|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna Commercial |
$7.61
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$7.36
|
| Rate for Payer: BCN Commercial |
$7.36
|
| Rate for Payer: BCN Medicare Advantage |
$2.24
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$8.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.71
|
| Rate for Payer: Mclaren Medicaid |
$1.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.35
|
| Rate for Payer: Meridian Medicaid |
$1.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.61
|
| Rate for Payer: Nomi Health Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.71
|
| Rate for Payer: PACE Senior Care Partners |
$2.13
|
| Rate for Payer: PACE SWMI |
$2.24
|
| Rate for Payer: PHP Commercial |
$7.61
|
| Rate for Payer: PHP Medicare Advantage |
$2.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.79
|
| Rate for Payer: Priority Health Medicare |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.23
|
| Rate for Payer: Railroad Medicare Medicare |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.88
|
| Rate for Payer: UHC Core |
$7.47
|
| Rate for Payer: UHC Exchange |
$2.24
|
| Rate for Payer: UHC Medicaid |
$1.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$1.58
|
| Rate for Payer: VA VA |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.71
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$613.41 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$727.90
|
| Rate for Payer: BCN Commercial |
$727.90
|
| 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 Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.41
|
| 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
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: Aetna Medicare |
$28.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.93
|
| Rate for Payer: BCBS Complete |
$20.10
|
| Rate for Payer: BCBS MAPPO |
$27.15
|
| Rate for Payer: BCBS Trust/PPO |
$89.27
|
| Rate for Payer: BCN Commercial |
$89.27
|
| Rate for Payer: BCN Medicare Advantage |
$27.15
|
| 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: Health Alliance Plan Medicare Advantage |
$27.15
|
| Rate for Payer: Healthscope Commercial |
$97.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.44
|
| Rate for Payer: Mclaren Medicaid |
$19.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: Meridian Medicaid |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.30
|
| Rate for Payer: Nomi Health Commercial |
$89.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.44
|
| Rate for Payer: PACE Senior Care Partners |
$25.79
|
| Rate for Payer: PACE SWMI |
$27.15
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: PHP Medicare Advantage |
$27.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.47
|
| Rate for Payer: Priority Health Medicare |
$27.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.58
|
| Rate for Payer: Railroad Medicare Medicare |
$27.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.56
|
| Rate for Payer: UHC Core |
$90.67
|
| Rate for Payer: UHC Exchange |
$27.15
|
| Rate for Payer: UHC Medicaid |
$19.14
|
| Rate for Payer: UHC Medicare Advantage |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$19.14
|
| Rate for Payer: VA VA |
$27.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.44
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$101.38
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna Commercial |
$86.17
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Healthscope Commercial |
$91.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Nomi Health Commercial |
$83.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: PHP Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.21
|
| Rate for Payer: UHC Core |
$84.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.03
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: BCBS Trust/PPO |
$89.68
|
| Rate for Payer: BCN Commercial |
$89.68
|
| 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 Commercial |
$92.30
|
| Rate for Payer: Nomi Health Commercial |
$89.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.44
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.58
|
| 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
|
$3.38
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.94
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$101.38
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna Commercial |
$86.17
|
| Rate for Payer: Aetna Medicare |
$26.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.68
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS MAPPO |
$25.34
|
| Rate for Payer: BCBS Trust/PPO |
$83.34
|
| Rate for Payer: BCN Commercial |
$83.34
|
| Rate for Payer: BCN Medicare Advantage |
$25.34
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.34
|
| Rate for Payer: Healthscope Commercial |
$91.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.03
|
| Rate for Payer: Mclaren Medicaid |
$17.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.61
|
| Rate for Payer: Meridian Medicaid |
$18.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Nomi Health Commercial |
$83.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: PACE Senior Care Partners |
$24.08
|
| Rate for Payer: PACE SWMI |
$25.34
|
| Rate for Payer: PHP Commercial |
$86.17
|
| Rate for Payer: PHP Medicare Advantage |
$25.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.20
|
| Rate for Payer: Priority Health Medicare |
$25.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.56
|
| Rate for Payer: Railroad Medicare Medicare |
$25.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.21
|
| Rate for Payer: UHC Core |
$84.65
|
| Rate for Payer: UHC Exchange |
$25.34
|
| Rate for Payer: UHC Medicaid |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$25.34
|
| Rate for Payer: UHCCP Medicaid |
$17.87
|
| Rate for Payer: VA VA |
$25.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.03
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: BCBS Trust/PPO |
$26.74
|
| Rate for Payer: BCN Commercial |
$26.74
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.49
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.78
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.42
|
| Rate for Payer: UHC Core |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
NDC 68462063925
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Mclaren Medicaid |
$1.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$1.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.74
|
| Rate for Payer: PACE Senior Care Partners |
$2.13
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: UHC Exchange |
$2.25
|
| Rate for Payer: UHC Medicaid |
$1.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$1.58
|
| Rate for Payer: VA VA |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.70
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$9.73
|
| Rate for Payer: BCN Commercial |
$9.73
|
| Rate for Payer: BCN Medicare Advantage |
$2.96
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.81
|
| Rate for Payer: PACE SWMI |
$2.96
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$2.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.30
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.42
|
| Rate for Payer: UHC Core |
$9.89
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicaid |
$2.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: VA VA |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
NDC 68462063945
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Mclaren Medicaid |
$1.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$1.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.74
|
| Rate for Payer: PACE Senior Care Partners |
$2.13
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: UHC Exchange |
$2.25
|
| Rate for Payer: UHC Medicaid |
$1.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$1.58
|
| Rate for Payer: VA VA |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$8.98
|
|
|
Service Code
|
NDC 68462063925
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: BCBS Trust/PPO |
$7.42
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.18
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.74
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.78
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.42
|
| Rate for Payer: UHC Core |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.70
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$9.73
|
| Rate for Payer: BCN Commercial |
$9.73
|
| Rate for Payer: BCN Medicare Advantage |
$2.96
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.81
|
| Rate for Payer: PACE SWMI |
$2.96
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$2.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.30
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.42
|
| Rate for Payer: UHC Core |
$9.89
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicaid |
$2.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: VA VA |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$8.98
|
|
|
Service Code
|
NDC 68462063945
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: BCBS Trust/PPO |
$7.42
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.18
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.74
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.12
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS MAPPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$26.62
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: BCN Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Mclaren Medicaid |
$5.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.50
|
| Rate for Payer: Meridian Medicaid |
$5.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PACE Senior Care Partners |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.10
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Medicare |
$8.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.49
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicaid |
$5.71
|
| Rate for Payer: UHC Medicare Advantage |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$5.71
|
| Rate for Payer: VA VA |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.19 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: BCBS Trust/PPO |
$109.40
|
| Rate for Payer: BCN Commercial |
$109.40
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.56
|
| Rate for Payer: UHC Core |
$110.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna Medicare |
$34.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.39
|
| Rate for Payer: BCBS Complete |
$24.52
|
| Rate for Payer: BCBS MAPPO |
$33.12
|
| Rate for Payer: BCBS Trust/PPO |
$108.90
|
| Rate for Payer: BCN Commercial |
$108.90
|
| Rate for Payer: BCN Medicare Advantage |
$33.12
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.12
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Mclaren Medicaid |
$23.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.77
|
| Rate for Payer: Meridian Medicaid |
$24.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PACE Senior Care Partners |
$31.46
|
| Rate for Payer: PACE SWMI |
$33.12
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: PHP Medicare Advantage |
$33.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.24
|
| Rate for Payer: Priority Health Medicare |
$33.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.19
|
| Rate for Payer: Railroad Medicare Medicare |
$33.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.56
|
| Rate for Payer: UHC Core |
$110.60
|
| Rate for Payer: UHC Exchange |
$33.12
|
| Rate for Payer: UHC Medicaid |
$23.35
|
| Rate for Payer: UHC Medicare Advantage |
$33.12
|
| Rate for Payer: UHCCP Medicaid |
$23.35
|
| Rate for Payer: VA VA |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$16.99
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$75.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicaid |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$16.18
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$7,912.84
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$7,536.04 |
| Max. Negotiated Rate |
$7,912.84 |
| Rate for Payer: BCBS Complete |
$7,912.84
|
| Rate for Payer: Mclaren Medicaid |
$7,536.04
|
| Rate for Payer: Meridian Medicaid |
$7,912.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,536.04
|
| Rate for Payer: UHC Medicaid |
$7,536.04
|
| Rate for Payer: UHCCP Medicaid |
$7,536.04
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$29,381.31
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$27,982.20 |
| Max. Negotiated Rate |
$29,381.31 |
| Rate for Payer: BCBS Complete |
$29,381.31
|
| Rate for Payer: Mclaren Medicaid |
$27,982.20
|
| Rate for Payer: Meridian Medicaid |
$29,381.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,982.20
|
| Rate for Payer: UHC Medicaid |
$27,982.20
|
| Rate for Payer: UHCCP Medicaid |
$27,982.20
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$11,141.50
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$10,610.95 |
| Max. Negotiated Rate |
$11,141.50 |
| Rate for Payer: BCBS Complete |
$11,141.50
|
| Rate for Payer: Mclaren Medicaid |
$10,610.95
|
| Rate for Payer: Meridian Medicaid |
$11,141.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,610.95
|
| Rate for Payer: UHC Medicaid |
$10,610.95
|
| Rate for Payer: UHCCP Medicaid |
$10,610.95
|
|
