|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.25
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$33.64
|
| Rate for Payer: Aetna American Axle |
$31.33
|
| Rate for Payer: Aetna American Axle |
$97.02
|
| Rate for Payer: Aetna American Axle |
$61.73
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$126.87
|
| Rate for Payer: Aetna Commercial |
$80.72
|
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna Medicare |
$74.63
|
| Rate for Payer: Aetna Medicare |
$47.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.33
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$59.70
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS Complete |
$37.99
|
| Rate for Payer: BCBS Complete |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$75.98
|
| Rate for Payer: Cash Price |
$75.98
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$81.67
|
| Rate for Payer: Cofinity Commercial |
$104.48
|
| Rate for Payer: Cofinity Commercial |
$41.45
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$66.48
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$85.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.87
|
| Rate for Payer: PHP Commercial |
$80.72
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$126.87
|
| Rate for Payer: PHP Commercial |
$40.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$59.83
|
| Rate for Payer: Priority Health SBD |
$32.61
|
| Rate for Payer: Priority Health SBD |
$94.03
|
| Rate for Payer: Priority Health SBD |
$30.37
|
| Rate for Payer: UMR Bronson Commercial |
$55.23
|
| Rate for Payer: UMR Bronson Commercial |
$17.83
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$19.15
|
| Rate for Payer: UMR Bronson Commercial |
$35.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.94
|
|
|
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.20
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$43.38 |
| Rate for Payer: Aetna American Axle |
$31.33
|
| Rate for Payer: Aetna American Axle |
$61.73
|
| Rate for Payer: Aetna American Axle |
$33.64
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$97.02
|
| Rate for Payer: Aetna Commercial |
$80.72
|
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$126.87
|
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.33
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cash Price |
$75.98
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$81.67
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Cofinity Commercial |
$104.48
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$41.45
|
| Rate for Payer: Cofinity Commercial |
$66.48
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Commercial |
$85.47
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$40.97
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$80.72
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: PHP Commercial |
$126.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.64
|
| Rate for Payer: Priority Health SBD |
$30.37
|
| Rate for Payer: Priority Health SBD |
$32.61
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$94.03
|
| Rate for Payer: Priority Health SBD |
$59.83
|
| Rate for Payer: UMR Bronson Commercial |
$41.79
|
| Rate for Payer: UMR Bronson Commercial |
$22.77
|
| Rate for Payer: UMR Bronson Commercial |
$21.21
|
| Rate for Payer: UMR Bronson Commercial |
$65.67
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.15
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$1,129.87
|
|
|
Service Code
|
NDC 42806050209
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.05 |
| Max. Negotiated Rate |
$1,016.88 |
| Rate for Payer: Aetna American Axle |
$734.42
|
| Rate for Payer: Aetna Commercial |
$960.39
|
| Rate for Payer: Aetna Medicare |
$564.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.42
|
| Rate for Payer: BCBS Complete |
$451.95
|
| Rate for Payer: Cash Price |
$903.90
|
| Rate for Payer: Cofinity Commercial |
$790.91
|
| Rate for Payer: Cofinity Commercial |
$971.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.90
|
| Rate for Payer: Healthscope Commercial |
$1,016.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.39
|
| Rate for Payer: PHP Commercial |
$960.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.42
|
| Rate for Payer: Priority Health SBD |
$711.82
|
| Rate for Payer: UMR Bronson Commercial |
$418.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.40
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$789.55
|
|
|
Service Code
|
NDC 00378143077
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.13 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna American Axle |
$513.21
|
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna Medicare |
$394.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: BCBS Complete |
$315.82
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Commercial |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.12
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.21
|
| Rate for Payer: Priority Health SBD |
$497.42
|
| Rate for Payer: UMR Bronson Commercial |
$292.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.16
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,129.87
|
|
|
Service Code
|
NDC 42806050209
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.14 |
| Max. Negotiated Rate |
$1,016.88 |
| Rate for Payer: Aetna American Axle |
$734.42
|
| Rate for Payer: Aetna Commercial |
$960.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.42
|
| Rate for Payer: Cash Price |
$903.90
|
| Rate for Payer: Cofinity Commercial |
$790.91
|
| Rate for Payer: Cofinity Commercial |
$971.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.90
|
| Rate for Payer: Healthscope Commercial |
$1,016.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.39
|
| Rate for Payer: PHP Commercial |
$960.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.42
|
| Rate for Payer: Priority Health SBD |
$711.82
|
| Rate for Payer: UMR Bronson Commercial |
$497.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.40
|
|
|
NICARDIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$789.55
|
|
|
Service Code
|
NDC 00378143077
|
| Hospital Charge Code |
10713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna American Axle |
$513.21
|
| Rate for Payer: Aetna Commercial |
$671.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.21
|
| Rate for Payer: Cash Price |
$631.64
|
| Rate for Payer: Cofinity Commercial |
$552.68
|
| Rate for Payer: Cofinity Commercial |
$679.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.64
|
| Rate for Payer: Healthscope Commercial |
$710.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.12
|
| Rate for Payer: PHP Commercial |
$671.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.21
|
| Rate for Payer: Priority Health SBD |
$497.42
|
| Rate for Payer: UMR Bronson Commercial |
$347.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.16
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$741.11
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna American Axle |
$481.72
|
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna American Axle |
$176.14
|
| Rate for Payer: Aetna American Axle |
$205.09
|
| Rate for Payer: Aetna Commercial |
$629.94
|
| Rate for Payer: Aetna Commercial |
$268.19
|
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna Medicare |
$157.76
|
| Rate for Payer: Aetna Medicare |
$135.49
|
| Rate for Payer: Aetna Medicare |
$370.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.09
|
| Rate for Payer: BCBS Complete |
$126.95
|
| Rate for Payer: BCBS Complete |
$108.39
|
| Rate for Payer: BCBS Complete |
$296.44
|
| Rate for Payer: BCBS Complete |
$126.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Cofinity Commercial |
$637.35
|
| Rate for Payer: Cofinity Commercial |
$271.35
|
| Rate for Payer: Cofinity Commercial |
$189.69
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Cofinity Commercial |
$518.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$518.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: Healthscope Commercial |
$667.00
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Healthscope Commercial |
$283.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: PHP Commercial |
$629.94
|
| Rate for Payer: PHP Commercial |
$268.19
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.30
|
| Rate for Payer: Priority Health SBD |
$170.72
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: Priority Health SBD |
$198.78
|
| Rate for Payer: Priority Health SBD |
$466.90
|
| Rate for Payer: UMR Bronson Commercial |
$100.26
|
| Rate for Payer: UMR Bronson Commercial |
$117.43
|
| Rate for Payer: UMR Bronson Commercial |
$274.21
|
| Rate for Payer: UMR Bronson Commercial |
$116.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.83
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$317.38
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$285.64 |
| Rate for Payer: Aetna American Axle |
$206.30
|
| Rate for Payer: Aetna American Axle |
$205.09
|
| Rate for Payer: Aetna American Axle |
$176.14
|
| Rate for Payer: Aetna American Axle |
$481.72
|
| Rate for Payer: Aetna Commercial |
$269.77
|
| Rate for Payer: Aetna Commercial |
$629.94
|
| Rate for Payer: Aetna Commercial |
$268.19
|
| Rate for Payer: Aetna Commercial |
$230.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.30
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$253.90
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$592.89
|
| Rate for Payer: Cofinity Commercial |
$189.69
|
| Rate for Payer: Cofinity Commercial |
$637.35
|
| Rate for Payer: Cofinity Commercial |
$518.78
|
| Rate for Payer: Cofinity Commercial |
$222.17
|
| Rate for Payer: Cofinity Commercial |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$271.35
|
| Rate for Payer: Cofinity Commercial |
$272.95
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$518.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Healthscope Commercial |
$285.64
|
| Rate for Payer: Healthscope Commercial |
$243.88
|
| Rate for Payer: Healthscope Commercial |
$283.97
|
| Rate for Payer: Healthscope Commercial |
$667.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.77
|
| Rate for Payer: PHP Commercial |
$269.77
|
| Rate for Payer: PHP Commercial |
$629.94
|
| Rate for Payer: PHP Commercial |
$230.33
|
| Rate for Payer: PHP Commercial |
$268.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.14
|
| Rate for Payer: Priority Health SBD |
$466.90
|
| Rate for Payer: Priority Health SBD |
$170.72
|
| Rate for Payer: Priority Health SBD |
$198.78
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: UMR Bronson Commercial |
$139.65
|
| Rate for Payer: UMR Bronson Commercial |
$326.09
|
| Rate for Payer: UMR Bronson Commercial |
$138.83
|
| Rate for Payer: UMR Bronson Commercial |
$119.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.04
|
|
|
NICARDIPINE 50 MG/250 ML NS (IV PREMIX)
|
Facility
|
OP
|
$193.50
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
180442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$174.15 |
| Rate for Payer: Aetna American Axle |
$125.78
|
| Rate for Payer: Aetna Commercial |
$164.48
|
| Rate for Payer: Aetna Medicare |
$96.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: BCBS Complete |
$77.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$174.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.48
|
| Rate for Payer: PHP Commercial |
$164.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.78
|
| Rate for Payer: Priority Health SBD |
$121.90
|
| Rate for Payer: UMR Bronson Commercial |
$71.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.12
|
|
|
NICARDIPINE 50 MG/250 ML NS (IV PREMIX)
|
Facility
|
IP
|
$193.50
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
180442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.14 |
| Max. Negotiated Rate |
$174.15 |
| Rate for Payer: Aetna American Axle |
$125.78
|
| Rate for Payer: Aetna Commercial |
$164.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Cofinity Commercial |
$166.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$174.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.48
|
| Rate for Payer: PHP Commercial |
$164.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.78
|
| Rate for Payer: Priority Health SBD |
$121.90
|
| Rate for Payer: UMR Bronson Commercial |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.12
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$107.93
|
|
|
Service Code
|
NDC 48985000150
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.93 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna American Axle |
$70.15
|
| Rate for Payer: Aetna Commercial |
$91.74
|
| Rate for Payer: Aetna Medicare |
$53.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.15
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cofinity Commercial |
$75.55
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.34
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.74
|
| Rate for Payer: PHP Commercial |
$91.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.15
|
| Rate for Payer: Priority Health SBD |
$68.00
|
| Rate for Payer: UMR Bronson Commercial |
$39.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.95
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$120.70
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.11 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna American Axle |
$78.46
|
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.46
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cofinity Commercial |
$103.80
|
| Rate for Payer: Cofinity Commercial |
$84.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.56
|
| Rate for Payer: Healthscope Commercial |
$108.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.60
|
| Rate for Payer: PHP Commercial |
$102.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.46
|
| Rate for Payer: Priority Health SBD |
$76.04
|
| Rate for Payer: UMR Bronson Commercial |
$53.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.52
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$107.93
|
|
|
Service Code
|
NDC 48985000150
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.49 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna American Axle |
$70.15
|
| Rate for Payer: Aetna Commercial |
$91.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.15
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cofinity Commercial |
$75.55
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.34
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.74
|
| Rate for Payer: PHP Commercial |
$91.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.15
|
| Rate for Payer: Priority Health SBD |
$68.00
|
| Rate for Payer: UMR Bronson Commercial |
$47.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.95
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$106.99
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$96.29 |
| Rate for Payer: Aetna American Axle |
$69.54
|
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.54
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Cofinity Commercial |
$92.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.59
|
| Rate for Payer: Healthscope Commercial |
$96.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.94
|
| Rate for Payer: PHP Commercial |
$90.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: Priority Health SBD |
$67.40
|
| Rate for Payer: UMR Bronson Commercial |
$47.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.24
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$111.15
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.91 |
| Max. Negotiated Rate |
$100.04 |
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Aetna American Axle |
$72.25
|
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.25
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Healthscope Commercial |
$100.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health SBD |
$70.02
|
| Rate for Payer: UMR Bronson Commercial |
$48.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.36
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$120.70
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Aetna American Axle |
$78.46
|
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Medicare |
$60.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.46
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: Cash Price |
$96.56
|
| Rate for Payer: Cofinity Commercial |
$103.80
|
| Rate for Payer: Cofinity Commercial |
$84.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.56
|
| Rate for Payer: Healthscope Commercial |
$108.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.60
|
| Rate for Payer: PHP Commercial |
$102.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.46
|
| Rate for Payer: Priority Health SBD |
$76.04
|
| Rate for Payer: UMR Bronson Commercial |
$44.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.52
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$106.99
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$96.29 |
| Rate for Payer: Aetna American Axle |
$69.54
|
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.54
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: Cash Price |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$74.89
|
| Rate for Payer: Cofinity Commercial |
$92.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.59
|
| Rate for Payer: Healthscope Commercial |
$96.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.94
|
| Rate for Payer: PHP Commercial |
$90.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.54
|
| Rate for Payer: Priority Health SBD |
$67.40
|
| Rate for Payer: UMR Bronson Commercial |
$39.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.24
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$111.15
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$100.04 |
| Rate for Payer: Aetna American Axle |
$72.25
|
| Rate for Payer: Aetna Commercial |
$94.48
|
| Rate for Payer: Aetna Medicare |
$55.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.25
|
| Rate for Payer: BCBS Complete |
$44.46
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$95.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.92
|
| Rate for Payer: Healthscope Commercial |
$100.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.48
|
| Rate for Payer: PHP Commercial |
$94.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health SBD |
$70.02
|
| Rate for Payer: UMR Bronson Commercial |
$41.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.36
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$95.09
|
|
|
Service Code
|
NDC 00536589688
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.84 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna American Axle |
$61.81
|
| Rate for Payer: Aetna Commercial |
$80.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.81
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.07
|
| Rate for Payer: Healthscope Commercial |
$85.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.83
|
| Rate for Payer: PHP Commercial |
$80.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.81
|
| Rate for Payer: Priority Health SBD |
$59.91
|
| Rate for Payer: UMR Bronson Commercial |
$41.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.32
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$115.86
|
|
|
Service Code
|
NDC 60505709000
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$104.27 |
| Rate for Payer: Aetna American Axle |
$75.31
|
| Rate for Payer: Aetna Commercial |
$98.48
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.31
|
| Rate for Payer: BCBS Complete |
$46.34
|
| Rate for Payer: Cash Price |
$92.69
|
| Rate for Payer: Cofinity Commercial |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.69
|
| Rate for Payer: Healthscope Commercial |
$104.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.48
|
| Rate for Payer: PHP Commercial |
$98.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.31
|
| Rate for Payer: Priority Health SBD |
$72.99
|
| Rate for Payer: UMR Bronson Commercial |
$42.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.90
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$170.53
|
|
|
Service Code
|
NDC 00766142020
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.03 |
| Max. Negotiated Rate |
$153.48 |
| Rate for Payer: Aetna American Axle |
$110.84
|
| Rate for Payer: Aetna Commercial |
$144.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.84
|
| Rate for Payer: Cash Price |
$136.42
|
| Rate for Payer: Cofinity Commercial |
$119.37
|
| Rate for Payer: Cofinity Commercial |
$146.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.42
|
| Rate for Payer: Healthscope Commercial |
$153.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.95
|
| Rate for Payer: PHP Commercial |
$144.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.84
|
| Rate for Payer: Priority Health SBD |
$107.43
|
| Rate for Payer: UMR Bronson Commercial |
$75.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.90
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$190.53
|
|
|
Service Code
|
NDC 00135019402
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$171.48 |
| Rate for Payer: Aetna American Axle |
$123.84
|
| Rate for Payer: Aetna Commercial |
$161.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.84
|
| Rate for Payer: Cash Price |
$152.42
|
| Rate for Payer: Cofinity Commercial |
$133.37
|
| Rate for Payer: Cofinity Commercial |
$163.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.42
|
| Rate for Payer: Healthscope Commercial |
$171.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.95
|
| Rate for Payer: PHP Commercial |
$161.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.84
|
| Rate for Payer: Priority Health SBD |
$120.03
|
| Rate for Payer: UMR Bronson Commercial |
$83.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.90
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$121.91
|
|
|
Service Code
|
NDC 48985000152
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.64 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna American Axle |
$79.24
|
| Rate for Payer: Aetna Commercial |
$103.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.24
|
| Rate for Payer: Cash Price |
$97.53
|
| Rate for Payer: Cofinity Commercial |
$104.84
|
| Rate for Payer: Cofinity Commercial |
$85.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.53
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.62
|
| Rate for Payer: PHP Commercial |
$103.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.24
|
| Rate for Payer: Priority Health SBD |
$76.80
|
| Rate for Payer: UMR Bronson Commercial |
$53.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.43
|
|
