|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
NDC 68084-022-11
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.97
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$378.72
|
|
|
Service Code
|
NDC 0228-2497-10
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Aetna American Axle |
$246.17
|
| Rate for Payer: Aetna Commercial |
$321.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.17
|
| Rate for Payer: Cash Price |
$302.98
|
| Rate for Payer: Cofinity Commercial |
$265.10
|
| Rate for Payer: Cofinity Commercial |
$325.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.98
|
| Rate for Payer: Healthscope Commercial |
$340.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.91
|
| Rate for Payer: PHP Commercial |
$321.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.10
|
| Rate for Payer: Priority Health SBD |
$238.59
|
| Rate for Payer: UMR Bronson Commercial |
$166.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.04
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 60687-425-11
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$475.68
|
|
|
Service Code
|
NDC 60687-425-01
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$428.11 |
| Rate for Payer: Aetna American Axle |
$309.19
|
| Rate for Payer: Aetna Commercial |
$404.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.19
|
| Rate for Payer: Cash Price |
$380.54
|
| Rate for Payer: Cofinity Commercial |
$332.98
|
| Rate for Payer: Cofinity Commercial |
$409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.54
|
| Rate for Payer: Healthscope Commercial |
$428.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.33
|
| Rate for Payer: PHP Commercial |
$404.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.98
|
| Rate for Payer: Priority Health SBD |
$299.68
|
| Rate for Payer: UMR Bronson Commercial |
$209.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.76
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 23155-194-01
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$376.80
|
|
|
Service Code
|
NDC 0904-7229-61
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.79 |
| Max. Negotiated Rate |
$339.12 |
| Rate for Payer: Aetna American Axle |
$244.92
|
| Rate for Payer: Aetna Commercial |
$320.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.92
|
| Rate for Payer: Cash Price |
$301.44
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$324.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.44
|
| Rate for Payer: Healthscope Commercial |
$339.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.28
|
| Rate for Payer: PHP Commercial |
$320.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.76
|
| Rate for Payer: Priority Health SBD |
$237.38
|
| Rate for Payer: UMR Bronson Commercial |
$165.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.60
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$822.24
|
|
|
Service Code
|
NDC 0228-2530-10
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.79 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.90
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.57
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UMR Bronson Commercial |
$361.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$370.08
|
|
|
Service Code
|
NDC 23155-195-01
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$333.07 |
| Rate for Payer: Aetna American Axle |
$240.55
|
| Rate for Payer: Aetna Commercial |
$314.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.55
|
| Rate for Payer: Cash Price |
$296.06
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Cofinity Commercial |
$318.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.06
|
| Rate for Payer: Healthscope Commercial |
$333.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.57
|
| Rate for Payer: PHP Commercial |
$314.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.06
|
| Rate for Payer: Priority Health SBD |
$233.15
|
| Rate for Payer: UMR Bronson Commercial |
$162.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.56
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$191.28
|
|
|
Service Code
|
NDC 50268-597-15
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.16 |
| Max. Negotiated Rate |
$172.15 |
| Rate for Payer: Aetna American Axle |
$124.33
|
| Rate for Payer: Aetna Commercial |
$162.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.33
|
| Rate for Payer: Cash Price |
$153.02
|
| Rate for Payer: Cofinity Commercial |
$133.90
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.02
|
| Rate for Payer: Healthscope Commercial |
$172.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.59
|
| Rate for Payer: PHP Commercial |
$162.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health SBD |
$120.51
|
| Rate for Payer: UMR Bronson Commercial |
$84.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.46
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 50742-260-01
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.92
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 68084-597-11
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna American Axle |
$2.46
|
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.46
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.84
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$477.60
|
|
|
Service Code
|
NDC 62175-260-37
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna American Axle |
$310.44
|
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Commercial |
$334.32
|
| Rate for Payer: Cofinity Commercial |
$410.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.08
|
| Rate for Payer: Healthscope Commercial |
$429.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.96
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.32
|
| Rate for Payer: Priority Health SBD |
$300.89
|
| Rate for Payer: UMR Bronson Commercial |
$210.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.20
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$377.28
|
|
|
Service Code
|
NDC 68084-597-01
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna American Axle |
$245.23
|
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Commercial |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.69
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.10
|
| Rate for Payer: Priority Health SBD |
$237.69
|
| Rate for Payer: UMR Bronson Commercial |
$166.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.96
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$953.76
|
|
|
Service Code
|
NDC 62175-262-37
|
| Hospital Charge Code |
27335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$419.65 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Aetna American Axle |
$619.94
|
| Rate for Payer: Aetna Commercial |
$810.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.94
|
| Rate for Payer: Cash Price |
$763.01
|
| Rate for Payer: Cofinity Commercial |
$667.63
|
| Rate for Payer: Cofinity Commercial |
$820.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.01
|
| Rate for Payer: Healthscope Commercial |
$858.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$667.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.70
|
| Rate for Payer: PHP Commercial |
$810.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.63
|
| Rate for Payer: Priority Health SBD |
$600.87
|
| Rate for Payer: UMR Bronson Commercial |
$419.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.32
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$159.53
|
|
|
Service Code
|
NDC 24338-230-05
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$143.58 |
| Rate for Payer: Aetna American Axle |
$103.69
|
| Rate for Payer: Aetna Commercial |
$135.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.69
|
| Rate for Payer: Cash Price |
$127.62
|
| Rate for Payer: Cofinity Commercial |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.62
|
| Rate for Payer: Healthscope Commercial |
$143.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.60
|
| Rate for Payer: PHP Commercial |
$135.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.67
|
| Rate for Payer: Priority Health SBD |
$100.50
|
| Rate for Payer: UMR Bronson Commercial |
$70.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.65
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$5.76
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna American Axle |
$3.74
|
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.90
|
| Rate for Payer: PHP Commercial |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.03
|
| Rate for Payer: Priority Health SBD |
$3.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.32
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
NDC 23155-512-00
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.20
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$253.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$44.70
|
|
|
Service Code
|
NDC 62559-210-52
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna American Axle |
$29.06
|
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.06
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Commercial |
$38.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$40.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.00
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.29
|
| Rate for Payer: Priority Health SBD |
$28.16
|
| Rate for Payer: UMR Bronson Commercial |
$19.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.52
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,771.56
|
|
|
Service Code
|
NDC 57664-135-65
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.49 |
| Max. Negotiated Rate |
$1,594.40 |
| Rate for Payer: Aetna American Axle |
$1,151.51
|
| Rate for Payer: Aetna Commercial |
$1,505.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.51
|
| Rate for Payer: Cash Price |
$1,417.25
|
| Rate for Payer: Cofinity Commercial |
$1,240.09
|
| Rate for Payer: Cofinity Commercial |
$1,523.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.25
|
| Rate for Payer: Healthscope Commercial |
$1,594.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.83
|
| Rate for Payer: PHP Commercial |
$1,505.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,240.09
|
| Rate for Payer: Priority Health SBD |
$1,116.08
|
| Rate for Payer: UMR Bronson Commercial |
$779.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.67
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$17.72
|
|
|
Service Code
|
NDC 57664-135-60
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$571.68
|
|
|
Service Code
|
NDC 69452-209-20
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.54 |
| Max. Negotiated Rate |
$514.51 |
| Rate for Payer: Aetna American Axle |
$371.59
|
| Rate for Payer: Aetna Commercial |
$485.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.59
|
| Rate for Payer: Cash Price |
$457.34
|
| Rate for Payer: Cofinity Commercial |
$400.18
|
| Rate for Payer: Cofinity Commercial |
$491.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.34
|
| Rate for Payer: Healthscope Commercial |
$514.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$485.93
|
| Rate for Payer: PHP Commercial |
$485.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.18
|
| Rate for Payer: Priority Health SBD |
$360.16
|
| Rate for Payer: UMR Bronson Commercial |
$251.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.76
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$215.57
|
|
|
Service Code
|
NDC 62559-210-31
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$194.01 |
| Rate for Payer: Aetna American Axle |
$140.12
|
| Rate for Payer: Aetna Commercial |
$183.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.12
|
| Rate for Payer: Cash Price |
$172.46
|
| Rate for Payer: Cofinity Commercial |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$185.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.46
|
| Rate for Payer: Healthscope Commercial |
$194.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.23
|
| Rate for Payer: PHP Commercial |
$183.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.90
|
| Rate for Payer: Priority Health SBD |
$135.81
|
| Rate for Payer: UMR Bronson Commercial |
$94.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.68
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$210.53
|
|
|
Service Code
|
NDC 69452-209-13
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.63 |
| Max. Negotiated Rate |
$189.48 |
| Rate for Payer: Aetna American Axle |
$136.84
|
| Rate for Payer: Aetna Commercial |
$178.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.84
|
| Rate for Payer: Cash Price |
$168.42
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Commercial |
$181.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.42
|
| Rate for Payer: Healthscope Commercial |
$189.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.95
|
| Rate for Payer: PHP Commercial |
$178.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.37
|
| Rate for Payer: Priority Health SBD |
$132.63
|
| Rate for Payer: UMR Bronson Commercial |
$92.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.90
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$7.02
|
|
|
Service Code
|
NDC 69452-209-07
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna American Axle |
$4.56
|
| Rate for Payer: Aetna Commercial |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.56
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cofinity Commercial |
$4.91
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$6.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.97
|
| Rate for Payer: PHP Commercial |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.91
|
| Rate for Payer: Priority Health SBD |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.26
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$319.06
|
|
|
Service Code
|
NDC 24338-260-10
|
| Hospital Charge Code |
193497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$287.15 |
| Rate for Payer: Aetna American Axle |
$207.39
|
| Rate for Payer: Aetna Commercial |
$271.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.39
|
| Rate for Payer: Cash Price |
$255.25
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$274.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.25
|
| Rate for Payer: Healthscope Commercial |
$287.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.20
|
| Rate for Payer: PHP Commercial |
$271.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.34
|
| Rate for Payer: Priority Health SBD |
$201.01
|
| Rate for Payer: UMR Bronson Commercial |
$140.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.30
|
|
