|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 00536110688
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna American Axle |
$69.63
|
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
| Rate for Payer: UMR Bronson Commercial |
$47.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 03215120107
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Aetna American Axle |
$34.79
|
| Rate for Payer: Aetna Commercial |
$45.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.79
|
| Rate for Payer: Cash Price |
$42.82
|
| Rate for Payer: Cofinity Advantage |
$37.47
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.82
|
| Rate for Payer: Healthscope Commercial |
$48.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.15
|
| Rate for Payer: PHP Commercial |
$45.50
|
| Rate for Payer: Priority Health SBD |
$33.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.15
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
NDC 03215120107
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Aetna American Axle |
$34.79
|
| Rate for Payer: Aetna Commercial |
$45.50
|
| Rate for Payer: Aetna Medicare |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.79
|
| Rate for Payer: BCBS Complete |
$21.41
|
| Rate for Payer: Cash Price |
$42.82
|
| Rate for Payer: Cofinity Advantage |
$37.47
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.82
|
| Rate for Payer: Healthscope Commercial |
$48.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.15
|
| Rate for Payer: PHP Commercial |
$45.50
|
| Rate for Payer: Priority Health SBD |
$33.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.79
|
| Rate for Payer: UHC Core |
$27.89
|
| Rate for Payer: UHC Exchange |
$21.04
|
| Rate for Payer: UMR Bronson Commercial |
$19.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.15
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
NDC 03215120106
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna American Axle |
$4.97
|
| Rate for Payer: Aetna Commercial |
$6.50
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.97
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Advantage |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$6.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.74
|
| Rate for Payer: PHP Commercial |
$6.50
|
| Rate for Payer: Priority Health SBD |
$4.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.97
|
| Rate for Payer: UHC Core |
$3.99
|
| Rate for Payer: UHC Exchange |
$3.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.74
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$98.52
|
|
|
Service Code
|
NDC 00536589488
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Aetna American Axle |
$64.04
|
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.04
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Advantage |
$68.96
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: Priority Health SBD |
$62.07
|
| Rate for Payer: UMR Bronson Commercial |
$43.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.89
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 00536110688
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Aetna American Axle |
$69.63
|
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Aetna Medicare |
$53.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.63
|
| Rate for Payer: BCBS Complete |
$42.85
|
| Rate for Payer: Cash Price |
$85.70
|
| Rate for Payer: Cofinity Advantage |
$74.98
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$96.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.34
|
| Rate for Payer: PHP Commercial |
$91.05
|
| Rate for Payer: Priority Health SBD |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.63
|
| Rate for Payer: UHC Core |
$55.81
|
| Rate for Payer: UHC Exchange |
$42.10
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.34
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$98.52
|
|
|
Service Code
|
NDC 00536589488
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Aetna American Axle |
$64.04
|
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: Aetna Medicare |
$49.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.04
|
| Rate for Payer: BCBS Complete |
$39.41
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Advantage |
$68.96
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: Priority Health SBD |
$62.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.04
|
| Rate for Payer: UHC Core |
$51.33
|
| Rate for Payer: UHC Exchange |
$38.72
|
| Rate for Payer: UMR Bronson Commercial |
$36.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.89
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE
|
Facility
|
IP
|
$247.61
|
|
|
Service Code
|
NDC 45802034405
|
| Hospital Charge Code |
34769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$222.85 |
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna Commercial |
$210.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: Cash Price |
$198.09
|
| Rate for Payer: Cofinity Advantage |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$212.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.09
|
| Rate for Payer: Healthscope Commercial |
$222.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.71
|
| Rate for Payer: PHP Commercial |
$210.47
|
| Rate for Payer: Priority Health SBD |
$155.99
|
| Rate for Payer: UMR Bronson Commercial |
$108.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.71
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE
|
Facility
|
OP
|
$247.61
|
|
|
Service Code
|
NDC 45802034405
|
| Hospital Charge Code |
34769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.62 |
| Max. Negotiated Rate |
$222.85 |
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna Commercial |
$210.47
|
| Rate for Payer: Aetna Medicare |
$123.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: Cash Price |
$198.09
|
| Rate for Payer: Cofinity Advantage |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$212.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.09
|
| Rate for Payer: Healthscope Commercial |
$222.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.71
|
| Rate for Payer: PHP Commercial |
$210.47
|
| Rate for Payer: Priority Health SBD |
$155.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.95
|
| Rate for Payer: UHC Core |
$129.00
|
| Rate for Payer: UHC Exchange |
$97.31
|
| Rate for Payer: UMR Bronson Commercial |
$91.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.71
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$268.71 |
| Rate for Payer: Aetna American Axle |
$194.07
|
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.07
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: Cash Price |
$238.86
|
| Rate for Payer: Cofinity Advantage |
$209.00
|
| Rate for Payer: Cofinity Commercial |
$256.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.86
|
| Rate for Payer: Healthscope Commercial |
$268.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.93
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health SBD |
$188.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.07
|
| Rate for Payer: UHC Core |
$155.55
|
| Rate for Payer: UHC Exchange |
$117.34
|
| Rate for Payer: UMR Bronson Commercial |
$110.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.93
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$99.53
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna American Axle |
$64.69
|
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Medicare |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.69
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Advantage |
$69.67
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.65
|
| Rate for Payer: PHP Commercial |
$84.60
|
| Rate for Payer: Priority Health SBD |
$62.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.69
|
| Rate for Payer: UHC Core |
$51.86
|
| Rate for Payer: UHC Exchange |
$39.12
|
| Rate for Payer: UMR Bronson Commercial |
$36.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.65
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$298.57
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.37 |
| Max. Negotiated Rate |
$268.71 |
| Rate for Payer: Aetna American Axle |
$194.07
|
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.07
|
| Rate for Payer: Cash Price |
$238.86
|
| Rate for Payer: Cofinity Advantage |
$209.00
|
| Rate for Payer: Cofinity Commercial |
$256.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.86
|
| Rate for Payer: Healthscope Commercial |
$268.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.93
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health SBD |
$188.10
|
| Rate for Payer: UMR Bronson Commercial |
$131.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.93
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$99.53
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna American Axle |
$64.69
|
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.69
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cofinity Advantage |
$69.67
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.65
|
| Rate for Payer: PHP Commercial |
$84.60
|
| Rate for Payer: Priority Health SBD |
$62.70
|
| Rate for Payer: UMR Bronson Commercial |
$43.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.65
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna American Axle |
$218.59
|
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.59
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Advantage |
$235.41
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health SBD |
$211.87
|
| Rate for Payer: UMR Bronson Commercial |
$147.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$430.56
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.31 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna American Axle |
$279.86
|
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Medicare |
$215.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.86
|
| Rate for Payer: BCBS Complete |
$172.22
|
| Rate for Payer: Cash Price |
$344.45
|
| Rate for Payer: Cofinity Advantage |
$301.39
|
| Rate for Payer: Cofinity Commercial |
$370.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.45
|
| Rate for Payer: Healthscope Commercial |
$387.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.92
|
| Rate for Payer: PHP Commercial |
$365.98
|
| Rate for Payer: Priority Health SBD |
$271.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.86
|
| Rate for Payer: UHC Core |
$224.32
|
| Rate for Payer: UHC Exchange |
$169.21
|
| Rate for Payer: UMR Bronson Commercial |
$159.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.92
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$430.56
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.45 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna American Axle |
$279.86
|
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.86
|
| Rate for Payer: Cash Price |
$344.45
|
| Rate for Payer: Cofinity Advantage |
$301.39
|
| Rate for Payer: Cofinity Commercial |
$370.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.45
|
| Rate for Payer: Healthscope Commercial |
$387.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.92
|
| Rate for Payer: PHP Commercial |
$365.98
|
| Rate for Payer: Priority Health SBD |
$271.25
|
| Rate for Payer: UMR Bronson Commercial |
$189.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.92
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.43 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna American Axle |
$218.59
|
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna Medicare |
$168.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.59
|
| Rate for Payer: BCBS Complete |
$134.52
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Advantage |
$235.41
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.22
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health SBD |
$211.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.59
|
| Rate for Payer: UHC Core |
$175.21
|
| Rate for Payer: UHC Exchange |
$132.17
|
| Rate for Payer: UMR Bronson Commercial |
$124.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$378.72
|
|
|
Service Code
|
NDC 00228249710
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Aetna American Axle |
$246.17
|
| Rate for Payer: Aetna Commercial |
$321.91
|
| Rate for Payer: Aetna Medicare |
$189.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.17
|
| Rate for Payer: BCBS Complete |
$151.49
|
| Rate for Payer: Cash Price |
$302.98
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$302.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.04
|
| Rate for Payer: PHP Commercial |
$321.91
|
| Rate for Payer: Priority Health SBD |
$238.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.17
|
| Rate for Payer: UHC Core |
$197.31
|
| Rate for Payer: UHC Exchange |
$148.84
|
| Rate for Payer: UMR Bronson Commercial |
$140.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.04
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$378.72
|
|
|
Service Code
|
NDC 00228249710
|
| 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 Advantage |
$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 Commercial |
$321.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.04
|
| Rate for Payer: PHP Commercial |
$321.91
|
| 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 20 MG CAPSULE
|
Facility
|
OP
|
$370.56
|
|
|
Service Code
|
NDC 23155019501
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.11 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Aetna American Axle |
$240.86
|
| Rate for Payer: Aetna Commercial |
$314.98
|
| Rate for Payer: Aetna Medicare |
$185.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.86
|
| Rate for Payer: BCBS Complete |
$148.22
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Cofinity Advantage |
$259.39
|
| Rate for Payer: Cofinity Commercial |
$318.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.45
|
| Rate for Payer: Healthscope Commercial |
$333.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.92
|
| Rate for Payer: PHP Commercial |
$314.98
|
| Rate for Payer: Priority Health SBD |
$233.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.86
|
| Rate for Payer: UHC Core |
$193.06
|
| Rate for Payer: UHC Exchange |
$145.63
|
| Rate for Payer: UMR Bronson Commercial |
$137.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.92
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$822.24
|
|
|
Service Code
|
NDC 00228253010
|
| 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 Advantage |
$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 Commercial |
$698.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.68
|
| Rate for Payer: PHP Commercial |
$698.90
|
| 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
|
OP
|
$822.24
|
|
|
Service Code
|
NDC 00228253010
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna Medicare |
$411.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: BCBS Complete |
$328.90
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$657.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.68
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.46
|
| Rate for Payer: UHC Core |
$428.39
|
| Rate for Payer: UHC Exchange |
$323.14
|
| Rate for Payer: UMR Bronson Commercial |
$304.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$370.56
|
|
|
Service Code
|
NDC 23155019501
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.05 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Aetna American Axle |
$240.86
|
| Rate for Payer: Aetna Commercial |
$314.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.86
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Cofinity Advantage |
$259.39
|
| Rate for Payer: Cofinity Commercial |
$318.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.45
|
| Rate for Payer: Healthscope Commercial |
$333.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.92
|
| Rate for Payer: PHP Commercial |
$314.98
|
| Rate for Payer: Priority Health SBD |
$233.45
|
| Rate for Payer: UMR Bronson Commercial |
$163.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.92
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 68084059711
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 68084059711
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
