|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna Medicare |
$73.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.20
|
| Rate for Payer: BCBS Complete |
$112.90
|
| Rate for Payer: BCBS MAPPO |
$70.56
|
| Rate for Payer: BCBS Trust/PPO |
$232.03
|
| Rate for Payer: BCN Commercial |
$219.44
|
| Rate for Payer: BCN Medicare Advantage |
$70.56
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: PACE Senior Care Partners |
$67.03
|
| Rate for Payer: PACE SWMI |
$70.56
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: PHP Medicare Advantage |
$70.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health HMO/PPO |
$245.55
|
| Rate for Payer: Priority Health Medicare |
$71.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: Railroad Medicare Medicare |
$70.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.37
|
| Rate for Payer: UHC Core |
$235.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.56
|
| Rate for Payer: UHC Exchange |
$70.56
|
| Rate for Payer: UHC Medicare Advantage |
$70.56
|
| Rate for Payer: VA VA |
$70.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.87 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: BCBS Trust/PPO |
$719.44
|
| Rate for Payer: BCN Commercial |
$681.10
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$757.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$793.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
NDC 50268062511
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: BCBS Trust/PPO |
$7.37
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$7.40
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.87
|
| Rate for Payer: Priority Health HMO/PPO |
$7.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.95
|
| Rate for Payer: UHC Core |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.77
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.32 |
| Max. Negotiated Rate |
$793.21 |
| Rate for Payer: Aetna Commercial |
$749.14
|
| Rate for Payer: Aetna Medicare |
$229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.42
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS MAPPO |
$220.34
|
| Rate for Payer: BCBS Trust/PPO |
$724.55
|
| Rate for Payer: BCN Commercial |
$685.24
|
| Rate for Payer: BCN Medicare Advantage |
$220.34
|
| 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: Health Alliance Plan Medicare Advantage |
$220.34
|
| Rate for Payer: Healthscope Commercial |
$793.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: PACE Senior Care Partners |
$209.32
|
| Rate for Payer: PACE SWMI |
$220.34
|
| Rate for Payer: PHP Commercial |
$749.14
|
| Rate for Payer: PHP Medicare Advantage |
$220.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: Priority Health HMO/PPO |
$766.77
|
| Rate for Payer: Priority Health Medicare |
$222.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.50
|
| Rate for Payer: Railroad Medicare Medicare |
$220.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.58
|
| Rate for Payer: UHC Core |
$735.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.34
|
| Rate for Payer: UHC Exchange |
$220.34
|
| Rate for Payer: UHC Medicare Advantage |
$220.34
|
| Rate for Payer: VA VA |
$220.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.00
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: Nomi Health Commercial |
$2.74
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.17
|
| Rate for Payer: Priority Health HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
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 |
$70.58 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: BCBS Trust/PPO |
$88.64
|
| Rate for Payer: BCN Commercial |
$83.92
|
| Rate for Payer: Cash Price |
$86.87
|
| Rate for Payer: Cofinity Commercial |
$93.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.87
|
| Rate for Payer: Healthscope Commercial |
$97.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.30
|
| Rate for Payer: Nomi Health Commercial |
$89.04
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.58
|
| Rate for Payer: Priority Health HMO/PPO |
$94.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.76
|
| 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
|
OP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna Medicare |
$25.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.23
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS MAPPO |
$24.98
|
| Rate for Payer: BCBS Trust/PPO |
$82.16
|
| Rate for Payer: BCN Commercial |
$77.70
|
| Rate for Payer: BCN Medicare Advantage |
$24.98
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$85.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$89.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: Nomi Health Commercial |
$81.95
|
| Rate for Payer: PACE Senior Care Partners |
$23.74
|
| Rate for Payer: PACE SWMI |
$24.98
|
| Rate for Payer: PHP Commercial |
$84.95
|
| Rate for Payer: PHP Medicare Advantage |
$24.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: Priority Health HMO/PPO |
$86.95
|
| Rate for Payer: Priority Health Medicare |
$25.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.96
|
| Rate for Payer: Railroad Medicare Medicare |
$24.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.95
|
| Rate for Payer: UHC Core |
$83.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.98
|
| Rate for Payer: UHC Exchange |
$24.98
|
| Rate for Payer: UHC Medicare Advantage |
$24.98
|
| Rate for Payer: VA VA |
$24.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.96
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 68382031001
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: BCBS Trust/PPO |
$81.58
|
| Rate for Payer: BCN Commercial |
$77.23
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$85.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$89.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: Nomi Health Commercial |
$81.95
|
| Rate for Payer: PHP Commercial |
$84.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: Priority Health HMO/PPO |
$86.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.95
|
| Rate for Payer: UHC Core |
$83.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.96
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$110.02
|
|
|
Service Code
|
NDC 68382031030
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.51 |
| Max. Negotiated Rate |
$99.02 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$85.02
|
| Rate for Payer: Cash Price |
$88.02
|
| Rate for Payer: Cofinity Commercial |
$94.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$99.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.52
|
| Rate for Payer: Nomi Health Commercial |
$90.22
|
| Rate for Payer: PHP Commercial |
$93.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.51
|
| Rate for Payer: Priority Health HMO/PPO |
$95.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.82
|
| Rate for Payer: UHC Core |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.52
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.79 |
| 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 |
$43.44
|
| Rate for Payer: BCBS MAPPO |
$27.15
|
| Rate for Payer: BCBS Trust/PPO |
$89.27
|
| Rate for Payer: BCN Commercial |
$84.43
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.30
|
| Rate for Payer: Nomi Health Commercial |
$89.04
|
| 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 Cigna Priority Health |
$70.58
|
| Rate for Payer: Priority Health HMO/PPO |
$94.47
|
| Rate for Payer: Priority Health Medicare |
$27.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.76
|
| 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 Dual Complete DSNP |
$27.15
|
| Rate for Payer: UHC Exchange |
$27.15
|
| Rate for Payer: UHC Medicare Advantage |
$27.15
|
| 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
|
OP
|
$110.02
|
|
|
Service Code
|
NDC 68382031030
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$99.02 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.38
|
| Rate for Payer: BCBS Complete |
$44.01
|
| Rate for Payer: BCBS MAPPO |
$27.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.45
|
| Rate for Payer: BCN Commercial |
$85.54
|
| Rate for Payer: BCN Medicare Advantage |
$27.50
|
| Rate for Payer: Cash Price |
$88.02
|
| Rate for Payer: Cofinity Commercial |
$94.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$99.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.52
|
| Rate for Payer: Nomi Health Commercial |
$90.22
|
| Rate for Payer: PACE Senior Care Partners |
$26.13
|
| Rate for Payer: PACE SWMI |
$27.50
|
| Rate for Payer: PHP Commercial |
$93.52
|
| Rate for Payer: PHP Medicare Advantage |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.51
|
| Rate for Payer: Priority Health HMO/PPO |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$27.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.71
|
| Rate for Payer: Railroad Medicare Medicare |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.82
|
| Rate for Payer: UHC Core |
$91.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.50
|
| Rate for Payer: UHC Exchange |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$27.50
|
| Rate for Payer: VA VA |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.52
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 68382031001
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.04
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: Nomi Health Commercial |
$2.74
|
| Rate for Payer: PACE Senior Care Partners |
$0.79
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.17
|
| Rate for Payer: Priority Health HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Medicare |
$0.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
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 |
$86.10 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: BCBS Trust/PPO |
$108.13
|
| Rate for Payer: BCN Commercial |
$102.37
|
| 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: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO |
$115.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.75
|
| 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
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.69 |
| 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 |
$12.95
|
| Rate for Payer: BCBS MAPPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$26.62
|
| Rate for Payer: BCN Commercial |
$25.18
|
| 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 |
$24.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| 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 Cigna Priority Health |
$21.05
|
| Rate for Payer: Priority Health HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Medicare |
$8.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.69
|
| 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 Dual Complete DSNP |
$8.10
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicare Advantage |
$8.10
|
| Rate for Payer: VA VA |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.28
|
|
|
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 |
$2.13 |
| 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 |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: BCN Medicare Advantage |
$2.24
|
| 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 |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: PACE Senior Care Partners |
$2.13
|
| Rate for Payer: PACE SWMI |
$2.24
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.24
|
| Rate for Payer: UHC Exchange |
$2.24
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
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 |
$2.13 |
| 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 |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: BCN Medicare Advantage |
$2.24
|
| 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 |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.63
|
| Rate for Payer: Nomi Health Commercial |
$7.36
|
| Rate for Payer: PACE Senior Care Partners |
$2.13
|
| Rate for Payer: PACE SWMI |
$2.24
|
| Rate for Payer: PHP Commercial |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.90
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.24
|
| Rate for Payer: UHC Exchange |
$2.24
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.74
|
|
|
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 |
$21.05 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: BCBS Trust/PPO |
$26.43
|
| Rate for Payer: BCN Commercial |
$25.02
|
| 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 |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.05
|
| Rate for Payer: Priority Health HMO/PPO |
$28.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.69
|
| 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 |
$24.28
|
|
|
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 |
$31.46 |
| 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 |
$52.98
|
| Rate for Payer: BCBS MAPPO |
$33.12
|
| Rate for Payer: BCBS Trust/PPO |
$108.90
|
| Rate for Payer: BCN Commercial |
$102.99
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| 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 Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO |
$115.24
|
| Rate for Payer: Priority Health Medicare |
$33.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.75
|
| 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 Dual Complete DSNP |
$33.12
|
| Rate for Payer: UHC Exchange |
$33.12
|
| Rate for Payer: UHC Medicare Advantage |
$33.12
|
| Rate for Payer: VA VA |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
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 |
$5.84 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$6.94
|
| 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: PHP Commercial |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.02
|
| 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
|
$8.98
|
|
|
Service Code
|
NDC 68462063925
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$6.94
|
| 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: PHP Commercial |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.02
|
| 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 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$89.51
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: BCBS Trust/PPO |
$73.07
|
| Rate for Payer: BCN Commercial |
$69.17
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cofinity Commercial |
$76.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.61
|
| Rate for Payer: Healthscope Commercial |
$80.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: Nomi Health Commercial |
$73.40
|
| Rate for Payer: PHP Commercial |
$76.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: Priority Health HMO/PPO |
$77.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.77
|
| Rate for Payer: UHC Core |
$74.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.13
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$89.51
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Medicare |
$23.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.97
|
| Rate for Payer: BCBS Complete |
$35.80
|
| Rate for Payer: BCBS MAPPO |
$22.38
|
| Rate for Payer: BCBS Trust/PPO |
$73.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: BCN Medicare Advantage |
$22.38
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cofinity Commercial |
$76.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$80.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: Nomi Health Commercial |
$73.40
|
| Rate for Payer: PACE Senior Care Partners |
$21.26
|
| Rate for Payer: PACE SWMI |
$22.38
|
| Rate for Payer: PHP Commercial |
$76.08
|
| Rate for Payer: PHP Medicare Advantage |
$22.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: Priority Health HMO/PPO |
$77.87
|
| Rate for Payer: Priority Health Medicare |
$22.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.97
|
| Rate for Payer: Railroad Medicare Medicare |
$22.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.77
|
| Rate for Payer: UHC Core |
$74.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.38
|
| Rate for Payer: UHC Exchange |
$22.38
|
| Rate for Payer: UHC Medicare Advantage |
$22.38
|
| Rate for Payer: VA VA |
$22.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.13
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.11
|
|
|
Service Code
|
NDC 51991098399
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$20.50
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.09
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health HMO/PPO |
$21.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.10
|
| Rate for Payer: UHC Core |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.83
|
|
