|
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS DUCT
|
Facility
|
OP
|
$10,666.11
|
|
|
Service Code
|
CPT 19110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.36 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,743.76
|
| Rate for Payer: BCCCP Commercial |
$519.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$350.36
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,266.89
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
204885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$557.43 |
| Max. Negotiated Rate |
$1,140.20 |
| Rate for Payer: Aetna American Axle |
$823.48
|
| Rate for Payer: Aetna Commercial |
$1,076.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.48
|
| Rate for Payer: Cash Price |
$1,013.51
|
| Rate for Payer: Cofinity Commercial |
$1,089.53
|
| Rate for Payer: Cofinity Commercial |
$886.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.51
|
| Rate for Payer: Healthscope Commercial |
$1,140.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$886.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,076.86
|
| Rate for Payer: PHP Commercial |
$1,076.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.82
|
| Rate for Payer: Priority Health SBD |
$798.14
|
| Rate for Payer: UMR Bronson Commercial |
$557.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.17
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,266.89
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
204884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$557.43 |
| Max. Negotiated Rate |
$1,140.20 |
| Rate for Payer: Aetna American Axle |
$823.48
|
| Rate for Payer: Aetna Commercial |
$1,076.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.48
|
| Rate for Payer: Cash Price |
$1,013.51
|
| Rate for Payer: Cofinity Commercial |
$1,089.53
|
| Rate for Payer: Cofinity Commercial |
$886.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.51
|
| Rate for Payer: Healthscope Commercial |
$1,140.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$886.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,076.86
|
| Rate for Payer: PHP Commercial |
$1,076.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.82
|
| Rate for Payer: Priority Health SBD |
$798.14
|
| Rate for Payer: UMR Bronson Commercial |
$557.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.17
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$5,983.93
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,632.93 |
| Max. Negotiated Rate |
$5,385.54 |
| Rate for Payer: Aetna American Axle |
$3,889.55
|
| Rate for Payer: Aetna Commercial |
$5,086.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,889.55
|
| Rate for Payer: Cash Price |
$4,787.14
|
| Rate for Payer: Cofinity Commercial |
$4,188.75
|
| Rate for Payer: Cofinity Commercial |
$5,146.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,787.14
|
| Rate for Payer: Healthscope Commercial |
$5,385.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,188.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,487.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,086.34
|
| Rate for Payer: PHP Commercial |
$5,086.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,188.75
|
| Rate for Payer: Priority Health SBD |
$3,769.88
|
| Rate for Payer: UMR Bronson Commercial |
$2,632.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,487.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$2,417.27
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,063.60 |
| Max. Negotiated Rate |
$2,175.54 |
| Rate for Payer: Aetna American Axle |
$1,571.23
|
| Rate for Payer: Aetna Commercial |
$2,054.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.23
|
| Rate for Payer: Cash Price |
$1,933.82
|
| Rate for Payer: Cofinity Commercial |
$1,692.09
|
| Rate for Payer: Cofinity Commercial |
$2,078.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,933.82
|
| Rate for Payer: Healthscope Commercial |
$2,175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,692.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,812.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,054.68
|
| Rate for Payer: PHP Commercial |
$2,054.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.09
|
| Rate for Payer: Priority Health SBD |
$1,522.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,063.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,812.95
|
|
|
NITAZOXANIDE 500 MG TABLET
|
Facility
|
IP
|
$13,935.61
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
39254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,131.67 |
| Max. Negotiated Rate |
$12,542.05 |
| Rate for Payer: Aetna American Axle |
$9,058.15
|
| Rate for Payer: Aetna Commercial |
$11,845.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,058.15
|
| Rate for Payer: Cash Price |
$11,148.49
|
| Rate for Payer: Cofinity Commercial |
$11,984.62
|
| Rate for Payer: Cofinity Commercial |
$9,754.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,148.49
|
| Rate for Payer: Healthscope Commercial |
$12,542.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,754.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,451.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,845.27
|
| Rate for Payer: PHP Commercial |
$11,845.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,754.93
|
| Rate for Payer: Priority Health SBD |
$8,779.43
|
| Rate for Payer: UMR Bronson Commercial |
$6,131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,451.71
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4,916.23
|
|
|
Service Code
|
NDC 70954-496-10
|
| Hospital Charge Code |
10723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,163.14 |
| Max. Negotiated Rate |
$4,424.61 |
| Rate for Payer: Aetna American Axle |
$3,195.55
|
| Rate for Payer: Aetna Commercial |
$4,178.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,195.55
|
| Rate for Payer: Cash Price |
$3,932.98
|
| Rate for Payer: Cofinity Commercial |
$3,441.36
|
| Rate for Payer: Cofinity Commercial |
$4,227.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,932.98
|
| Rate for Payer: Healthscope Commercial |
$4,424.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,441.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,687.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,178.80
|
| Rate for Payer: PHP Commercial |
$4,178.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,441.36
|
| Rate for Payer: Priority Health SBD |
$3,097.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,163.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,687.17
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE
|
Facility
|
IP
|
$808.08
|
|
|
Service Code
|
NDC 47781-308-01
|
| Hospital Charge Code |
5593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.56 |
| Max. Negotiated Rate |
$727.27 |
| Rate for Payer: Aetna American Axle |
$525.25
|
| Rate for Payer: Aetna Commercial |
$686.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.25
|
| Rate for Payer: Cash Price |
$646.46
|
| Rate for Payer: Cofinity Commercial |
$565.66
|
| Rate for Payer: Cofinity Commercial |
$694.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.46
|
| Rate for Payer: Healthscope Commercial |
$727.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.87
|
| Rate for Payer: PHP Commercial |
$686.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.66
|
| Rate for Payer: Priority Health SBD |
$509.09
|
| Rate for Payer: UMR Bronson Commercial |
$355.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.06
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
NDC 0904-7026-61
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.36 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Aetna American Axle |
$483.60
|
| Rate for Payer: Aetna Commercial |
$632.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.60
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$520.80
|
| Rate for Payer: Cofinity Commercial |
$639.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.20
|
| Rate for Payer: Healthscope Commercial |
$669.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$632.40
|
| Rate for Payer: PHP Commercial |
$632.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.80
|
| Rate for Payer: Priority Health SBD |
$468.72
|
| Rate for Payer: UMR Bronson Commercial |
$327.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.00
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$7.64
|
|
|
Service Code
|
NDC 60687-472-11
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna American Axle |
$4.97
|
| Rate for Payer: Aetna Commercial |
$6.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.97
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.11
|
| Rate for Payer: Healthscope Commercial |
$6.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.49
|
| Rate for Payer: PHP Commercial |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.35
|
| Rate for Payer: Priority Health SBD |
$4.81
|
| Rate for Payer: UMR Bronson Commercial |
$3.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.73
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE
|
Facility
|
IP
|
$763.20
|
|
|
Service Code
|
NDC 60687-472-01
|
| Hospital Charge Code |
5595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.81 |
| Max. Negotiated Rate |
$686.88 |
| Rate for Payer: Aetna American Axle |
$496.08
|
| Rate for Payer: Aetna Commercial |
$648.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.08
|
| Rate for Payer: Cash Price |
$610.56
|
| Rate for Payer: Cofinity Commercial |
$534.24
|
| Rate for Payer: Cofinity Commercial |
$656.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.56
|
| Rate for Payer: Healthscope Commercial |
$686.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$534.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.72
|
| Rate for Payer: PHP Commercial |
$648.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.24
|
| Rate for Payer: Priority Health SBD |
$480.82
|
| Rate for Payer: UMR Bronson Commercial |
$335.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.40
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$313.50
|
|
|
Service Code
|
NDC 65162-478-10
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Commercial |
$219.45
|
| Rate for Payer: Cofinity Commercial |
$269.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.80
|
| Rate for Payer: Healthscope Commercial |
$282.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.48
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.45
|
| Rate for Payer: Priority Health SBD |
$197.50
|
| Rate for Payer: UMR Bronson Commercial |
$137.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.12
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$1,111.85
|
|
|
Service Code
|
NDC 51079-348-20
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.21 |
| Max. Negotiated Rate |
$1,000.66 |
| Rate for Payer: Aetna American Axle |
$722.70
|
| Rate for Payer: Aetna Commercial |
$945.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.70
|
| Rate for Payer: Cash Price |
$889.48
|
| Rate for Payer: Cofinity Commercial |
$778.30
|
| Rate for Payer: Cofinity Commercial |
$956.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.48
|
| Rate for Payer: Healthscope Commercial |
$1,000.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.07
|
| Rate for Payer: PHP Commercial |
$945.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.30
|
| Rate for Payer: Priority Health SBD |
$700.47
|
| Rate for Payer: UMR Bronson Commercial |
$489.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.89
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51079-348-01
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.78
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$698.40
|
|
|
Service Code
|
NDC 47781-303-01
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.30 |
| Max. Negotiated Rate |
$628.56 |
| Rate for Payer: Aetna American Axle |
$453.96
|
| Rate for Payer: Aetna Commercial |
$593.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.96
|
| Rate for Payer: Cash Price |
$558.72
|
| Rate for Payer: Cofinity Commercial |
$488.88
|
| Rate for Payer: Cofinity Commercial |
$600.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.72
|
| Rate for Payer: Healthscope Commercial |
$628.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$523.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$593.64
|
| Rate for Payer: PHP Commercial |
$593.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.88
|
| Rate for Payer: Priority Health SBD |
$439.99
|
| Rate for Payer: UMR Bronson Commercial |
$307.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$523.80
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$139.94
|
|
|
Service Code
|
NDC 0378-9102-93
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.57 |
| Max. Negotiated Rate |
$125.95 |
| Rate for Payer: Aetna American Axle |
$90.96
|
| Rate for Payer: Aetna Commercial |
$118.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.96
|
| Rate for Payer: Cash Price |
$111.95
|
| Rate for Payer: Cofinity Commercial |
$120.35
|
| Rate for Payer: Cofinity Commercial |
$97.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.95
|
| Rate for Payer: Healthscope Commercial |
$125.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.95
|
| Rate for Payer: PHP Commercial |
$118.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.96
|
| Rate for Payer: Priority Health SBD |
$88.16
|
| Rate for Payer: UMR Bronson Commercial |
$61.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.96
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 0378-9102-16
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.97
|
| Rate for Payer: PHP Commercial |
$3.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.27
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$107.45
|
|
|
Service Code
|
NDC 49730-111-30
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$96.70 |
| Rate for Payer: Aetna American Axle |
$69.84
|
| Rate for Payer: Aetna Commercial |
$91.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.84
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.96
|
| Rate for Payer: Healthscope Commercial |
$96.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.33
|
| Rate for Payer: PHP Commercial |
$91.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.22
|
| Rate for Payer: Priority Health SBD |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$47.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.59
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$133.67
|
|
|
Service Code
|
NDC 0378-9104-93
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$120.30 |
| Rate for Payer: Aetna American Axle |
$86.89
|
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.89
|
| Rate for Payer: Cash Price |
$106.94
|
| Rate for Payer: Cofinity Commercial |
$114.96
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.94
|
| Rate for Payer: Healthscope Commercial |
$120.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.62
|
| Rate for Payer: PHP Commercial |
$113.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.57
|
| Rate for Payer: Priority Health SBD |
$84.21
|
| Rate for Payer: UMR Bronson Commercial |
$58.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.25
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 0378-9104-16
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna American Axle |
$2.90
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.90
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.79
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$182.35
|
|
|
Service Code
|
NDC 50742-515-01
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.23 |
| Max. Negotiated Rate |
$164.12 |
| Rate for Payer: Aetna American Axle |
$118.53
|
| Rate for Payer: Aetna Commercial |
$155.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.53
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Cofinity Commercial |
$127.64
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.88
|
| Rate for Payer: Healthscope Commercial |
$164.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.00
|
| Rate for Payer: PHP Commercial |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.64
|
| Rate for Payer: Priority Health SBD |
$114.88
|
| Rate for Payer: UMR Bronson Commercial |
$80.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.76
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$5,470.31
|
|
|
Service Code
|
NDC 50742-515-30
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,406.94 |
| Max. Negotiated Rate |
$4,923.28 |
| Rate for Payer: Aetna American Axle |
$3,555.70
|
| Rate for Payer: Aetna Commercial |
$4,649.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,555.70
|
| Rate for Payer: Cash Price |
$4,376.25
|
| Rate for Payer: Cofinity Commercial |
$3,829.22
|
| Rate for Payer: Cofinity Commercial |
$4,704.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,376.25
|
| Rate for Payer: Healthscope Commercial |
$4,923.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,829.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,102.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,649.76
|
| Rate for Payer: PHP Commercial |
$4,649.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,829.22
|
| Rate for Payer: Priority Health SBD |
$3,446.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,406.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,102.73
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 0378-9112-16
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.59
|
|
|
Service Code
|
NDC 49730-112-30
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna American Axle |
$70.58
|
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.58
|
| Rate for Payer: Cash Price |
$86.87
|
| Rate for Payer: Cofinity Commercial |
$76.01
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$76.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.30
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.01
|
| Rate for Payer: Priority Health SBD |
$68.41
|
| Rate for Payer: UMR Bronson Commercial |
$47.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.44
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
NDC 0378-9112-93
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Aetna American Axle |
$63.18
|
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.18
|
| Rate for Payer: Cash Price |
$77.76
|
| Rate for Payer: Cofinity Commercial |
$68.04
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.76
|
| Rate for Payer: Healthscope Commercial |
$87.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.62
|
| Rate for Payer: PHP Commercial |
$82.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.04
|
| Rate for Payer: Priority Health SBD |
$61.24
|
| Rate for Payer: UMR Bronson Commercial |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.90
|
|
