|
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: PHP Commercial |
$3.14
|
| 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: 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
|
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 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 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 |
$10.40 |
| 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 |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.08
|
| 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 |
$10.40 |
| 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 |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.08
|
| 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 |
$3.78 |
| 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: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$78.95
|
| 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
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
OP
|
$24.19
|
|
|
Service Code
|
NDC 09900000738
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna American Axle |
$15.72
|
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$21.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.56
|
| Rate for Payer: PHP Commercial |
$20.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health SBD |
$15.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.14
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
IP
|
$45.61
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna American Axle |
$29.65
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cofinity Commercial |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.65
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.21
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
IP
|
$24.19
|
|
|
Service Code
|
NDC 09900000738
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna American Axle |
$15.72
|
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.72
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$21.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.56
|
| Rate for Payer: PHP Commercial |
$20.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health SBD |
$15.24
|
| Rate for Payer: UMR Bronson Commercial |
$10.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.14
|
|
|
NITROGLYCERIN (200 MCG/ML) IN D5W PEDIATRIC INFUSION
|
Facility
|
OP
|
$45.61
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
180234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna American Axle |
$29.65
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: BCBS Complete |
$18.24
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cofinity Commercial |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.65
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.21
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.50
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna American Axle |
$10.72
|
| Rate for Payer: Aetna Commercial |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.72
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.02
|
| Rate for Payer: PHP Commercial |
$14.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$114.60
|
|
|
Service Code
|
NDC 09900001982
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$103.14 |
| Rate for Payer: Aetna American Axle |
$74.49
|
| Rate for Payer: Aetna Commercial |
$97.41
|
| Rate for Payer: Aetna Medicare |
$57.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.49
|
| Rate for Payer: BCBS Complete |
$45.84
|
| Rate for Payer: Cash Price |
$91.68
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Cofinity Commercial |
$98.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.68
|
| Rate for Payer: Healthscope Commercial |
$103.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.41
|
| Rate for Payer: PHP Commercial |
$97.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.49
|
| Rate for Payer: Priority Health SBD |
$72.20
|
| Rate for Payer: UMR Bronson Commercial |
$42.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.95
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$114.60
|
|
|
Service Code
|
NDC 09900001982
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$103.14 |
| Rate for Payer: Aetna American Axle |
$74.49
|
| Rate for Payer: Aetna Commercial |
$97.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.49
|
| Rate for Payer: Cash Price |
$91.68
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Cofinity Commercial |
$98.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.68
|
| Rate for Payer: Healthscope Commercial |
$103.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.41
|
| Rate for Payer: PHP Commercial |
$97.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.49
|
| Rate for Payer: Priority Health SBD |
$72.20
|
| Rate for Payer: UMR Bronson Commercial |
$50.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.95
|
|
|
NITROGLYCERIN 200 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
NDC 09900000649
|
| Hospital Charge Code |
500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Aetna American Axle |
$10.72
|
| Rate for Payer: Aetna Commercial |
$14.02
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.72
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$14.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.02
|
| Rate for Payer: PHP Commercial |
$14.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: UMR Bronson Commercial |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna American Axle |
$6.00
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.00
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.85
|
| Rate for Payer: PHP Commercial |
$7.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.00
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
IP
|
$9.23
|
|
|
Service Code
|
NDC 00281032608
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna American Axle |
$6.00
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.00
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.38
|
| Rate for Payer: Healthscope Commercial |
$8.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.85
|
| Rate for Payer: PHP Commercial |
$7.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.00
|
| Rate for Payer: Priority Health SBD |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.92
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
IP
|
$621.98
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.67 |
| Max. Negotiated Rate |
$559.78 |
| Rate for Payer: Aetna American Axle |
$404.29
|
| Rate for Payer: Aetna Commercial |
$528.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.29
|
| Rate for Payer: Cash Price |
$497.58
|
| Rate for Payer: Cofinity Commercial |
$435.39
|
| Rate for Payer: Cofinity Commercial |
$534.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.58
|
| Rate for Payer: Healthscope Commercial |
$559.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.68
|
| Rate for Payer: PHP Commercial |
$528.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.29
|
| Rate for Payer: Priority Health SBD |
$391.85
|
| Rate for Payer: UMR Bronson Commercial |
$273.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.48
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
OP
|
$621.98
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$559.78 |
| Rate for Payer: Aetna American Axle |
$404.29
|
| Rate for Payer: Aetna Commercial |
$528.68
|
| Rate for Payer: Aetna Medicare |
$310.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.29
|
| Rate for Payer: BCBS Complete |
$248.79
|
| Rate for Payer: Cash Price |
$497.58
|
| Rate for Payer: Cofinity Commercial |
$435.39
|
| Rate for Payer: Cofinity Commercial |
$534.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.58
|
| Rate for Payer: Healthscope Commercial |
$559.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.68
|
| Rate for Payer: PHP Commercial |
$528.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.29
|
| Rate for Payer: Priority Health SBD |
$391.85
|
| Rate for Payer: UMR Bronson Commercial |
$230.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.48
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
IP
|
$384.77
|
|
|
Service Code
|
NDC 28595012049
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.30 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: Aetna American Axle |
$250.10
|
| Rate for Payer: Aetna Commercial |
$327.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.10
|
| Rate for Payer: Cash Price |
$307.82
|
| Rate for Payer: Cofinity Commercial |
$269.34
|
| Rate for Payer: Cofinity Commercial |
$330.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.82
|
| Rate for Payer: Healthscope Commercial |
$346.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.05
|
| Rate for Payer: PHP Commercial |
$327.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.10
|
| Rate for Payer: Priority Health SBD |
$242.41
|
| Rate for Payer: UMR Bronson Commercial |
$169.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.58
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL
|
Facility
|
OP
|
$384.77
|
|
|
Service Code
|
NDC 28595012049
|
| Hospital Charge Code |
27096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.36 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: Aetna American Axle |
$250.10
|
| Rate for Payer: Aetna Commercial |
$327.05
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.10
|
| Rate for Payer: BCBS Complete |
$153.91
|
| Rate for Payer: Cash Price |
$307.82
|
| Rate for Payer: Cofinity Commercial |
$269.34
|
| Rate for Payer: Cofinity Commercial |
$330.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.82
|
| Rate for Payer: Healthscope Commercial |
$346.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.05
|
| Rate for Payer: PHP Commercial |
$327.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.10
|
| Rate for Payer: Priority Health SBD |
$242.41
|
| Rate for Payer: UMR Bronson Commercial |
$142.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.58
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50.25
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
5599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$45.22 |
| Rate for Payer: Aetna American Axle |
$32.66
|
| Rate for Payer: Aetna Commercial |
$42.71
|
| Rate for Payer: Aetna Medicare |
$25.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.66
|
| Rate for Payer: BCBS Complete |
$20.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$43.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.20
|
| Rate for Payer: Healthscope Commercial |
$45.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.71
|
| Rate for Payer: PHP Commercial |
$42.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.66
|
| Rate for Payer: Priority Health SBD |
$31.66
|
| Rate for Payer: UMR Bronson Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.69
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.25
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
5599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$45.22 |
| Rate for Payer: Aetna American Axle |
$32.66
|
| Rate for Payer: Aetna Commercial |
$42.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.66
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$43.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.20
|
| Rate for Payer: Healthscope Commercial |
$45.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.71
|
| Rate for Payer: PHP Commercial |
$42.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.66
|
| Rate for Payer: Priority Health SBD |
$31.66
|
| Rate for Payer: UMR Bronson Commercial |
$22.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.69
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$89.51
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna American Axle |
$58.18
|
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.18
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$76.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.61
|
| Rate for Payer: Healthscope Commercial |
$80.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: PHP Commercial |
$76.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: Priority Health SBD |
$56.39
|
| Rate for Payer: UMR Bronson Commercial |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.13
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$89.51
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna American Axle |
$58.18
|
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Medicare |
$44.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.18
|
| Rate for Payer: BCBS Complete |
$35.80
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cash Price |
$71.61
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$76.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.61
|
| Rate for Payer: Healthscope Commercial |
$80.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: PHP Commercial |
$76.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.18
|
| Rate for Payer: Priority Health SBD |
$56.39
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.13
|
|
