|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$115.12
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$103.61 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Medicare |
$29.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.98
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$28.78
|
| Rate for Payer: BCBS Trust/PPO |
$94.64
|
| Rate for Payer: BCN Commercial |
$89.51
|
| Rate for Payer: BCN Medicare Advantage |
$28.78
|
| 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: Health Alliance Plan Medicare Advantage |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$103.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.85
|
| Rate for Payer: Nomi Health Commercial |
$94.40
|
| Rate for Payer: PACE Senior Care Partners |
$27.34
|
| Rate for Payer: PACE SWMI |
$28.78
|
| Rate for Payer: PHP Commercial |
$97.85
|
| Rate for Payer: PHP Medicare Advantage |
$28.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.83
|
| Rate for Payer: Priority Health HMO/PPO |
$100.15
|
| Rate for Payer: Priority Health Medicare |
$29.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.13
|
| Rate for Payer: Railroad Medicare Medicare |
$28.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.78
|
| Rate for Payer: UHC Exchange |
$28.78
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: VA VA |
$28.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.34
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$111.15
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: BCBS Trust/PPO |
$90.73
|
| Rate for Payer: BCN Commercial |
$85.90
|
| 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: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.47
|
| 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 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 |
$26.40 |
| 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 |
$44.46
|
| Rate for Payer: BCBS MAPPO |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$91.38
|
| Rate for Payer: BCN Commercial |
$86.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Nomi Health Commercial |
$91.14
|
| 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 Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.47
|
| 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 Dual Complete DSNP |
$27.79
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$27.79
|
| 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
|
$8.63
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCN Commercial |
$6.67
|
| 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: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.78
|
| 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
|
$8.63
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| 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 |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$6.71
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| 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: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| 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 |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| 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 |
$6.47
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$106.99
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$96.29 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: BCBS Trust/PPO |
$87.34
|
| Rate for Payer: BCN Commercial |
$82.68
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$92.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.59
|
| Rate for Payer: Healthscope Commercial |
$96.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.94
|
| Rate for Payer: Nomi Health Commercial |
$87.73
|
| Rate for Payer: PHP Commercial |
$90.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: Priority Health HMO/PPO |
$93.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.15
|
| Rate for Payer: UHC Core |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.24
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$106.99
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$96.29 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Aetna Medicare |
$27.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.43
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$26.75
|
| Rate for Payer: BCBS Trust/PPO |
$87.96
|
| Rate for Payer: BCN Commercial |
$83.18
|
| Rate for Payer: BCN Medicare Advantage |
$26.75
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$92.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.75
|
| Rate for Payer: Healthscope Commercial |
$96.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.94
|
| Rate for Payer: Nomi Health Commercial |
$87.73
|
| Rate for Payer: PACE Senior Care Partners |
$25.41
|
| Rate for Payer: PACE SWMI |
$26.75
|
| Rate for Payer: PHP Commercial |
$90.94
|
| Rate for Payer: PHP Medicare Advantage |
$26.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: Priority Health HMO/PPO |
$93.08
|
| Rate for Payer: Priority Health Medicare |
$27.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.68
|
| Rate for Payer: Railroad Medicare Medicare |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.15
|
| Rate for Payer: UHC Core |
$89.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.75
|
| Rate for Payer: UHC Exchange |
$26.75
|
| Rate for Payer: UHC Medicare Advantage |
$26.75
|
| Rate for Payer: VA VA |
$26.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.24
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$115.12
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$103.61 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Medicare |
$29.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.98
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$28.78
|
| Rate for Payer: BCBS Trust/PPO |
$94.64
|
| Rate for Payer: BCN Commercial |
$89.51
|
| Rate for Payer: BCN Medicare Advantage |
$28.78
|
| 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: Health Alliance Plan Medicare Advantage |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$103.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.85
|
| Rate for Payer: Nomi Health Commercial |
$94.40
|
| Rate for Payer: PACE Senior Care Partners |
$27.34
|
| Rate for Payer: PACE SWMI |
$28.78
|
| Rate for Payer: PHP Commercial |
$97.85
|
| Rate for Payer: PHP Medicare Advantage |
$28.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.83
|
| Rate for Payer: Priority Health HMO/PPO |
$100.15
|
| Rate for Payer: Priority Health Medicare |
$29.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.13
|
| Rate for Payer: Railroad Medicare Medicare |
$28.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.78
|
| Rate for Payer: UHC Exchange |
$28.78
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: VA VA |
$28.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.34
|
|
|
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 |
$72.25 |
| Max. Negotiated Rate |
$100.03 |
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: BCBS Trust/PPO |
$90.73
|
| Rate for Payer: BCN Commercial |
$85.90
|
| 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: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.47
|
| 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
|
IP
|
$115.12
|
|
|
Service Code
|
NDC 00536110888
|
| Hospital Charge Code |
27863
|
|
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
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$95.09
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$80.83
|
| Rate for Payer: Aetna Medicare |
$24.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.72
|
| Rate for Payer: BCBS Complete |
$38.04
|
| Rate for Payer: BCBS MAPPO |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$78.17
|
| Rate for Payer: BCN Commercial |
$73.93
|
| Rate for Payer: BCN Medicare Advantage |
$23.77
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$85.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.83
|
| Rate for Payer: Nomi Health Commercial |
$77.97
|
| Rate for Payer: PACE Senior Care Partners |
$22.58
|
| Rate for Payer: PACE SWMI |
$23.77
|
| Rate for Payer: PHP Commercial |
$80.83
|
| Rate for Payer: PHP Medicare Advantage |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.81
|
| Rate for Payer: Priority Health HMO/PPO |
$82.73
|
| Rate for Payer: Priority Health Medicare |
$24.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.71
|
| Rate for Payer: Railroad Medicare Medicare |
$23.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.68
|
| Rate for Payer: UHC Core |
$79.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.77
|
| Rate for Payer: UHC Exchange |
$23.77
|
| Rate for Payer: UHC Medicare Advantage |
$23.77
|
| Rate for Payer: VA VA |
$23.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.32
|
|
|
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 |
$1.70 |
| 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 |
$2.86
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Commercial |
$5.57
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Nomi Health Commercial |
$5.87
|
| 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 Cigna Priority Health |
$4.65
|
| Rate for Payer: Priority Health HMO/PPO |
$6.23
|
| Rate for Payer: Priority Health Medicare |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.80
|
| 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 Dual Complete DSNP |
$1.79
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UHC Medicare Advantage |
$1.79
|
| 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
|
$111.15
|
|
|
Service Code
|
NDC 43598044874
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.40 |
| 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 |
$44.46
|
| Rate for Payer: BCBS MAPPO |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$91.38
|
| Rate for Payer: BCN Commercial |
$86.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Nomi Health Commercial |
$91.14
|
| 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 Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO |
$96.70
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.47
|
| 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 Dual Complete DSNP |
$27.79
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$27.79
|
| 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
|
$95.09
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$80.83
|
| Rate for Payer: BCBS Trust/PPO |
$77.62
|
| Rate for Payer: BCN Commercial |
$73.49
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.07
|
| Rate for Payer: Healthscope Commercial |
$85.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.83
|
| Rate for Payer: Nomi Health Commercial |
$77.97
|
| Rate for Payer: PHP Commercial |
$80.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.81
|
| Rate for Payer: Priority Health HMO/PPO |
$82.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.68
|
| Rate for Payer: UHC Core |
$79.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.32
|
|
|
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 |
$4.65 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$5.84
|
| Rate for Payer: BCN Commercial |
$5.53
|
| 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: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.65
|
| Rate for Payer: Priority Health HMO/PPO |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.80
|
| 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 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$8.04
|
|
|
Service Code
|
NDC 43598044671
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.61
|
| Rate for Payer: BCN Commercial |
$6.25
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Nomi Health Commercial |
$6.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.91
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6.99
|
| Rate for Payer: Priority Health Medicare |
$2.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Exchange |
$2.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: VA VA |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
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 |
$15.57 |
| 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 |
$26.22
|
| Rate for Payer: BCBS MAPPO |
$16.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.90
|
| Rate for Payer: BCN Commercial |
$50.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.73
|
| Rate for Payer: Nomi Health Commercial |
$53.76
|
| 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 Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.93
|
| 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 Dual Complete DSNP |
$16.39
|
| Rate for Payer: UHC Exchange |
$16.39
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| 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
|
$65.56
|
|
|
Service Code
|
NDC 43598044670
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$53.52
|
| Rate for Payer: BCN Commercial |
$50.66
|
| 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: PHP Commercial |
$55.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.93
|
| 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
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 43598044671
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.56
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Nomi Health Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.69 |
| Max. Negotiated Rate |
$86.81 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$78.73
|
| Rate for Payer: BCN Commercial |
$74.54
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Healthscope Commercial |
$86.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health HMO/PPO |
$83.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$80.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$86.81 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: Aetna Medicare |
$25.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$38.58
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$79.29
|
| Rate for Payer: BCN Commercial |
$74.99
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.91
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health HMO/PPO |
$83.91
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.62
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$80.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: Aetna Medicare |
$75.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.42
|
| Rate for Payer: BCBS Complete |
$115.74
|
| Rate for Payer: BCBS MAPPO |
$72.33
|
| Rate for Payer: BCBS Trust/PPO |
$237.87
|
| Rate for Payer: BCN Commercial |
$224.96
|
| Rate for Payer: BCN Medicare Advantage |
$72.33
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.33
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: Nomi Health Commercial |
$237.26
|
| Rate for Payer: PACE Senior Care Partners |
$68.72
|
| Rate for Payer: PACE SWMI |
$72.33
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: PHP Medicare Advantage |
$72.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health HMO/PPO |
$251.73
|
| Rate for Payer: Priority Health Medicare |
$73.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.86
|
| Rate for Payer: Railroad Medicare Medicare |
$72.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.62
|
| Rate for Payer: UHC Core |
$241.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.33
|
| Rate for Payer: UHC Exchange |
$72.33
|
| Rate for Payer: UHC Medicare Advantage |
$72.33
|
| Rate for Payer: VA VA |
$72.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: BCBS Trust/PPO |
$236.19
|
| Rate for Payer: BCN Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: Nomi Health Commercial |
$237.26
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health HMO/PPO |
$251.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.62
|
| Rate for Payer: UHC Core |
$241.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: Aetna Medicare |
$84.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.12
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS MAPPO |
$81.70
|
| Rate for Payer: BCBS Trust/PPO |
$268.66
|
| Rate for Payer: BCN Commercial |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$81.70
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PACE Senior Care Partners |
$77.61
|
| Rate for Payer: PACE SWMI |
$81.70
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: PHP Medicare Advantage |
$81.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Medicare |
$82.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: Railroad Medicare Medicare |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.70
|
| Rate for Payer: UHC Exchange |
$81.70
|
| Rate for Payer: UHC Medicare Advantage |
$81.70
|
| Rate for Payer: VA VA |
$81.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: BCBS Trust/PPO |
$266.77
|
| Rate for Payer: BCN Commercial |
$252.55
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health HMO/PPO |
$284.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.58
|
| Rate for Payer: UHC Core |
$272.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
