|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna American Axle |
$183.46
|
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna Medicare |
$141.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.46
|
| Rate for Payer: BCBS Complete |
$112.90
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$197.57
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health SBD |
$177.81
|
| Rate for Payer: UMR Bronson Commercial |
$104.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$138.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$628.32
|
|
|
Service Code
|
NDC 65162047810
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.46 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna American Axle |
$408.41
|
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health SBD |
$395.84
|
| Rate for Payer: UMR Bronson Commercial |
$276.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.24
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$315.40
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$157.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$116.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$1,111.85
|
|
|
Service Code
|
NDC 51079034820
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.21 |
| Max. Negotiated Rate |
$1,000.66 |
| Rate for Payer: Aetna American Axle |
$722.70
|
| Rate for Payer: Aetna Commercial |
$945.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.70
|
| Rate for Payer: Cash Price |
$889.48
|
| Rate for Payer: Cofinity Commercial |
$778.29
|
| Rate for Payer: Cofinity Commercial |
$956.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.48
|
| Rate for Payer: Healthscope Commercial |
$1,000.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.07
|
| Rate for Payer: PHP Commercial |
$945.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.70
|
| Rate for Payer: Priority Health SBD |
$700.47
|
| Rate for Payer: UMR Bronson Commercial |
$489.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.89
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$1,111.85
|
|
|
Service Code
|
NDC 51079034820
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.38 |
| Max. Negotiated Rate |
$1,000.66 |
| Rate for Payer: Aetna American Axle |
$722.70
|
| Rate for Payer: Aetna Commercial |
$945.07
|
| Rate for Payer: Aetna Medicare |
$555.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.70
|
| Rate for Payer: BCBS Complete |
$444.74
|
| Rate for Payer: Cash Price |
$889.48
|
| Rate for Payer: Cofinity Commercial |
$778.29
|
| Rate for Payer: Cofinity Commercial |
$956.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$778.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.48
|
| Rate for Payer: Healthscope Commercial |
$1,000.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.07
|
| Rate for Payer: PHP Commercial |
$945.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.70
|
| Rate for Payer: Priority Health SBD |
$700.47
|
| Rate for Payer: UMR Bronson Commercial |
$411.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.89
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$628.32
|
|
|
Service Code
|
NDC 65162047810
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.48 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna American Axle |
$408.41
|
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna Medicare |
$314.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: BCBS Complete |
$251.33
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health SBD |
$395.84
|
| Rate for Payer: UMR Bronson Commercial |
$232.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.24
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$254.02 |
| Rate for Payer: Aetna American Axle |
$183.46
|
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.46
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$197.57
|
| Rate for Payer: Cofinity Commercial |
$242.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$254.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: PHP Commercial |
$239.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.46
|
| Rate for Payer: Priority Health SBD |
$177.81
|
| Rate for Payer: UMR Bronson Commercial |
$124.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.68
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$72.58
|
|
|
Service Code
|
NDC 00378910293
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$65.32 |
| Rate for Payer: Aetna American Axle |
$47.18
|
| Rate for Payer: Aetna Commercial |
$61.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.18
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.06
|
| Rate for Payer: Healthscope Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.69
|
| Rate for Payer: PHP Commercial |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.18
|
| Rate for Payer: Priority Health SBD |
$45.73
|
| Rate for Payer: UMR Bronson Commercial |
$31.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.44
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 00378910216
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$72.58
|
|
|
Service Code
|
NDC 00378910293
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$65.32 |
| Rate for Payer: Aetna American Axle |
$47.18
|
| Rate for Payer: Aetna Commercial |
$61.69
|
| Rate for Payer: Aetna Medicare |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.18
|
| Rate for Payer: BCBS Complete |
$29.03
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.06
|
| Rate for Payer: Healthscope Commercial |
$65.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.69
|
| Rate for Payer: PHP Commercial |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.18
|
| Rate for Payer: Priority Health SBD |
$45.73
|
| Rate for Payer: UMR Bronson Commercial |
$26.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.44
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 00378910216
|
| Hospital Charge Code |
27471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$135.09
|
|
|
Service Code
|
NDC 00378910493
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$121.58 |
| Rate for Payer: Aetna American Axle |
$87.81
|
| Rate for Payer: Aetna Commercial |
$114.83
|
| Rate for Payer: Aetna Medicare |
$67.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.81
|
| Rate for Payer: BCBS Complete |
$54.04
|
| Rate for Payer: Cash Price |
$108.07
|
| Rate for Payer: Cofinity Commercial |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$94.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.07
|
| Rate for Payer: Healthscope Commercial |
$121.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.83
|
| Rate for Payer: PHP Commercial |
$114.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.81
|
| Rate for Payer: Priority Health SBD |
$85.11
|
| Rate for Payer: UMR Bronson Commercial |
$49.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.32
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 00378910416
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna American Axle |
$2.93
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.93
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$107.45
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$96.70 |
| Rate for Payer: Aetna American Axle |
$69.84
|
| Rate for Payer: Aetna Commercial |
$91.33
|
| Rate for Payer: Aetna Medicare |
$53.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.84
|
| Rate for Payer: BCBS Complete |
$42.98
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.96
|
| Rate for Payer: Healthscope Commercial |
$96.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.33
|
| Rate for Payer: PHP Commercial |
$91.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.84
|
| Rate for Payer: Priority Health SBD |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$39.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.59
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 00378910416
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna American Axle |
$2.93
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.93
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$135.09
|
|
|
Service Code
|
NDC 00378910493
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$121.58 |
| Rate for Payer: Aetna American Axle |
$87.81
|
| Rate for Payer: Aetna Commercial |
$114.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.81
|
| Rate for Payer: Cash Price |
$108.07
|
| Rate for Payer: Cofinity Commercial |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$94.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.07
|
| Rate for Payer: Healthscope Commercial |
$121.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.83
|
| Rate for Payer: PHP Commercial |
$114.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.81
|
| Rate for Payer: Priority Health SBD |
$85.11
|
| Rate for Payer: UMR Bronson Commercial |
$59.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.32
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$107.45
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$96.70 |
| Rate for Payer: Aetna American Axle |
$69.84
|
| Rate for Payer: Aetna Commercial |
$91.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.84
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.96
|
| Rate for Payer: Healthscope Commercial |
$96.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.33
|
| Rate for Payer: PHP Commercial |
$91.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.84
|
| Rate for Payer: Priority Health SBD |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$47.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.59
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$5,470.31
|
|
|
Service Code
|
NDC 50742051530
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,406.94 |
| Max. Negotiated Rate |
$4,923.28 |
| Rate for Payer: Aetna American Axle |
$3,555.70
|
| Rate for Payer: Aetna Commercial |
$4,649.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,555.70
|
| Rate for Payer: Cash Price |
$4,376.25
|
| Rate for Payer: Cofinity Commercial |
$3,829.22
|
| Rate for Payer: Cofinity Commercial |
$4,704.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,829.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,376.25
|
| Rate for Payer: Healthscope Commercial |
$4,923.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,829.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,102.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,649.76
|
| Rate for Payer: PHP Commercial |
$4,649.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,555.70
|
| Rate for Payer: Priority Health SBD |
$3,446.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,406.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,102.73
|
|
|
NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$182.35
|
|
|
Service Code
|
NDC 50742051501
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$164.12 |
| Rate for Payer: Aetna American Axle |
$118.53
|
| Rate for Payer: Aetna Commercial |
$155.00
|
| Rate for Payer: Aetna Medicare |
$91.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.53
|
| Rate for Payer: BCBS Complete |
$72.94
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Cofinity Commercial |
$127.64
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.64
|
| 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: PHP Commercial |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.53
|
| Rate for Payer: Priority Health SBD |
$114.88
|
| Rate for Payer: UMR Bronson Commercial |
$67.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.76
|
|
|
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 Commercial |
$127.64
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.64
|
| 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: PHP Commercial |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.53
|
| 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 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$5,470.31
|
|
|
Service Code
|
NDC 50742051530
|
| Hospital Charge Code |
27473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,024.01 |
| Max. Negotiated Rate |
$4,923.28 |
| Rate for Payer: Aetna American Axle |
$3,555.70
|
| Rate for Payer: Aetna Commercial |
$4,649.76
|
| Rate for Payer: Aetna Medicare |
$2,735.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,555.70
|
| Rate for Payer: BCBS Complete |
$2,188.12
|
| Rate for Payer: Cash Price |
$4,376.25
|
| Rate for Payer: Cofinity Commercial |
$3,829.22
|
| Rate for Payer: Cofinity Commercial |
$4,704.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,829.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,376.25
|
| Rate for Payer: Healthscope Commercial |
$4,923.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,829.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,102.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,649.76
|
| Rate for Payer: PHP Commercial |
$4,649.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,555.70
|
| Rate for Payer: Priority Health SBD |
$3,446.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,024.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,102.73
|
|
|
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 Commercial |
$76.01
|
| Rate for Payer: Cofinity Commercial |
$93.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.01
|
| 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: PHP Commercial |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.58
|
| 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
|
|
