|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna American Axle |
$2.83
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Advantage |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.27
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
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 |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Advantage |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| 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 |
$3.27
|
|
|
NITROGLYCERIN 100 MCG/ML IN HEPARINIZED SALINE 14 ML
|
Facility
|
IP
|
$11.55
|
|
|
Service Code
|
NDC 09900000082
|
| Hospital Charge Code |
151054
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna American Axle |
$7.51
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cofinity Advantage |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.66
|
| Rate for Payer: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| Rate for Payer: UMR Bronson Commercial |
$5.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.66
|
|
|
NITROGLYCERIN 100 MCG/ML IN HEPARINIZED SALINE 14 ML
|
Facility
|
OP
|
$11.55
|
|
|
Service Code
|
NDC 09900000082
|
| Hospital Charge Code |
151054
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna American Axle |
$7.51
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: BCBS Complete |
$4.62
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cofinity Advantage |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.66
|
| Rate for Payer: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.51
|
| Rate for Payer: UHC Core |
$6.02
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.66
|
|
|
NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
14895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
14895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.51
|
| Rate for Payer: UHC Exchange |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
OP
|
$45.61
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna American Axle |
$29.65
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: BCBS Complete |
$18.24
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cofinity Advantage |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.21
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.65
|
| Rate for Payer: UHC Core |
$23.76
|
| Rate for Payer: UHC Exchange |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.21
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
OP
|
$24.19
|
|
|
Service Code
|
NDC 09900000738
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna American Axle |
$15.72
|
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cofinity Advantage |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$21.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.14
|
| Rate for Payer: PHP Commercial |
$20.56
|
| Rate for Payer: Priority Health SBD |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.72
|
| Rate for Payer: UHC Core |
$12.60
|
| Rate for Payer: UHC Exchange |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.14
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
IP
|
$45.61
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna American Axle |
$29.65
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cofinity Advantage |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.21
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.21
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
IP
|
$24.19
|
|
|
Service Code
|
NDC 09900000738
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna American Axle |
$15.72
|
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cofinity Advantage |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$21.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.14
|
| Rate for Payer: PHP Commercial |
$20.56
|
| Rate for Payer: Priority Health SBD |
$15.24
|
| Rate for Payer: UMR Bronson Commercial |
$10.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.14
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$8.58
|
|
|
Service Code
|
NDC 09900001982
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna American Axle |
$5.58
|
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.58
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$7.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.29
|
| Rate for Payer: Priority Health SBD |
$5.41
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna American Axle |
$10.72
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.72
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Advantage |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: Priority Health SBD |
$10.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.72
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Exchange |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$8.58
|
|
|
Service Code
|
NDC 09900001982
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna American Axle |
$5.58
|
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.58
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$7.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.29
|
| Rate for Payer: Priority Health SBD |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.58
|
| Rate for Payer: UHC Core |
$4.47
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.50
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna American Axle |
$10.72
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.72
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Advantage |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: Priority Health SBD |
$10.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
IP
|
$9.23
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna American Axle |
$6.00
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.00
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Advantage |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.92
|
| Rate for Payer: PHP Commercial |
$7.85
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna American Axle |
$6.00
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.00
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Advantage |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.92
|
| Rate for Payer: PHP Commercial |
$7.85
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.00
|
| Rate for Payer: UHC Core |
$4.81
|
| Rate for Payer: UHC Exchange |
$3.63
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
IP
|
$608.90
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.92 |
| Max. Negotiated Rate |
$548.01 |
| Rate for Payer: Aetna American Axle |
$395.79
|
| Rate for Payer: Aetna Commercial |
$517.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.79
|
| Rate for Payer: Cash Price |
$487.12
|
| Rate for Payer: Cofinity Advantage |
$426.23
|
| Rate for Payer: Cofinity Commercial |
$523.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$487.12
|
| Rate for Payer: Healthscope Commercial |
$548.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$426.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.68
|
| Rate for Payer: PHP Commercial |
$517.57
|
| Rate for Payer: Priority Health SBD |
$383.61
|
| Rate for Payer: UMR Bronson Commercial |
$267.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.68
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
OP
|
$608.90
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.29 |
| Max. Negotiated Rate |
$548.01 |
| Rate for Payer: Aetna American Axle |
$395.79
|
| Rate for Payer: Aetna Commercial |
$517.57
|
| Rate for Payer: Aetna Medicare |
$304.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.79
|
| Rate for Payer: BCBS Complete |
$243.56
|
| Rate for Payer: Cash Price |
$487.12
|
| Rate for Payer: Cofinity Advantage |
$426.23
|
| Rate for Payer: Cofinity Commercial |
$523.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$487.12
|
| Rate for Payer: Healthscope Commercial |
$548.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$426.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$487.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.68
|
| Rate for Payer: PHP Commercial |
$517.57
|
| Rate for Payer: Priority Health SBD |
$383.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.79
|
| Rate for Payer: UHC Core |
$317.24
|
| Rate for Payer: UHC Exchange |
$239.30
|
| Rate for Payer: UMR Bronson Commercial |
$225.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.68
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
IP
|
$398.76
|
|
|
Service Code
|
NDC 66993024150
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.45 |
| Max. Negotiated Rate |
$358.88 |
| Rate for Payer: Aetna American Axle |
$259.19
|
| Rate for Payer: Aetna Commercial |
$338.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.19
|
| Rate for Payer: Cash Price |
$319.01
|
| Rate for Payer: Cofinity Advantage |
$279.13
|
| Rate for Payer: Cofinity Commercial |
$342.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.01
|
| Rate for Payer: Healthscope Commercial |
$358.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.07
|
| Rate for Payer: PHP Commercial |
$338.95
|
| Rate for Payer: Priority Health SBD |
$251.22
|
| Rate for Payer: UMR Bronson Commercial |
$175.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.07
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
OP
|
$384.77
|
|
|
Service Code
|
NDC 28595012049
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.36 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: Aetna American Axle |
$250.10
|
| Rate for Payer: Aetna Commercial |
$327.05
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.10
|
| Rate for Payer: BCBS Complete |
$153.91
|
| Rate for Payer: Cash Price |
$307.82
|
| Rate for Payer: Cofinity Advantage |
$269.34
|
| Rate for Payer: Cofinity Commercial |
$330.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.82
|
| Rate for Payer: Healthscope Commercial |
$346.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.58
|
| Rate for Payer: PHP Commercial |
$327.05
|
| Rate for Payer: Priority Health SBD |
$242.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.10
|
| Rate for Payer: UHC Core |
$200.47
|
| Rate for Payer: UHC Exchange |
$151.21
|
| Rate for Payer: UMR Bronson Commercial |
$142.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.58
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
OP
|
$398.76
|
|
|
Service Code
|
NDC 66993024150
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.54 |
| Max. Negotiated Rate |
$358.88 |
| Rate for Payer: Aetna American Axle |
$259.19
|
| Rate for Payer: Aetna Commercial |
$338.95
|
| Rate for Payer: Aetna Medicare |
$199.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.19
|
| Rate for Payer: BCBS Complete |
$159.50
|
| Rate for Payer: Cash Price |
$319.01
|
| Rate for Payer: Cofinity Advantage |
$279.13
|
| Rate for Payer: Cofinity Commercial |
$342.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.01
|
| Rate for Payer: Healthscope Commercial |
$358.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.07
|
| Rate for Payer: PHP Commercial |
$338.95
|
| Rate for Payer: Priority Health SBD |
$251.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Exchange |
$156.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.07
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
IP
|
$384.77
|
|
|
Service Code
|
NDC 28595012049
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.30 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: Aetna American Axle |
$250.10
|
| Rate for Payer: Aetna Commercial |
$327.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.10
|
| Rate for Payer: Cash Price |
$307.82
|
| Rate for Payer: Cofinity Advantage |
$269.34
|
| Rate for Payer: Cofinity Commercial |
$330.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.82
|
| Rate for Payer: Healthscope Commercial |
$346.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.58
|
| Rate for Payer: PHP Commercial |
$327.05
|
| Rate for Payer: Priority Health SBD |
$242.41
|
| Rate for Payer: UMR Bronson Commercial |
$169.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.58
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$54.74
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
5599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$49.27 |
| Rate for Payer: Aetna American Axle |
$35.58
|
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Aetna Medicare |
$27.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.58
|
| Rate for Payer: BCBS Complete |
$21.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$43.79
|
| Rate for Payer: Cash Price |
$43.79
|
| Rate for Payer: Cofinity Advantage |
$38.32
|
| Rate for Payer: Cofinity Commercial |
$47.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.79
|
| Rate for Payer: Healthscope Commercial |
$49.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.05
|
| Rate for Payer: PHP Commercial |
$46.53
|
| Rate for Payer: Priority Health SBD |
$34.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.51
|
| Rate for Payer: UHC Exchange |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$20.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.05
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$54.74
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
5599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$49.27 |
| Rate for Payer: Aetna American Axle |
$35.58
|
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.58
|
| Rate for Payer: Cash Price |
$43.79
|
| Rate for Payer: Cofinity Advantage |
$38.32
|
| Rate for Payer: Cofinity Commercial |
$47.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.79
|
| Rate for Payer: Healthscope Commercial |
$49.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.05
|
| Rate for Payer: PHP Commercial |
$46.53
|
| Rate for Payer: Priority Health SBD |
$34.49
|
| Rate for Payer: UMR Bronson Commercial |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.05
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.51
|
| Rate for Payer: UHC Exchange |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
