|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$182.35
|
|
|
Service Code
|
NDC 50742051501
|
| 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 Advantage |
$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 Commercial |
$155.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.76
|
| Rate for Payer: PHP Commercial |
$155.00
|
| 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 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$101.38
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna American Axle |
$65.90
|
| Rate for Payer: Aetna Commercial |
$86.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.90
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Advantage |
$70.97
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Healthscope Commercial |
$91.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: PHP Commercial |
$86.17
|
| Rate for Payer: Priority Health SBD |
$63.87
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.03
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.33
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna American Axle |
$70.58
|
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: Aetna Medicare |
$54.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.58
|
| Rate for Payer: BCBS Complete |
$43.44
|
| Rate for Payer: Cash Price |
$86.87
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$86.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.44
|
| Rate for Payer: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health SBD |
$68.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.58
|
| Rate for Payer: UHC Core |
$56.58
|
| Rate for Payer: UHC Exchange |
$42.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.44
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$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 Commercial |
$92.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.44
|
| Rate for Payer: PHP Commercial |
$92.30
|
| 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
|
OP
|
$101.38
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna American Axle |
$65.90
|
| Rate for Payer: Aetna Commercial |
$86.17
|
| Rate for Payer: Aetna Medicare |
$50.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.90
|
| Rate for Payer: BCBS Complete |
$40.55
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Advantage |
$70.97
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Healthscope Commercial |
$91.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: PHP Commercial |
$86.17
|
| Rate for Payer: Priority Health SBD |
$63.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.90
|
| Rate for Payer: UHC Core |
$52.82
|
| Rate for Payer: UHC Exchange |
$39.84
|
| Rate for Payer: UMR Bronson Commercial |
$37.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.03
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 69339017402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Advantage |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.50
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.97
|
| Rate for Payer: UHC Core |
$18.41
|
| Rate for Payer: UHC Exchange |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna American Axle |
$21.05
|
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.05
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Advantage |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health SBD |
$20.40
|
| Rate for Payer: UMR Bronson Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna American Axle |
$47.32
|
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.32
|
| Rate for Payer: UHC Core |
$37.93
|
| Rate for Payer: UHC Exchange |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$26.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.60
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna American Axle |
$21.05
|
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.05
|
| Rate for Payer: BCBS Complete |
$12.95
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Advantage |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.29
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health SBD |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.05
|
| Rate for Payer: UHC Core |
$16.87
|
| Rate for Payer: UHC Exchange |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna American Axle |
$7.70
|
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.70
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Advantage |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health SBD |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.70
|
| Rate for Payer: UHC Core |
$6.17
|
| Rate for Payer: UHC Exchange |
$4.65
|
| Rate for Payer: UMR Bronson Commercial |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna American Axle |
$7.70
|
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.70
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Advantage |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health SBD |
$7.46
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.01 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna American Axle |
$86.10
|
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Advantage |
$92.72
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.10
|
| Rate for Payer: UHC Core |
$69.01
|
| Rate for Payer: UHC Exchange |
$52.06
|
| Rate for Payer: UMR Bronson Commercial |
$49.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 69339017441
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Advantage |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.50
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna American Axle |
$7.70
|
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.70
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Advantage |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health SBD |
$7.46
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 69339017441
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Advantage |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.50
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.97
|
| Rate for Payer: UHC Core |
$18.41
|
| Rate for Payer: UHC Exchange |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna American Axle |
$47.32
|
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna Medicare |
$36.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.32
|
| Rate for Payer: UHC Core |
$37.93
|
| Rate for Payer: UHC Exchange |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$26.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.60
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna American Axle |
$47.32
|
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UMR Bronson Commercial |
$32.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.60
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 69339017402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Advantage |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.50
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna American Axle |
$86.10
|
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Advantage |
$92.72
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UMR Bronson Commercial |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$72.80
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Aetna American Axle |
$47.32
|
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.32
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Advantage |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$62.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$65.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: PHP Commercial |
$61.88
|
| Rate for Payer: Priority Health SBD |
$45.86
|
| Rate for Payer: UMR Bronson Commercial |
$32.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.60
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna American Axle |
$7.70
|
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.70
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Advantage |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health SBD |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.70
|
| Rate for Payer: UHC Core |
$6.17
|
| Rate for Payer: UHC Exchange |
$4.65
|
| Rate for Payer: UMR Bronson Commercial |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.88
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$130.61
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.47 |
| Max. Negotiated Rate |
$117.55 |
| Rate for Payer: Aetna American Axle |
$84.90
|
| Rate for Payer: Aetna Commercial |
$111.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.90
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Advantage |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: PHP Commercial |
$111.02
|
| Rate for Payer: Priority Health SBD |
$82.28
|
| Rate for Payer: UMR Bronson Commercial |
$57.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.96
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$130.61
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$117.55 |
| Rate for Payer: Aetna American Axle |
$84.90
|
| Rate for Payer: Aetna Commercial |
$111.02
|
| Rate for Payer: Aetna Medicare |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.90
|
| Rate for Payer: BCBS Complete |
$52.24
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Advantage |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: PHP Commercial |
$111.02
|
| Rate for Payer: Priority Health SBD |
$82.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.90
|
| Rate for Payer: UHC Core |
$68.05
|
| Rate for Payer: UHC Exchange |
$51.33
|
| Rate for Payer: UMR Bronson Commercial |
$48.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.96
|
|
