|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$45.71
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$41.14 |
| Rate for Payer: Aetna Commercial |
$38.85
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$41.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.85
|
| Rate for Payer: Nomi Health Commercial |
$37.48
|
| Rate for Payer: PHP Commercial |
$38.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.71
|
| Rate for Payer: Priority Health HMO/PPO |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Core |
$38.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.28
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
OP
|
$45.71
|
|
|
Service Code
|
NDC 24208083060
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$41.14 |
| Rate for Payer: Aetna Commercial |
$38.85
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.28
|
| Rate for Payer: BCBS Complete |
$18.28
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$37.58
|
| Rate for Payer: BCN Commercial |
$35.54
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$41.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.85
|
| Rate for Payer: Nomi Health Commercial |
$37.48
|
| Rate for Payer: PACE Senior Care Partners |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$38.85
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.71
|
| Rate for Payer: Priority Health HMO/PPO |
$39.77
|
| Rate for Payer: Priority Health Medicare |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.63
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Core |
$38.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.43
|
| Rate for Payer: UHC Exchange |
$11.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.43
|
| Rate for Payer: VA VA |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.28
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna Medicare |
$39.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.05
|
| Rate for Payer: BCBS Complete |
$61.50
|
| Rate for Payer: BCBS MAPPO |
$38.44
|
| Rate for Payer: BCBS Trust/PPO |
$126.41
|
| Rate for Payer: BCN Commercial |
$119.55
|
| Rate for Payer: BCN Medicare Advantage |
$38.44
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.44
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: Nomi Health Commercial |
$126.08
|
| Rate for Payer: PACE Senior Care Partners |
$36.52
|
| Rate for Payer: PACE SWMI |
$38.44
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health HMO/PPO |
$133.77
|
| Rate for Payer: Priority Health Medicare |
$38.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.02
|
| Rate for Payer: Railroad Medicare Medicare |
$38.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.31
|
| Rate for Payer: UHC Core |
$128.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.44
|
| Rate for Payer: UHC Exchange |
$38.44
|
| Rate for Payer: UHC Medicare Advantage |
$38.44
|
| Rate for Payer: VA VA |
$38.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: Nomi Health Commercial |
$126.08
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health HMO/PPO |
$133.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.31
|
| Rate for Payer: UHC Core |
$128.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: Aetna Medicare |
$49.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.33
|
| Rate for Payer: BCBS Complete |
$75.94
|
| Rate for Payer: BCBS MAPPO |
$47.46
|
| Rate for Payer: BCBS Trust/PPO |
$156.07
|
| Rate for Payer: BCN Commercial |
$147.60
|
| Rate for Payer: BCN Medicare Advantage |
$47.46
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.46
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: Nomi Health Commercial |
$155.67
|
| Rate for Payer: PACE Senior Care Partners |
$45.09
|
| Rate for Payer: PACE SWMI |
$47.46
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: PHP Medicare Advantage |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health HMO/PPO |
$165.16
|
| Rate for Payer: Priority Health Medicare |
$47.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.19
|
| Rate for Payer: Railroad Medicare Medicare |
$47.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.06
|
| Rate for Payer: UHC Core |
$158.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.46
|
| Rate for Payer: UHC Exchange |
$47.46
|
| Rate for Payer: UHC Medicare Advantage |
$47.46
|
| Rate for Payer: VA VA |
$47.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.38
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: BCBS Trust/PPO |
$154.97
|
| Rate for Payer: BCN Commercial |
$146.71
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: Nomi Health Commercial |
$155.67
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health HMO/PPO |
$165.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.06
|
| Rate for Payer: UHC Core |
$158.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.38
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.83
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS MAPPO |
$3.87
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS Trust/PPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Commercial |
$12.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.74
|
| Rate for Payer: BCN Medicare Advantage |
$3.87
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$13.92
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.15
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: PACE Senior Care Partners |
$6.41
|
| Rate for Payer: PACE Senior Care Partners |
$3.67
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PACE SWMI |
$3.87
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$13.15
|
| Rate for Payer: PHP Medicare Advantage |
$3.87
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health HMO/PPO |
$13.46
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Core |
$12.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.87
|
| Rate for Payer: UHC Exchange |
$3.87
|
| Rate for Payer: UHC Exchange |
$6.74
|
| Rate for Payer: UHC Medicare Advantage |
$3.87
|
| Rate for Payer: UHC Medicare Advantage |
$6.74
|
| Rate for Payer: VA VA |
$3.87
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.60
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.47
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$13.92 |
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.63
|
| Rate for Payer: BCBS Trust/PPO |
$22.02
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$13.92
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: PHP Commercial |
$13.15
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO |
$13.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC Core |
$12.92
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$1,482.54
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,411.85 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$1,482.54
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,411.85 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 50268058411
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 50268058411
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.10
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.16
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$234.27
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$210.84 |
| Rate for Payer: Aetna Commercial |
$199.13
|
| Rate for Payer: Aetna Medicare |
$60.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.21
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS MAPPO |
$58.57
|
| Rate for Payer: BCBS Trust/PPO |
$192.59
|
| Rate for Payer: BCN Commercial |
$182.14
|
| Rate for Payer: BCN Medicare Advantage |
$58.57
|
| Rate for Payer: Cash Price |
$187.42
|
| Rate for Payer: Cofinity Commercial |
$201.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.57
|
| Rate for Payer: Healthscope Commercial |
$210.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.13
|
| Rate for Payer: Nomi Health Commercial |
$192.10
|
| Rate for Payer: PACE Senior Care Partners |
$55.64
|
| Rate for Payer: PACE SWMI |
$58.57
|
| Rate for Payer: PHP Commercial |
$199.13
|
| Rate for Payer: PHP Medicare Advantage |
$58.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health HMO/PPO |
$203.81
|
| Rate for Payer: Priority Health Medicare |
$59.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.96
|
| Rate for Payer: Railroad Medicare Medicare |
$58.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.16
|
| Rate for Payer: UHC Core |
$195.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.57
|
| Rate for Payer: UHC Exchange |
$58.57
|
| Rate for Payer: UHC Medicare Advantage |
$58.57
|
| Rate for Payer: VA VA |
$58.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.70
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$259.06
|
|
|
Service Code
|
NDC 50268058413
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.53 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Aetna Commercial |
$220.20
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.96
|
| Rate for Payer: BCBS Complete |
$103.62
|
| Rate for Payer: BCBS MAPPO |
$64.77
|
| Rate for Payer: BCBS Trust/PPO |
$212.97
|
| Rate for Payer: BCN Commercial |
$201.42
|
| Rate for Payer: BCN Medicare Advantage |
$64.77
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Commercial |
$222.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.77
|
| Rate for Payer: Healthscope Commercial |
$233.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: Nomi Health Commercial |
$212.43
|
| Rate for Payer: PACE Senior Care Partners |
$61.53
|
| Rate for Payer: PACE SWMI |
$64.77
|
| Rate for Payer: PHP Commercial |
$220.20
|
| Rate for Payer: PHP Medicare Advantage |
$64.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.39
|
| Rate for Payer: Priority Health HMO/PPO |
$225.38
|
| Rate for Payer: Priority Health Medicare |
$65.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.57
|
| Rate for Payer: Railroad Medicare Medicare |
$64.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.97
|
| Rate for Payer: UHC Core |
$216.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.77
|
| Rate for Payer: UHC Exchange |
$64.77
|
| Rate for Payer: UHC Medicare Advantage |
$64.77
|
| Rate for Payer: VA VA |
$64.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.29
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$234.27
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.28 |
| Max. Negotiated Rate |
$210.84 |
| Rate for Payer: Aetna Commercial |
$199.13
|
| Rate for Payer: BCBS Trust/PPO |
$191.23
|
| Rate for Payer: BCN Commercial |
$181.04
|
| Rate for Payer: Cash Price |
$187.42
|
| Rate for Payer: Cofinity Commercial |
$201.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.42
|
| Rate for Payer: Healthscope Commercial |
$210.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.13
|
| Rate for Payer: Nomi Health Commercial |
$192.10
|
| Rate for Payer: PHP Commercial |
$199.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health HMO/PPO |
$203.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.16
|
| Rate for Payer: UHC Core |
$195.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.70
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$259.06
|
|
|
Service Code
|
NDC 50268058413
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.39 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Aetna Commercial |
$220.20
|
| Rate for Payer: BCBS Trust/PPO |
$211.47
|
| Rate for Payer: BCN Commercial |
$200.20
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Commercial |
$222.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Healthscope Commercial |
$233.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: Nomi Health Commercial |
$212.43
|
| Rate for Payer: PHP Commercial |
$220.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.39
|
| Rate for Payer: Priority Health HMO/PPO |
$225.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.97
|
| Rate for Payer: UHC Core |
$216.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.29
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.76
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.25
|
| Rate for Payer: BCN Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Nomi Health Commercial |
$42.44
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health HMO/PPO |
$45.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.55
|
| Rate for Payer: UHC Core |
$43.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.82
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.76
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.18
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS MAPPO |
$12.94
|
| Rate for Payer: BCBS Trust/PPO |
$42.55
|
| Rate for Payer: BCN Commercial |
$40.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.94
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Nomi Health Commercial |
$42.44
|
| Rate for Payer: PACE Senior Care Partners |
$12.29
|
| Rate for Payer: PACE SWMI |
$12.94
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health HMO/PPO |
$45.03
|
| Rate for Payer: Priority Health Medicare |
$13.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.68
|
| Rate for Payer: Railroad Medicare Medicare |
$12.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.55
|
| Rate for Payer: UHC Core |
$43.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.94
|
| Rate for Payer: UHC Exchange |
$12.94
|
| Rate for Payer: UHC Medicare Advantage |
$12.94
|
| Rate for Payer: VA VA |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.82
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$270.98
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.14 |
| Max. Negotiated Rate |
$243.88 |
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: BCBS Trust/PPO |
$221.20
|
| Rate for Payer: BCN Commercial |
$209.41
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health HMO/PPO |
$235.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.46
|
| Rate for Payer: UHC Core |
$226.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.24
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$270.98
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$243.88 |
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.68
|
| Rate for Payer: BCBS Complete |
$108.39
|
| Rate for Payer: BCBS MAPPO |
$67.75
|
| Rate for Payer: BCBS Trust/PPO |
$222.77
|
| Rate for Payer: BCN Commercial |
$210.69
|
| Rate for Payer: BCN Medicare Advantage |
$67.75
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.75
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: PACE Senior Care Partners |
$64.36
|
| Rate for Payer: PACE SWMI |
$67.75
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: PHP Medicare Advantage |
$67.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health HMO/PPO |
$235.75
|
| Rate for Payer: Priority Health Medicare |
$68.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.56
|
| Rate for Payer: Railroad Medicare Medicare |
$67.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.46
|
| Rate for Payer: UHC Core |
$226.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.75
|
| Rate for Payer: UHC Exchange |
$67.75
|
| Rate for Payer: UHC Medicare Advantage |
$67.75
|
| Rate for Payer: VA VA |
$67.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.24
|
|
|
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 |
$78.45 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna Commercial |
$102.59
|
| Rate for Payer: BCBS Trust/PPO |
$98.53
|
| Rate for Payer: BCN Commercial |
$93.28
|
| 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: PHP Commercial |
$102.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.45
|
| Rate for Payer: Priority Health HMO/PPO |
$105.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.87
|
| 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
|
IP
|
$8.23
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.00
|
| Rate for Payer: Nomi Health Commercial |
$6.75
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.35
|
| Rate for Payer: Priority Health HMO/PPO |
$7.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC Core |
$6.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.17
|
|
|
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 |
$28.67 |
| 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 |
$48.28
|
| Rate for Payer: BCBS MAPPO |
$30.18
|
| Rate for Payer: BCBS Trust/PPO |
$99.23
|
| Rate for Payer: BCN Commercial |
$93.84
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| 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 Cigna Priority Health |
$78.45
|
| Rate for Payer: Priority Health HMO/PPO |
$105.01
|
| Rate for Payer: Priority Health Medicare |
$30.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.87
|
| 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 Dual Complete DSNP |
$30.18
|
| Rate for Payer: UHC Exchange |
$30.18
|
| Rate for Payer: UHC Medicare Advantage |
$30.18
|
| 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
|
$8.23
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.57
|
| Rate for Payer: BCBS Complete |
$3.29
|
| Rate for Payer: BCBS MAPPO |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.77
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.06
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.00
|
| Rate for Payer: Nomi Health Commercial |
$6.75
|
| Rate for Payer: PACE Senior Care Partners |
$1.95
|
| Rate for Payer: PACE SWMI |
$2.06
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: PHP Medicare Advantage |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.35
|
| Rate for Payer: Priority Health HMO/PPO |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$2.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC Core |
$6.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UHC Medicare Advantage |
$2.06
|
| Rate for Payer: VA VA |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.17
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$115.12
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.83 |
| Max. Negotiated Rate |
$103.61 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: BCBS Trust/PPO |
$93.97
|
| 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 Commercial |
$97.85
|
| Rate for Payer: Nomi Health Commercial |
$94.40
|
| Rate for Payer: PHP Commercial |
$97.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.83
|
| Rate for Payer: Priority Health HMO/PPO |
$100.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.13
|
| 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
|
|
