|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 68084059711
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| 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 |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$390.72
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna American Axle |
$253.97
|
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| 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 |
$171.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 50742026001
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| 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 |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$953.76
|
|
|
Service Code
|
NDC 62175026237
|
| Hospital Charge Code |
27335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.89 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Aetna American Axle |
$619.94
|
| Rate for Payer: Aetna Commercial |
$810.70
|
| Rate for Payer: Aetna Medicare |
$476.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.94
|
| Rate for Payer: BCBS Complete |
$381.50
|
| Rate for Payer: Cash Price |
$763.01
|
| Rate for Payer: Cofinity Commercial |
$667.63
|
| Rate for Payer: Cofinity Commercial |
$820.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$667.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.01
|
| Rate for Payer: Healthscope Commercial |
$858.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$667.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.70
|
| Rate for Payer: PHP Commercial |
$810.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.94
|
| Rate for Payer: Priority Health SBD |
$600.87
|
| Rate for Payer: UMR Bronson Commercial |
$352.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.32
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$953.76
|
|
|
Service Code
|
NDC 62175026237
|
| Hospital Charge Code |
27335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$419.65 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Aetna American Axle |
$619.94
|
| Rate for Payer: Aetna Commercial |
$810.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.94
|
| Rate for Payer: Cash Price |
$763.01
|
| Rate for Payer: Cofinity Commercial |
$667.63
|
| Rate for Payer: Cofinity Commercial |
$820.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$667.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.01
|
| Rate for Payer: Healthscope Commercial |
$858.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$667.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.70
|
| Rate for Payer: PHP Commercial |
$810.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.94
|
| Rate for Payer: Priority Health SBD |
$600.87
|
| Rate for Payer: UMR Bronson Commercial |
$419.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.32
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$181.32
|
|
|
Service Code
|
NDC 24338023030
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna American Axle |
$117.86
|
| Rate for Payer: Aetna Commercial |
$154.12
|
| Rate for Payer: Aetna Medicare |
$90.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.86
|
| Rate for Payer: BCBS Complete |
$72.53
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$155.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.06
|
| Rate for Payer: Healthscope Commercial |
$163.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.12
|
| Rate for Payer: PHP Commercial |
$154.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.86
|
| Rate for Payer: Priority Health SBD |
$114.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.99
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$173.89
|
|
|
Service Code
|
NDC 24338023005
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Commercial |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$181.32
|
|
|
Service Code
|
NDC 24338023030
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna American Axle |
$117.86
|
| Rate for Payer: Aetna Commercial |
$154.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.86
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$155.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.06
|
| Rate for Payer: Healthscope Commercial |
$163.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.12
|
| Rate for Payer: PHP Commercial |
$154.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.86
|
| Rate for Payer: Priority Health SBD |
$114.23
|
| Rate for Payer: UMR Bronson Commercial |
$79.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.99
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$173.89
|
|
|
Service Code
|
NDC 24338023012
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Commercial |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$181.32
|
|
|
Service Code
|
NDC 24338023015
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna American Axle |
$117.86
|
| Rate for Payer: Aetna Commercial |
$154.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.86
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$155.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.06
|
| Rate for Payer: Healthscope Commercial |
$163.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.12
|
| Rate for Payer: PHP Commercial |
$154.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.86
|
| Rate for Payer: Priority Health SBD |
$114.23
|
| Rate for Payer: UMR Bronson Commercial |
$79.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.99
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$173.89
|
|
|
Service Code
|
NDC 24338023005
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Commercial |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$173.89
|
|
|
Service Code
|
NDC 24338023012
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.11
|
| Rate for Payer: Cofinity Commercial |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.11
|
| Rate for Payer: Healthscope Commercial |
$156.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.55
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$181.32
|
|
|
Service Code
|
NDC 24338023015
|
| Hospital Charge Code |
193496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Aetna American Axle |
$117.86
|
| Rate for Payer: Aetna Commercial |
$154.12
|
| Rate for Payer: Aetna Medicare |
$90.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.86
|
| Rate for Payer: BCBS Complete |
$72.53
|
| Rate for Payer: Cash Price |
$145.06
|
| Rate for Payer: Cofinity Commercial |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$155.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.06
|
| Rate for Payer: Healthscope Commercial |
$163.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.12
|
| Rate for Payer: PHP Commercial |
$154.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.86
|
| Rate for Payer: Priority Health SBD |
$114.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.99
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$5.76
|
|
|
Service Code
|
NDC 23155051211
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna American Axle |
$3.74
|
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.90
|
| Rate for Payer: PHP Commercial |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health SBD |
$3.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.32
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$215.57
|
|
|
Service Code
|
NDC 62559021031
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$194.01 |
| Rate for Payer: Aetna American Axle |
$140.12
|
| Rate for Payer: Aetna Commercial |
$183.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.12
|
| Rate for Payer: Cash Price |
$172.46
|
| Rate for Payer: Cofinity Commercial |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$185.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.46
|
| Rate for Payer: Healthscope Commercial |
$194.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.23
|
| Rate for Payer: PHP Commercial |
$183.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.12
|
| Rate for Payer: Priority Health SBD |
$135.81
|
| Rate for Payer: UMR Bronson Commercial |
$94.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.68
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$583.20
|
|
|
Service Code
|
NDC 69452020920
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.61 |
| Max. Negotiated Rate |
$524.88 |
| Rate for Payer: Aetna American Axle |
$379.08
|
| Rate for Payer: Aetna Commercial |
$495.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.08
|
| Rate for Payer: Cash Price |
$466.56
|
| Rate for Payer: Cofinity Commercial |
$408.24
|
| Rate for Payer: Cofinity Commercial |
$501.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.56
|
| Rate for Payer: Healthscope Commercial |
$524.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.72
|
| Rate for Payer: PHP Commercial |
$495.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$367.42
|
| Rate for Payer: UMR Bronson Commercial |
$256.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.40
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$1,771.56
|
|
|
Service Code
|
NDC 57664013565
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.49 |
| Max. Negotiated Rate |
$1,594.40 |
| Rate for Payer: Aetna American Axle |
$1,151.51
|
| Rate for Payer: Aetna Commercial |
$1,505.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.51
|
| Rate for Payer: Cash Price |
$1,417.25
|
| Rate for Payer: Cofinity Commercial |
$1,240.09
|
| Rate for Payer: Cofinity Commercial |
$1,523.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.25
|
| Rate for Payer: Healthscope Commercial |
$1,594.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,505.83
|
| Rate for Payer: PHP Commercial |
$1,505.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,151.51
|
| Rate for Payer: Priority Health SBD |
$1,116.08
|
| Rate for Payer: UMR Bronson Commercial |
$779.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.67
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$146.16
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.24
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.00
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$64.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
IP
|
$17.72
|
|
|
Service Code
|
NDC 57664013560
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.52
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 69452020907
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna American Axle |
$3.17
|
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$2.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.17
|
| Rate for Payer: BCBS Complete |
$1.95
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$4.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.15
|
| Rate for Payer: PHP Commercial |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.17
|
| Rate for Payer: Priority Health SBD |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.66
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
NDC 23155051200
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Medicare |
$288.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$213.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$5.76
|
|
|
Service Code
|
NDC 23155051211
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna American Axle |
$3.74
|
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna Medicare |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.90
|
| Rate for Payer: PHP Commercial |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health SBD |
$3.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.32
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$215.57
|
|
|
Service Code
|
NDC 62559021031
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$194.01 |
| Rate for Payer: Aetna American Axle |
$140.12
|
| Rate for Payer: Aetna Commercial |
$183.23
|
| Rate for Payer: Aetna Medicare |
$107.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.12
|
| Rate for Payer: BCBS Complete |
$86.23
|
| Rate for Payer: Cash Price |
$172.46
|
| Rate for Payer: Cofinity Commercial |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$185.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.46
|
| Rate for Payer: Healthscope Commercial |
$194.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.23
|
| Rate for Payer: PHP Commercial |
$183.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.12
|
| Rate for Payer: Priority Health SBD |
$135.81
|
| Rate for Payer: UMR Bronson Commercial |
$79.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.68
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$583.20
|
|
|
Service Code
|
NDC 69452020920
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.78 |
| Max. Negotiated Rate |
$524.88 |
| Rate for Payer: Aetna American Axle |
$379.08
|
| Rate for Payer: Aetna Commercial |
$495.72
|
| Rate for Payer: Aetna Medicare |
$291.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.08
|
| Rate for Payer: BCBS Complete |
$233.28
|
| Rate for Payer: Cash Price |
$466.56
|
| Rate for Payer: Cofinity Commercial |
$408.24
|
| Rate for Payer: Cofinity Commercial |
$501.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.56
|
| Rate for Payer: Healthscope Commercial |
$524.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.72
|
| Rate for Payer: PHP Commercial |
$495.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$367.42
|
| Rate for Payer: UMR Bronson Commercial |
$215.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.40
|
|
|
NIMODIPINE 30 MG CAPSULE
|
Facility
|
OP
|
$1,771.56
|
|
|
Service Code
|
NDC 57664013565
|
| Hospital Charge Code |
10722
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$655.48 |
| Max. Negotiated Rate |
$1,594.40 |
| Rate for Payer: Aetna American Axle |
$1,151.51
|
| Rate for Payer: Aetna Commercial |
$1,505.83
|
| Rate for Payer: Aetna Medicare |
$885.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.51
|
| Rate for Payer: BCBS Complete |
$708.62
|
| Rate for Payer: Cash Price |
$1,417.25
|
| Rate for Payer: Cofinity Commercial |
$1,240.09
|
| Rate for Payer: Cofinity Commercial |
$1,523.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.25
|
| Rate for Payer: Healthscope Commercial |
$1,594.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,505.83
|
| Rate for Payer: PHP Commercial |
$1,505.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,151.51
|
| Rate for Payer: Priority Health SBD |
$1,116.08
|
| Rate for Payer: UMR Bronson Commercial |
$655.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.67
|
|
