|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$467.04
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna American Axle |
$303.58
|
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.58
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Advantage |
$326.93
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.28
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: Priority Health SBD |
$294.24
|
| Rate for Payer: UMR Bronson Commercial |
$205.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 50742026001
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$477.60
|
|
|
Service Code
|
NDC 62175026037
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.71 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna American Axle |
$310.44
|
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna Medicare |
$238.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: BCBS Complete |
$191.04
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$382.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.20
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health SBD |
$300.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.44
|
| Rate for Payer: UHC Core |
$248.83
|
| Rate for Payer: UHC Exchange |
$187.70
|
| Rate for Payer: UMR Bronson Commercial |
$176.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.20
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$467.04
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna American Axle |
$303.58
|
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: Aetna Medicare |
$233.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.58
|
| Rate for Payer: BCBS Complete |
$186.82
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Advantage |
$326.93
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.28
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: Priority Health SBD |
$294.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.58
|
| Rate for Payer: UHC Core |
$243.33
|
| Rate for Payer: UHC Exchange |
$183.55
|
| Rate for Payer: UMR Bronson Commercial |
$172.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$477.60
|
|
|
Service Code
|
NDC 62175026037
|
| 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 Advantage |
$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 Commercial |
$405.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.20
|
| Rate for Payer: PHP Commercial |
$405.96
|
| 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
|
$186.72
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$168.05 |
| Rate for Payer: Aetna American Axle |
$121.37
|
| Rate for Payer: Aetna Commercial |
$158.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.37
|
| Rate for Payer: Cash Price |
$149.38
|
| Rate for Payer: Cofinity Advantage |
$130.70
|
| Rate for Payer: Cofinity Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.38
|
| Rate for Payer: Healthscope Commercial |
$168.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.04
|
| Rate for Payer: PHP Commercial |
$158.71
|
| Rate for Payer: Priority Health SBD |
$117.63
|
| Rate for Payer: UMR Bronson Commercial |
$82.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.04
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 50742026001
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: BCBS Complete |
$145.70
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.76
|
| Rate for Payer: UHC Core |
$189.77
|
| Rate for Payer: UHC Exchange |
$143.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$186.72
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$168.05 |
| Rate for Payer: Aetna American Axle |
$121.37
|
| Rate for Payer: Aetna Commercial |
$158.71
|
| Rate for Payer: Aetna Medicare |
$93.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.37
|
| Rate for Payer: BCBS Complete |
$74.69
|
| Rate for Payer: Cash Price |
$149.38
|
| Rate for Payer: Cofinity Advantage |
$130.70
|
| Rate for Payer: Cofinity Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.38
|
| Rate for Payer: Healthscope Commercial |
$168.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.04
|
| Rate for Payer: PHP Commercial |
$158.71
|
| Rate for Payer: Priority Health SBD |
$117.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.37
|
| Rate for Payer: UHC Core |
$97.28
|
| Rate for Payer: UHC Exchange |
$73.38
|
| Rate for Payer: UMR Bronson Commercial |
$69.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.04
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$953.76
|
|
|
Service Code
|
NDC 62175026237
|
| Hospital Charge Code |
27335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.89 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Aetna American Axle |
$619.94
|
| Rate for Payer: Aetna Commercial |
$810.70
|
| Rate for Payer: Aetna Medicare |
$476.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.94
|
| Rate for Payer: BCBS Complete |
$381.50
|
| Rate for Payer: Cash Price |
$763.01
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$763.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.32
|
| Rate for Payer: PHP Commercial |
$810.70
|
| Rate for Payer: Priority Health SBD |
$600.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.94
|
| Rate for Payer: UHC Core |
$496.91
|
| Rate for Payer: UHC Exchange |
$374.83
|
| Rate for Payer: UMR Bronson Commercial |
$352.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.32
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$953.76
|
|
|
Service Code
|
NDC 62175026237
|
| 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 Advantage |
$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 Commercial |
$810.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.32
|
| Rate for Payer: PHP Commercial |
$810.70
|
| 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
|
OP
|
$173.89
|
|
|
Service Code
|
NDC 24338023012
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.42
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$189.54
|
|
|
Service Code
|
NDC 24338023015
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$170.59 |
| Rate for Payer: Aetna American Axle |
$123.20
|
| Rate for Payer: Aetna Commercial |
$161.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.20
|
| Rate for Payer: Cash Price |
$151.63
|
| Rate for Payer: Cofinity Advantage |
$132.68
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.63
|
| Rate for Payer: Healthscope Commercial |
$170.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.16
|
| Rate for Payer: PHP Commercial |
$161.11
|
| Rate for Payer: Priority Health SBD |
$119.41
|
| Rate for Payer: UMR Bronson Commercial |
$83.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.16
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$189.54
|
|
|
Service Code
|
NDC 24338023030
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$170.59 |
| Rate for Payer: Aetna American Axle |
$123.20
|
| Rate for Payer: Aetna Commercial |
$161.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.20
|
| Rate for Payer: Cash Price |
$151.63
|
| Rate for Payer: Cofinity Advantage |
$132.68
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.63
|
| Rate for Payer: Healthscope Commercial |
$170.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.16
|
| Rate for Payer: PHP Commercial |
$161.11
|
| Rate for Payer: Priority Health SBD |
$119.41
|
| Rate for Payer: UMR Bronson Commercial |
$83.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.16
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$189.54
|
|
|
Service Code
|
NDC 24338023030
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$170.59 |
| Rate for Payer: Aetna American Axle |
$123.20
|
| Rate for Payer: Aetna Commercial |
$161.11
|
| Rate for Payer: Aetna Medicare |
$94.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.20
|
| Rate for Payer: BCBS Complete |
$75.82
|
| Rate for Payer: Cash Price |
$151.63
|
| Rate for Payer: Cofinity Advantage |
$132.68
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.63
|
| Rate for Payer: Healthscope Commercial |
$170.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.16
|
| Rate for Payer: PHP Commercial |
$161.11
|
| Rate for Payer: Priority Health SBD |
$119.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.20
|
| Rate for Payer: UHC Core |
$98.75
|
| Rate for Payer: UHC Exchange |
$74.49
|
| Rate for Payer: UMR Bronson Commercial |
$70.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.16
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$173.89
|
|
|
Service Code
|
NDC 24338023012
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.42
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$173.89
|
|
|
Service Code
|
NDC 24338023005
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.42
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$189.54
|
|
|
Service Code
|
NDC 24338023015
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$170.59 |
| Rate for Payer: Aetna American Axle |
$123.20
|
| Rate for Payer: Aetna Commercial |
$161.11
|
| Rate for Payer: Aetna Medicare |
$94.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.20
|
| Rate for Payer: BCBS Complete |
$75.82
|
| Rate for Payer: Cash Price |
$151.63
|
| Rate for Payer: Cofinity Advantage |
$132.68
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.63
|
| Rate for Payer: Healthscope Commercial |
$170.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.16
|
| Rate for Payer: PHP Commercial |
$161.11
|
| Rate for Payer: Priority Health SBD |
$119.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.20
|
| Rate for Payer: UHC Core |
$98.75
|
| Rate for Payer: UHC Exchange |
$74.49
|
| Rate for Payer: UMR Bronson Commercial |
$70.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.16
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$173.89
|
|
|
Service Code
|
NDC 24338023005
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.42
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$5.36
|
|
|
Service Code
|
NDC 23155051211
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna American Axle |
$3.48
|
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Advantage |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.02
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$535.68
|
|
|
Service Code
|
NDC 23155051200
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$482.11 |
| Rate for Payer: Aetna American Axle |
$348.19
|
| Rate for Payer: Aetna Commercial |
$455.33
|
| Rate for Payer: Aetna Medicare |
$267.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.19
|
| Rate for Payer: BCBS Complete |
$214.27
|
| Rate for Payer: Cash Price |
$428.54
|
| Rate for Payer: Cofinity Advantage |
$374.98
|
| Rate for Payer: Cofinity Commercial |
$460.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.54
|
| Rate for Payer: Healthscope Commercial |
$482.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$428.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.76
|
| Rate for Payer: PHP Commercial |
$455.33
|
| Rate for Payer: Priority Health SBD |
$337.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.19
|
| Rate for Payer: UHC Core |
$279.09
|
| Rate for Payer: UHC Exchange |
$210.52
|
| Rate for Payer: UMR Bronson Commercial |
$198.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.76
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$497.28
|
|
|
Service Code
|
NDC 69452020920
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna American Axle |
$323.23
|
| Rate for Payer: Aetna Commercial |
$422.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.23
|
| Rate for Payer: Cash Price |
$397.82
|
| Rate for Payer: Cofinity Advantage |
$348.10
|
| Rate for Payer: Cofinity Commercial |
$427.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.82
|
| Rate for Payer: Healthscope Commercial |
$447.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.96
|
| Rate for Payer: PHP Commercial |
$422.69
|
| Rate for Payer: Priority Health SBD |
$313.29
|
| Rate for Payer: UMR Bronson Commercial |
$218.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.96
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 69452020907
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna American Axle |
$2.83
|
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Advantage |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health SBD |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.27
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 69452020907
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna American Axle |
$2.83
|
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Advantage |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health SBD |
$2.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$5.36
|
|
|
Service Code
|
NDC 23155051211
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna American Axle |
$3.48
|
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Advantage |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.02
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: UHC Exchange |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$130.47
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.27 |
| Max. Negotiated Rate |
$117.42 |
| Rate for Payer: Aetna American Axle |
$84.81
|
| Rate for Payer: Aetna Commercial |
$110.90
|
| Rate for Payer: Aetna Medicare |
$65.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.81
|
| Rate for Payer: BCBS Complete |
$52.19
|
| Rate for Payer: Cash Price |
$104.38
|
| Rate for Payer: Cofinity Advantage |
$91.33
|
| Rate for Payer: Cofinity Commercial |
$112.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.38
|
| Rate for Payer: Healthscope Commercial |
$117.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.85
|
| Rate for Payer: PHP Commercial |
$110.90
|
| Rate for Payer: Priority Health SBD |
$82.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.81
|
| Rate for Payer: UHC Core |
$67.97
|
| Rate for Payer: UHC Exchange |
$51.27
|
| Rate for Payer: UMR Bronson Commercial |
$48.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.85
|
|
