPO |
$48.15
|
| Rate for Payer: BCN Commercial |
$48.15
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$56.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.96
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.82
|
| Rate for Payer: UHC Core |
$52.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.72
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$89.01
|
|
|
Service Code
|
NDC 45802-089-01
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$80.11 |
| Rate for Payer: Aetna Commercial |
$75.66
|
| Rate for Payer: BCBS Trust/PPO |
$68.79
|
| Rate for Payer: BCN Commercial |
$68.79
|
| Rate for Payer: Cash Price |
$71.21
|
| Rate for Payer: Cofinity Commercial |
$76.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.21
|
| Rate for Payer: Healthscope Commercial |
$80.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.66
|
| Rate for Payer: PHP Commercial |
$75.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.33
|
| Rate for Payer: UHC Core |
$74.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.76
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$267.02
|
|
|
Service Code
|
NDC 45802-089-02
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.86 |
| Max. Negotiated Rate |
$240.32 |
| Rate for Payer: Aetna Commercial |
$226.97
|
| Rate for Payer: BCBS Trust/PPO |
$206.35
|
| Rate for Payer: BCN Commercial |
$206.35
|
| Rate for Payer: Cash Price |
$213.62
|
| Rate for Payer: Cofinity Commercial |
$229.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.62
|
| Rate for Payer: Healthscope Commercial |
$240.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.97
|
| Rate for Payer: PHP Commercial |
$226.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.98
|
| Rate for Payer: UHC Core |
$222.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.26
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 23155-194-01
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.29 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: BCBS Trust/PPO |
$210.70
|
| Rate for Payer: BCN Commercial |
$210.70
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.93
|
| Rate for Payer: UHC Core |
$227.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$7.52
|
|
|
Service Code
|
NDC 50268-624-11
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$6.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$6.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.39
|
| Rate for Payer: PHP Commercial |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.62
|
| Rate for Payer: UHC Core |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.64
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$375.92
|
|
|
Service Code
|
NDC 50268-624-15
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.27 |
| Max. Negotiated Rate |
$338.33 |
| Rate for Payer: Aetna Commercial |
$319.53
|
| Rate for Payer: BCBS Trust/PPO |
$290.51
|
| Rate for Payer: BCN Commercial |
$290.51
|
| Rate for Payer: Cash Price |
$300.74
|
| Rate for Payer: Cofinity Commercial |
$323.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.74
|
| Rate for Payer: Healthscope Commercial |
$338.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.53
|
| Rate for Payer: PHP Commercial |
$319.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.81
|
| Rate for Payer: UHC Core |
$313.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.94
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$6.10
|
|
|
Service Code
|
NDC 50268-623-11
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Aetna Commercial |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.71
|
| Rate for Payer: BCN Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cofinity Commercial |
$5.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$5.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.37
|
| Rate for Payer: UHC Core |
$5.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.58
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$617.28
|
|
|
Service Code
|
NDC 47781-307-01
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.48 |
| Max. Negotiated Rate |
$555.55 |
| Rate for Payer: Aetna Commercial |
$524.69
|
| Rate for Payer: BCBS Trust/PPO |
$477.03
|
| Rate for Payer: BCN Commercial |
$477.03
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Cofinity Commercial |
$530.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.82
|
| Rate for Payer: Healthscope Commercial |
$555.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.69
|
| Rate for Payer: PHP Commercial |
$524.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.21
|
| Rate for Payer: UHC Core |
$515.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.96
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$304.80
|
|
|
Service Code
|
NDC 50268-623-15
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.90 |
| Max. Negotiated Rate |
$274.32 |
| Rate for Payer: Aetna Commercial |
$259.08
|
| Rate for Payer: BCBS Trust/PPO |
$235.55
|
| Rate for Payer: BCN Commercial |
$235.55
|
| Rate for Payer: Cash Price |
$243.84
|
| Rate for Payer: Cofinity Commercial |
$262.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.84
|
| Rate for Payer: Healthscope Commercial |
$274.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.08
|
| Rate for Payer: PHP Commercial |
$259.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.22
|
| Rate for Payer: UHC Core |
$254.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.60
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084-446-01
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.53 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$681.10
|
| Rate for Payer: BCN Commercial |
$681.10
|
| Rate for Payer: Cash Price |
$705.07
|
| 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: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.14
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084-446-11
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.53 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$681.10
|
| Rate for Payer: BCN Commercial |
$681.10
|
| Rate for Payer: Cash Price |
$705.07
|
| 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: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.14
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$8.84
|
|
|
Service Code
|
NDC 50268-625-11
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: BCBS Trust/PPO |
$6.83
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cofinity Commercial |
$7.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.07
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.51
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.78
|
| Rate for Payer: UHC Core |
$7.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.63
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
NDC 50268-625-15
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.33 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$375.36
|
| Rate for Payer: BCBS Trust/PPO |
$341.27
|
| Rate for Payer: BCN Commercial |
$341.27
|
| Rate for Payer: Cash Price |
$353.28
|
| Rate for Payer: Cofinity Commercial |
$379.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.28
|
| Rate for Payer: Healthscope Commercial |
$397.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.36
|
| Rate for Payer: PHP Commercial |
$375.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.61
|
| Rate for Payer: UHC Core |
$368.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.20
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$698.40
|
|
|
Service Code
|
NDC 47781-303-01
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.95 |
| Max. Negotiated Rate |
$628.56 |
| Rate for Payer: Aetna Commercial |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$539.72
|
| Rate for Payer: BCN Commercial |
$539.72
|
| Rate for Payer: Cash Price |
$558.72
|
| Rate for Payer: Cofinity Commercial |
$600.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.72
|
| Rate for Payer: Healthscope Commercial |
$628.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$523.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$593.64
|
| Rate for Payer: PHP Commercial |
$593.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$607.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.59
|
| Rate for Payer: UHC Core |
$583.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$523.80
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$879.12
|
|
|
Service Code
|
NDC 0378-3422-01
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$536.18 |
| Max. Negotiated Rate |
$791.21 |
| Rate for Payer: Aetna Commercial |
$747.25
|
| Rate for Payer: BCBS Trust/PPO |
$679.38
|
| Rate for Payer: BCN Commercial |
$679.38
|
| Rate for Payer: Cash Price |
$703.30
|
| Rate for Payer: Cofinity Commercial |
$756.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.30
|
| Rate for Payer: Healthscope Commercial |
$791.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$747.25
|
| Rate for Payer: PHP Commercial |
$747.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$773.63
|
| Rate for Payer: UHC Core |
$734.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.34
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
NDC 0378-9112-93
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: BCBS Trust/PPO |
$75.12
|
| Rate for Payer: BCN Commercial |
$75.12
|
| Rate for Payer: Cash Price |
$77.76
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.76
|
| Rate for Payer: Healthscope Commercial |
$87.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.62
|
| Rate for Payer: PHP Commercial |
$82.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$81.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.90
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 0378-9112-16
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 68382-310-01
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.59
|
|
|
Service Code
|
NDC 49730-112-30
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: BCBS Trust/PPO |
$83.92
|
| Rate for Payer: BCN Commercial |
$83.92
|
| Rate for Payer: Cash Price |
$86.87
|
| 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: Lakeland Regional Health Systems Commercial |
$81.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.30
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.56
|
| Rate for Payer: UHC Core |
$90.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.44
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$110.02
|
|
|
Service Code
|
NDC 68382-310-30
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$99.02 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: BCBS Trust/PPO |
$85.02
|
| Rate for Payer: BCN Commercial |
$85.02
|
| Rate for Payer: Cash Price |
$88.02
|
| Rate for Payer: Cofinity Commercial |
$94.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$99.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.52
|
| Rate for Payer: PHP Commercial |
$93.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.82
|
| Rate for Payer: UHC Core |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.52
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$70.67
|
|
|
Service Code
|
NDC 68462-639-45
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$60.07
|
| Rate for Payer: BCBS Trust/PPO |
$54.61
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.07
|
| Rate for Payer: PHP Commercial |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.19
|
| Rate for Payer: UHC Core |
$59.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.00
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$29.05
|
|
|
Service Code
|
NDC 59762-3304-3
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: BCBS Trust/PPO |
$22.45
|
| Rate for Payer: BCN Commercial |
$22.45
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.69
|
| Rate for Payer: PHP Commercial |
$24.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.56
|
| Rate for Payer: UHC Core |
$24.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.79
|
|
