|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna American Axle |
$64.96
|
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.96
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Cofinity Commercial |
$85.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$89.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: PHP Commercial |
$84.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: Priority Health SBD |
$62.96
|
| Rate for Payer: UMR Bronson Commercial |
$43.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.95
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.59
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Aetna American Axle |
$70.58
|
| Rate for Payer: Aetna Commercial |
$92.30
|
| Rate for Payer: Aetna Medicare |
$54.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.58
|
| Rate for Payer: BCBS Complete |
$43.44
|
| Rate for Payer: Cash Price |
$86.87
|
| Rate for Payer: Cofinity 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 |
$40.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.44
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna American Axle |
$64.96
|
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna Medicare |
$49.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.96
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Cofinity Commercial |
$85.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$89.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: PHP Commercial |
$84.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: Priority Health SBD |
$62.96
|
| Rate for Payer: UMR Bronson Commercial |
$36.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.95
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna American Axle |
$2.17
|
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.17
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.17
|
| Rate for Payer: Priority Health SBD |
$2.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna American Axle |
$2.17
|
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.17
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.17
|
| Rate for Payer: Priority Health SBD |
$2.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna American Axle |
$48.34
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: UMR Bronson Commercial |
$27.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna American Axle |
$48.34
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna American Axle |
$48.34
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: UMR Bronson Commercial |
$27.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna American Axle |
$48.34
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna American Axle |
$21.05
|
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.05
|
| Rate for Payer: BCBS Complete |
$12.95
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.05
|
| Rate for Payer: Priority Health SBD |
$20.40
|
| Rate for Payer: UMR Bronson Commercial |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 69339017441
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$32.38
|
|
|
Service Code
|
NDC 59762330403
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Aetna American Axle |
$21.05
|
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.05
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$29.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.52
|
| Rate for Payer: PHP Commercial |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.05
|
| Rate for Payer: Priority Health SBD |
$20.40
|
| Rate for Payer: UMR Bronson Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.29
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 69339017402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 69339017402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 69339017441
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.01 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna American Axle |
$86.10
|
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$92.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UMR Bronson Commercial |
$49.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna American Axle |
$86.10
|
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$92.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health SBD |
$83.45
|
| Rate for Payer: UMR Bronson Commercial |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.34
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.89
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: UMR Bronson Commercial |
$48.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
NDC 00378911693
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.89
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00378911616
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
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 Commercial |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.09
|
| 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: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.51
|
| 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 Commercial |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.09
|
| 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: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.51
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| 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
|
OP
|
$98.69
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
14895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.82 |
| Rate for Payer: Aetna American Axle |
$64.15
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.15
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$84.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$88.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.15
|
| Rate for Payer: Priority Health SBD |
$62.17
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
|
NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$98.69
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
14895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$88.82 |
| Rate for Payer: Aetna American Axle |
$64.15
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.15
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$84.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$88.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.15
|
| Rate for Payer: Priority Health SBD |
$62.17
|
| Rate for Payer: UMR Bronson Commercial |
$43.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
