|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.06 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna American Axle |
$188.07
|
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: Aetna Medicare |
$144.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.07
|
| Rate for Payer: BCBS Complete |
$115.74
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$202.54
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health SBD |
$182.28
|
| Rate for Payer: UMR Bronson Commercial |
$107.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$289.34
|
|
|
Service Code
|
NDC 45802008902
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.31 |
| Max. Negotiated Rate |
$260.41 |
| Rate for Payer: Aetna American Axle |
$188.07
|
| Rate for Payer: Aetna Commercial |
$245.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.07
|
| Rate for Payer: Cash Price |
$231.47
|
| Rate for Payer: Cofinity Commercial |
$202.54
|
| Rate for Payer: Cofinity Commercial |
$248.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.47
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.94
|
| Rate for Payer: PHP Commercial |
$245.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.07
|
| Rate for Payer: Priority Health SBD |
$182.28
|
| Rate for Payer: UMR Bronson Commercial |
$127.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.00
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
IP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna American Axle |
$62.69
|
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.69
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$67.52
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Healthscope Commercial |
$86.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health SBD |
$60.76
|
| Rate for Payer: UMR Bronson Commercial |
$42.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE
|
Facility
|
OP
|
$96.45
|
|
|
Service Code
|
NDC 45802008901
|
| Hospital Charge Code |
182298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna American Axle |
$62.69
|
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.69
|
| Rate for Payer: BCBS Complete |
$38.58
|
| Rate for Payer: Cash Price |
$77.16
|
| Rate for Payer: Cofinity Commercial |
$67.52
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.16
|
| Rate for Payer: Healthscope Commercial |
$86.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.98
|
| Rate for Payer: PHP Commercial |
$81.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.69
|
| Rate for Payer: Priority Health SBD |
$60.76
|
| Rate for Payer: UMR Bronson Commercial |
$35.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.34
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
NDC 68084002211
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.92 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna American Axle |
$212.42
|
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: Aetna Medicare |
$163.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.42
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health SBD |
$205.88
|
| Rate for Payer: UMR Bronson Commercial |
$120.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$348.96
|
|
|
Service Code
|
NDC 68084002201
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.54 |
| Max. Negotiated Rate |
$314.06 |
| Rate for Payer: Aetna American Axle |
$226.82
|
| Rate for Payer: Aetna Commercial |
$296.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.82
|
| Rate for Payer: Cash Price |
$279.17
|
| Rate for Payer: Cofinity Commercial |
$244.27
|
| Rate for Payer: Cofinity Commercial |
$300.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.17
|
| Rate for Payer: Healthscope Commercial |
$314.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.62
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.82
|
| Rate for Payer: Priority Health SBD |
$219.84
|
| Rate for Payer: UMR Bronson Commercial |
$153.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.72
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$378.72
|
|
|
Service Code
|
NDC 00228249710
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Aetna American Axle |
$246.17
|
| Rate for Payer: Aetna Commercial |
$321.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.17
|
| Rate for Payer: Cash Price |
$302.98
|
| Rate for Payer: Cofinity Commercial |
$265.10
|
| Rate for Payer: Cofinity Commercial |
$325.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.98
|
| Rate for Payer: Healthscope Commercial |
$340.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.91
|
| Rate for Payer: PHP Commercial |
$321.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.17
|
| Rate for Payer: Priority Health SBD |
$238.59
|
| Rate for Payer: UMR Bronson Commercial |
$166.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.04
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$378.72
|
|
|
Service Code
|
NDC 00228249710
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Aetna American Axle |
$246.17
|
| Rate for Payer: Aetna Commercial |
$321.91
|
| Rate for Payer: Aetna Medicare |
$189.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.17
|
| Rate for Payer: BCBS Complete |
$151.49
|
| Rate for Payer: Cash Price |
$302.98
|
| Rate for Payer: Cofinity Commercial |
$265.10
|
| Rate for Payer: Cofinity Commercial |
$325.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.98
|
| Rate for Payer: Healthscope Commercial |
$340.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.91
|
| Rate for Payer: PHP Commercial |
$321.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.17
|
| Rate for Payer: Priority Health SBD |
$238.59
|
| Rate for Payer: UMR Bronson Commercial |
$140.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.04
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$382.08
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.12 |
| Max. Negotiated Rate |
$343.87 |
| Rate for Payer: Aetna American Axle |
$248.35
|
| Rate for Payer: Aetna Commercial |
$324.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.35
|
| Rate for Payer: Cash Price |
$305.66
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Cofinity Commercial |
$328.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.66
|
| Rate for Payer: Healthscope Commercial |
$343.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.77
|
| Rate for Payer: PHP Commercial |
$324.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.35
|
| Rate for Payer: Priority Health SBD |
$240.71
|
| Rate for Payer: UMR Bronson Commercial |
$168.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.56
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.79 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna American Axle |
$212.42
|
| Rate for Payer: Aetna Commercial |
$277.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.42
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$281.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$294.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: PHP Commercial |
$277.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.42
|
| Rate for Payer: Priority Health SBD |
$205.88
|
| Rate for Payer: UMR Bronson Commercial |
$143.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.10
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$348.96
|
|
|
Service Code
|
NDC 68084002201
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.12 |
| Max. Negotiated Rate |
$314.06 |
| Rate for Payer: Aetna American Axle |
$226.82
|
| Rate for Payer: Aetna Commercial |
$296.62
|
| Rate for Payer: Aetna Medicare |
$174.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.82
|
| Rate for Payer: BCBS Complete |
$139.58
|
| Rate for Payer: Cash Price |
$279.17
|
| Rate for Payer: Cofinity Commercial |
$244.27
|
| Rate for Payer: Cofinity Commercial |
$300.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.17
|
| Rate for Payer: Healthscope Commercial |
$314.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.62
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.82
|
| Rate for Payer: Priority Health SBD |
$219.84
|
| Rate for Payer: UMR Bronson Commercial |
$129.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.72
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
OP
|
$382.08
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$343.87 |
| Rate for Payer: Aetna American Axle |
$248.35
|
| Rate for Payer: Aetna Commercial |
$324.77
|
| Rate for Payer: Aetna Medicare |
$191.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.35
|
| Rate for Payer: BCBS Complete |
$152.83
|
| Rate for Payer: Cash Price |
$305.66
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Cofinity Commercial |
$328.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.66
|
| Rate for Payer: Healthscope Commercial |
$343.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.77
|
| Rate for Payer: PHP Commercial |
$324.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.35
|
| Rate for Payer: Priority Health SBD |
$240.71
|
| Rate for Payer: UMR Bronson Commercial |
$141.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.56
|
|
|
NIFEDIPINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
NDC 68084002211
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
OP
|
$370.08
|
|
|
Service Code
|
NDC 23155019501
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.93 |
| Max. Negotiated Rate |
$333.07 |
| Rate for Payer: Aetna American Axle |
$240.55
|
| Rate for Payer: Aetna Commercial |
$314.57
|
| Rate for Payer: Aetna Medicare |
$185.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.55
|
| Rate for Payer: BCBS Complete |
$148.03
|
| Rate for Payer: Cash Price |
$296.06
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Cofinity Commercial |
$318.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.06
|
| Rate for Payer: Healthscope Commercial |
$333.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.57
|
| Rate for Payer: PHP Commercial |
$314.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.55
|
| Rate for Payer: Priority Health SBD |
$233.15
|
| Rate for Payer: UMR Bronson Commercial |
$136.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.56
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$822.24
|
|
|
Service Code
|
NDC 00228253010
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.79 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.90
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.46
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UMR Bronson Commercial |
$361.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
OP
|
$822.24
|
|
|
Service Code
|
NDC 00228253010
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$740.02 |
| Rate for Payer: Aetna American Axle |
$534.46
|
| Rate for Payer: Aetna Commercial |
$698.90
|
| Rate for Payer: Aetna Medicare |
$411.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.46
|
| Rate for Payer: BCBS Complete |
$328.90
|
| Rate for Payer: Cash Price |
$657.79
|
| Rate for Payer: Cofinity Commercial |
$575.57
|
| Rate for Payer: Cofinity Commercial |
$707.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.79
|
| Rate for Payer: Healthscope Commercial |
$740.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.90
|
| Rate for Payer: PHP Commercial |
$698.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.46
|
| Rate for Payer: Priority Health SBD |
$518.01
|
| Rate for Payer: UMR Bronson Commercial |
$304.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.68
|
|
|
NIFEDIPINE 20 MG CAPSULE
|
Facility
|
IP
|
$370.08
|
|
|
Service Code
|
NDC 23155019501
|
| Hospital Charge Code |
5559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$333.07 |
| Rate for Payer: Aetna American Axle |
$240.55
|
| Rate for Payer: Aetna Commercial |
$314.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.55
|
| Rate for Payer: Cash Price |
$296.06
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Cofinity Commercial |
$318.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.06
|
| Rate for Payer: Healthscope Commercial |
$333.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.57
|
| Rate for Payer: PHP Commercial |
$314.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.55
|
| Rate for Payer: Priority Health SBD |
$233.15
|
| Rate for Payer: UMR Bronson Commercial |
$162.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.56
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 50742026001
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$477.60
|
|
|
Service Code
|
NDC 62175026037
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna American Axle |
$310.44
|
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Commercial |
$334.32
|
| Rate for Payer: Cofinity Commercial |
$410.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$334.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.08
|
| Rate for Payer: Healthscope Commercial |
$429.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.96
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.44
|
| Rate for Payer: Priority Health SBD |
$300.89
|
| Rate for Payer: UMR Bronson Commercial |
$210.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.20
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$390.72
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna American Axle |
$253.97
|
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna Medicare |
$195.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| Rate for Payer: BCBS Complete |
$156.29
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.97
|
| Rate for Payer: Priority Health SBD |
$246.15
|
| Rate for Payer: UMR Bronson Commercial |
$144.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 68084059711
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$477.60
|
|
|
Service Code
|
NDC 62175026037
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.71 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna American Axle |
$310.44
|
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna Medicare |
$238.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: BCBS Complete |
$191.04
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Commercial |
$334.32
|
| Rate for Payer: Cofinity Commercial |
$410.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$334.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.08
|
| Rate for Payer: Healthscope Commercial |
$429.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.96
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.44
|
| Rate for Payer: Priority Health SBD |
$300.89
|
| Rate for Payer: UMR Bronson Commercial |
$176.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.20
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$189.12
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.21 |
| Max. Negotiated Rate |
$170.21 |
| Rate for Payer: Aetna American Axle |
$122.93
|
| Rate for Payer: Aetna Commercial |
$160.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.93
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cofinity Commercial |
$132.38
|
| Rate for Payer: Cofinity Commercial |
$162.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.30
|
| Rate for Payer: Healthscope Commercial |
$170.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.75
|
| Rate for Payer: PHP Commercial |
$160.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.93
|
| Rate for Payer: Priority Health SBD |
$119.15
|
| Rate for Payer: UMR Bronson Commercial |
$83.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.84
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$189.12
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$170.21 |
| Rate for Payer: Aetna American Axle |
$122.93
|
| Rate for Payer: Aetna Commercial |
$160.75
|
| Rate for Payer: Aetna Medicare |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.93
|
| Rate for Payer: BCBS Complete |
$75.65
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cofinity Commercial |
$132.38
|
| Rate for Payer: Cofinity Commercial |
$162.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.30
|
| Rate for Payer: Healthscope Commercial |
$170.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.75
|
| Rate for Payer: PHP Commercial |
$160.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.93
|
| Rate for Payer: Priority Health SBD |
$119.15
|
| Rate for Payer: UMR Bronson Commercial |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.84
|
|
