|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.13
|
| Rate for Payer: BCN Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
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 |
$18.89 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.48
|
| Rate for Payer: BCBS Complete |
$19.83
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$88.06
|
| Rate for Payer: BCN Commercial |
$88.06
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: Mclaren Medicaid |
$18.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.12
|
| Rate for Payer: Meridian Medicaid |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$27.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.56
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.27
|
| Rate for Payer: UHC Core |
$89.45
|
| Rate for Payer: UHC Exchange |
$26.78
|
| Rate for Payer: UHC Medicaid |
$18.89
|
| Rate for Payer: UHC Medicare Advantage |
$26.78
|
| Rate for Payer: UHCCP Medicaid |
$18.89
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$120.70
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna Commercial |
$102.59
|
| Rate for Payer: Aetna Medicare |
$31.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.72
|
| Rate for Payer: BCBS Complete |
$22.34
|
| Rate for Payer: BCBS MAPPO |
$30.18
|
| Rate for Payer: BCBS Trust/PPO |
$99.23
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: BCN Medicare Advantage |
$30.18
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cofinity Commercial |
$103.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.18
|
| Rate for Payer: Healthscope Commercial |
$108.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.53
|
| Rate for Payer: Mclaren Medicaid |
$21.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.68
|
| Rate for Payer: Meridian Medicaid |
$22.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.53
|
| Rate for Payer: PACE Senior Care Partners |
$28.67
|
| Rate for Payer: PACE SWMI |
$30.18
|
| Rate for Payer: PHP Commercial |
$102.59
|
| Rate for Payer: PHP Medicare Advantage |
$30.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.01
|
| Rate for Payer: Priority Health Medicare |
$30.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.01
|
| Rate for Payer: Railroad Medicare Medicare |
$30.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.22
|
| Rate for Payer: UHC Core |
$100.78
|
| Rate for Payer: UHC Exchange |
$30.18
|
| Rate for Payer: UHC Medicaid |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$30.18
|
| Rate for Payer: UHCCP Medicaid |
$21.28
|
| Rate for Payer: VA VA |
$30.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.53
|
|
|
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 |
$1.35 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: BCBS MAPPO |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Medicare Advantage |
$1.92
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.75
|
| Rate for Payer: Mclaren Medicaid |
$1.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.01
|
| Rate for Payer: Meridian Medicaid |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Nomi Health Commercial |
$6.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PACE Senior Care Partners |
$1.82
|
| Rate for Payer: PACE SWMI |
$1.92
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.66
|
| Rate for Payer: Priority Health Medicare |
$1.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.74
|
| Rate for Payer: UHC Core |
$6.40
|
| Rate for Payer: UHC Exchange |
$1.92
|
| Rate for Payer: UHC Medicaid |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.92
|
| Rate for Payer: UHCCP Medicaid |
$1.35
|
| Rate for Payer: VA VA |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.75
|
|
|
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 |
$15.75 |
| Max. Negotiated Rate |
$80.38 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.91
|
| Rate for Payer: BCBS Complete |
$16.53
|
| Rate for Payer: BCBS MAPPO |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: BCN Medicare Advantage |
$22.33
|
| Rate for Payer: Cash Price |
$71.45
|
| Rate for Payer: Cofinity Commercial |
$76.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.33
|
| Rate for Payer: Healthscope Commercial |
$80.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.44
|
| Rate for Payer: Meridian Medicaid |
$16.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: PACE Senior Care Partners |
$21.21
|
| Rate for Payer: PACE SWMI |
$22.33
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: PHP Medicare Advantage |
$22.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.70
|
| Rate for Payer: Priority Health Medicare |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.16
|
| Rate for Payer: Railroad Medicare Medicare |
$22.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.59
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: UHC Exchange |
$22.33
|
| Rate for Payer: UHC Medicaid |
$15.75
|
| Rate for Payer: UHC Medicare Advantage |
$22.33
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
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 |
$62.16 |
| Max. Negotiated Rate |
$80.38 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: BCBS Trust/PPO |
$73.76
|
| Rate for Payer: BCN Commercial |
$73.76
|
| Rate for Payer: Cash Price |
$71.45
|
| 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: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.59
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
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 |
$74.56 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.47
|
| Rate for Payer: BCN Commercial |
$88.47
|
| Rate for Payer: Cash Price |
$85.70
|
| 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: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.27
|
| Rate for Payer: UHC Core |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$120.70
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna Commercial |
$102.59
|
| Rate for Payer: BCBS Trust/PPO |
$99.69
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cofinity Commercial |
$103.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.56
|
| Rate for Payer: Healthscope Commercial |
$108.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.53
|
| Rate for Payer: PHP Commercial |
$102.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.22
|
| Rate for Payer: UHC Core |
$100.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.53
|
|
|
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 |
$19.60 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna Medicare |
$28.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.73
|
| Rate for Payer: BCBS Complete |
$20.57
|
| Rate for Payer: BCBS MAPPO |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$91.38
|
| Rate for Payer: BCN Commercial |
$91.38
|
| Rate for Payer: BCN Medicare Advantage |
$27.79
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.79
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.36
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: Meridian Medicaid |
$20.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Nomi Health Commercial |
$91.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$26.40
|
| Rate for Payer: PACE SWMI |
$27.79
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: PHP Medicare Advantage |
$27.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.81
|
| Rate for Payer: UHC Core |
$92.81
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$19.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.79
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: VA VA |
$27.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.36
|
|
|
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 |
$5.33 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$6.13
|
| 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: Lakeland Regional Health Systems Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Nomi Health Commercial |
$6.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.74
|
| Rate for Payer: UHC Core |
$6.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.75
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$5.91
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.30
|
| Rate for Payer: UHC Core |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$111.15
|
|
|
Service Code
|
NDC 43598044874
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: BCBS Trust/PPO |
$91.80
|
| Rate for Payer: BCN Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$88.92
|
| 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: Lakeland Regional Health Systems Commercial |
$83.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Nomi Health Commercial |
$91.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.81
|
| Rate for Payer: UHC Core |
$92.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.36
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: Mclaren Medicaid |
$1.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: Meridian Medicaid |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PACE Senior Care Partners |
$1.70
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.23
|
| Rate for Payer: Priority Health Medicare |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.30
|
| Rate for Payer: UHC Core |
$5.98
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UHC Medicaid |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.79
|
| Rate for Payer: UHCCP Medicaid |
$1.26
|
| Rate for Payer: VA VA |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
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 |
$15.25 |
| Max. Negotiated Rate |
$77.84 |
| Rate for Payer: Aetna Commercial |
$73.52
|
| Rate for Payer: Aetna Medicare |
$22.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.03
|
| Rate for Payer: BCBS Complete |
$16.01
|
| Rate for Payer: BCBS MAPPO |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: BCN Medicare Advantage |
$21.62
|
| Rate for Payer: Cash Price |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$77.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.87
|
| Rate for Payer: Mclaren Medicaid |
$15.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.70
|
| Rate for Payer: Meridian Medicaid |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.52
|
| Rate for Payer: Nomi Health Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.87
|
| Rate for Payer: PACE Senior Care Partners |
$20.54
|
| Rate for Payer: PACE SWMI |
$21.62
|
| Rate for Payer: PHP Commercial |
$73.52
|
| Rate for Payer: PHP Medicare Advantage |
$21.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.25
|
| Rate for Payer: Priority Health Medicare |
$21.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.11
|
| Rate for Payer: UHC Core |
$72.22
|
| Rate for Payer: UHC Exchange |
$21.62
|
| Rate for Payer: UHC Medicaid |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$21.62
|
| Rate for Payer: UHCCP Medicaid |
$15.25
|
| Rate for Payer: VA VA |
$21.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.87
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$86.49
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.84 |
| Rate for Payer: Aetna Commercial |
$73.52
|
| Rate for Payer: BCBS Trust/PPO |
$71.43
|
| Rate for Payer: BCN Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$69.19
|
| 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: Lakeland Regional Health Systems Commercial |
$64.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.52
|
| Rate for Payer: Nomi Health Commercial |
$70.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.87
|
| Rate for Payer: PHP Commercial |
$73.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.11
|
| Rate for Payer: UHC Core |
$72.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.87
|
|
|
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 |
$18.89 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.48
|
| Rate for Payer: BCBS Complete |
$19.83
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$88.06
|
| Rate for Payer: BCN Commercial |
$88.06
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: Mclaren Medicaid |
$18.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.12
|
| Rate for Payer: Meridian Medicaid |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$27.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.56
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.27
|
| Rate for Payer: UHC Core |
$89.45
|
| Rate for Payer: UHC Exchange |
$26.78
|
| Rate for Payer: UHC Medicaid |
$18.89
|
| Rate for Payer: UHC Medicare Advantage |
$26.78
|
| Rate for Payer: UHCCP Medicaid |
$18.89
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
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 |
$19.60 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna Medicare |
$28.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.73
|
| Rate for Payer: BCBS Complete |
$20.57
|
| Rate for Payer: BCBS MAPPO |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$91.38
|
| Rate for Payer: BCN Commercial |
$91.38
|
| Rate for Payer: BCN Medicare Advantage |
$27.79
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.79
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.36
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: Meridian Medicaid |
$20.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Nomi Health Commercial |
$91.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$26.40
|
| Rate for Payer: PACE SWMI |
$27.79
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: PHP Medicare Advantage |
$27.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.81
|
| Rate for Payer: UHC Core |
$92.81
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$19.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.79
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: VA VA |
$27.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.36
|
|
|
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 |
$74.56 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.47
|
| Rate for Payer: BCN Commercial |
$88.47
|
| Rate for Payer: Cash Price |
$85.70
|
| 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: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Nomi Health Commercial |
$87.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.27
|
| Rate for Payer: UHC Core |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$65.56
|
|
|
Service Code
|
NDC 43598044670
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$54.15
|
| Rate for Payer: BCN Commercial |
$54.15
|
| Rate for Payer: Cash Price |
$52.45
|
| Rate for Payer: Cofinity Commercial |
$56.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.45
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.73
|
| Rate for Payer: Nomi Health Commercial |
$53.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.17
|
| Rate for Payer: PHP Commercial |
$55.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.69
|
| Rate for Payer: UHC Core |
$54.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.17
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$7.66
|
|
|
Service Code
|
NDC 43598044671
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: BCBS MAPPO |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Medicare Advantage |
$1.92
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.75
|
| Rate for Payer: Mclaren Medicaid |
$1.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.01
|
| Rate for Payer: Meridian Medicaid |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Nomi Health Commercial |
$6.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PACE Senior Care Partners |
$1.82
|
| Rate for Payer: PACE SWMI |
$1.92
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.66
|
| Rate for Payer: Priority Health Medicare |
$1.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.74
|
| Rate for Payer: UHC Core |
$6.40
|
| Rate for Payer: UHC Exchange |
$1.92
|
| Rate for Payer: UHC Medicaid |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.92
|
| Rate for Payer: UHCCP Medicaid |
$1.35
|
| Rate for Payer: VA VA |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.75
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$65.56
|
|
|
Service Code
|
NDC 43598044670
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: Aetna Medicare |
$17.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.49
|
| Rate for Payer: BCBS Complete |
$12.14
|
| Rate for Payer: BCBS MAPPO |
$16.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.90
|
| Rate for Payer: BCN Commercial |
$53.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.39
|
| Rate for Payer: Cash Price |
$52.45
|
| Rate for Payer: Cofinity Commercial |
$56.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.17
|
| Rate for Payer: Mclaren Medicaid |
$11.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.21
|
| Rate for Payer: Meridian Medicaid |
$12.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.73
|
| Rate for Payer: Nomi Health Commercial |
$53.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.17
|
| Rate for Payer: PACE Senior Care Partners |
$15.57
|
| Rate for Payer: PACE SWMI |
$16.39
|
| Rate for Payer: PHP Commercial |
$55.73
|
| Rate for Payer: PHP Medicare Advantage |
$16.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.63
|
| Rate for Payer: Railroad Medicare Medicare |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.69
|
| Rate for Payer: UHC Core |
$54.74
|
| Rate for Payer: UHC Exchange |
$16.39
|
| Rate for Payer: UHC Medicaid |
$11.56
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: UHCCP Medicaid |
$11.56
|
| Rate for Payer: VA VA |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.17
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$7.66
|
|
|
Service Code
|
NDC 43598044671
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$6.13
|
| 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: Lakeland Regional Health Systems Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.51
|
| Rate for Payer: Nomi Health Commercial |
$6.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.75
|
| Rate for Payer: PHP Commercial |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.74
|
| Rate for Payer: UHC Core |
$6.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.75
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$99.53
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.20
|
| Rate for Payer: BCN Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.60
|
| Rate for Payer: Nomi Health Commercial |
$81.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.65
|
| Rate for Payer: PHP Commercial |
$84.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.59
|
| Rate for Payer: UHC Core |
$83.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.65
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.80 |
| Max. Negotiated Rate |
$268.71 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: BCBS Trust/PPO |
$246.59
|
| Rate for Payer: BCN Commercial |
$246.59
|
| Rate for Payer: Cash Price |
$238.86
|
| Rate for Payer: Cofinity Commercial |
$256.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.86
|
| Rate for Payer: Healthscope Commercial |
$268.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.93
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.74
|
| Rate for Payer: UHC Core |
$249.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.93
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$99.53
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.10
|
| Rate for Payer: BCBS Complete |
$18.42
|
| Rate for Payer: BCBS MAPPO |
$24.88
|
| Rate for Payer: BCBS Trust/PPO |
$81.82
|
| Rate for Payer: BCN Commercial |
$81.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.88
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.65
|
| Rate for Payer: Mclaren Medicaid |
$17.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.13
|
| Rate for Payer: Meridian Medicaid |
$18.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.60
|
| Rate for Payer: Nomi Health Commercial |
$81.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.65
|
| Rate for Payer: PACE Senior Care Partners |
$23.64
|
| Rate for Payer: PACE SWMI |
$24.88
|
| Rate for Payer: PHP Commercial |
$84.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.59
|
| Rate for Payer: Priority Health Medicare |
$25.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.59
|
| Rate for Payer: UHC Core |
$83.11
|
| Rate for Payer: UHC Exchange |
$24.88
|
| Rate for Payer: UHC Medicaid |
$17.55
|
| Rate for Payer: UHC Medicare Advantage |
$24.88
|
| Rate for Payer: UHCCP Medicaid |
$17.55
|
| Rate for Payer: VA VA |
$24.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.65
|
|
