|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$282.24
|
|
|
Service Code
|
NDC 47781030301
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.68 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: ASR ASR |
$273.77
|
| Rate for Payer: BCBS Trust/PPO |
$231.78
|
| Rate for Payer: BCN Commercial |
$231.78
|
| Rate for Payer: Cash Price |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$273.77
|
| Rate for Payer: Healthscope Whirlpool |
$282.24
|
| Rate for Payer: Mclaren Commercial |
$254.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.90
|
| Rate for Payer: Nomi Health Commercial |
$231.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.37
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: Aetna Medicare |
$326.10
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$726.66
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Healthscope Whirlpool |
$881.34
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$705.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$772.23
|
| Rate for Payer: Priority Health Narrow Network |
$617.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: Aetna Medicare |
$326.10
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: BCBS Complete |
$352.54
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$726.66
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Healthscope Whirlpool |
$881.34
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$705.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$772.23
|
| Rate for Payer: Priority Health Narrow Network |
$617.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51079034801
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.17
|
| Rate for Payer: BCN Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$11.12
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$7.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.78
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044611
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: BCBS Trust/PPO |
$723.76
|
| Rate for Payer: BCN Commercial |
$723.76
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Healthscope Whirlpool |
$881.34
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$881.34
|
|
|
Service Code
|
NDC 68084044601
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: BCBS Trust/PPO |
$723.76
|
| Rate for Payer: BCN Commercial |
$723.76
|
| Rate for Payer: Cash Price |
$705.07
|
| Rate for Payer: Cofinity Commercial |
$828.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.07
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Healthscope Whirlpool |
$881.34
|
| Rate for Payer: Mclaren Commercial |
$793.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.14
|
| Rate for Payer: Nomi Health Commercial |
$722.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 70756040411
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.84 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$283.00
|
| Rate for Payer: ASR ASR |
$305.02
|
| Rate for Payer: BCBS Trust/PPO |
$258.23
|
| Rate for Payer: BCN Commercial |
$258.23
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$295.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$305.02
|
| Rate for Payer: Healthscope Whirlpool |
$314.45
|
| Rate for Payer: Mclaren Commercial |
$283.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.72
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$108.30
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.94
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$101.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$105.05
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$97.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.06
|
| Rate for Payer: Nomi Health Commercial |
$88.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.30
|
|
|
NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$108.30
|
|
|
Service Code
|
NDC 49730011130
|
| Hospital Charge Code |
27472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: Aetna Medicare |
$40.07
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: BCBS Complete |
$43.32
|
| Rate for Payer: BCBS Trust/PPO |
$89.29
|
| Rate for Payer: BCN Commercial |
$89.29
|
| Rate for Payer: Cash Price |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$101.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$105.05
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$97.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.06
|
| Rate for Payer: Nomi Health Commercial |
$88.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.89
|
| Rate for Payer: Priority Health Narrow Network |
$75.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.30
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$109.44
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: BCBS Complete |
$43.78
|
| Rate for Payer: BCBS Trust/PPO |
$90.23
|
| Rate for Payer: BCN Commercial |
$90.23
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$106.16
|
| Rate for Payer: Healthscope Whirlpool |
$109.44
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.89
|
| Rate for Payer: Priority Health Narrow Network |
$76.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: ASR ASR |
$3.28
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.96
|
| Rate for Payer: Priority Health Narrow Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$101.38
|
|
|
Service Code
|
NDC 378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$101.38 |
| Rate for Payer: Aetna Commercial |
$91.24
|
| Rate for Payer: ASR ASR |
$98.33
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$83.25
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$95.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Healthscope Commercial |
$98.33
|
| Rate for Payer: Healthscope Whirlpool |
$101.38
|
| Rate for Payer: Mclaren Commercial |
$91.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Nomi Health Commercial |
$83.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.21
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$101.38
|
|
|
Service Code
|
NDC 378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$101.38 |
| Rate for Payer: Aetna Commercial |
$91.24
|
| Rate for Payer: Aetna Medicare |
$37.51
|
| Rate for Payer: ASR ASR |
$98.33
|
| Rate for Payer: BCBS Complete |
$40.55
|
| Rate for Payer: BCBS Trust/PPO |
$83.58
|
| Rate for Payer: BCN Commercial |
$83.58
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cofinity Commercial |
$95.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.10
|
| Rate for Payer: Healthscope Commercial |
$98.33
|
| Rate for Payer: Healthscope Whirlpool |
$101.38
|
| Rate for Payer: Mclaren Commercial |
$91.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.17
|
| Rate for Payer: Nomi Health Commercial |
$83.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.83
|
| Rate for Payer: Priority Health Narrow Network |
$71.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.21
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
NDC 49730011230
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$89.87
|
| Rate for Payer: BCN Commercial |
$89.87
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$106.16
|
| Rate for Payer: Healthscope Whirlpool |
$109.44
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: ASR ASR |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$10.66
|
| Rate for Payer: ASR ASR |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.72
|
| Rate for Payer: BCN Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Whirlpool |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.42
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: ASR ASR |
$70.61
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: BCBS Trust/PPO |
$60.02
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Healthscope Whirlpool |
$72.80
|
| Rate for Payer: Mclaren Commercial |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Nomi Health Commercial |
$59.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.79
|
| Rate for Payer: Priority Health Narrow Network |
$51.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.06
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 71041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.34 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: BCBS Trust/PPO |
$108.78
|
| Rate for Payer: BCN Commercial |
$108.78
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$124.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$128.49
|
| Rate for Payer: Healthscope Whirlpool |
$132.46
|
| Rate for Payer: Mclaren Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$10.66
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: ASR ASR |
$11.48
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.76
|
| Rate for Payer: BCN Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Whirlpool |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$10.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.37
|
| Rate for Payer: Priority Health Narrow Network |
$8.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.42
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 71041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.01 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: Aetna Medicare |
$49.01
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: BCBS Trust/PPO |
$109.21
|
| Rate for Payer: BCN Commercial |
$109.21
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$124.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$128.49
|
| Rate for Payer: Healthscope Whirlpool |
$132.46
|
| Rate for Payer: Mclaren Commercial |
$119.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.59
|
| Rate for Payer: Nomi Health Commercial |
$108.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.06
|
| Rate for Payer: Priority Health Narrow Network |
$92.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$72.80
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: ASR ASR |
$70.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.78
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Healthscope Whirlpool |
$72.80
|
| Rate for Payer: Mclaren Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Nomi Health Commercial |
$59.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.06
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$10.66
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: ASR ASR |
$11.48
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.76
|
| Rate for Payer: BCN Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Whirlpool |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$10.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.37
|
| Rate for Payer: Priority Health Narrow Network |
$8.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.42
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: ASR ASR |
$70.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.78
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Healthscope Whirlpool |
$72.80
|
| Rate for Payer: Mclaren Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Nomi Health Commercial |
$59.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.06
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$72.80
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: ASR ASR |
$70.61
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: BCBS Trust/PPO |
$60.02
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.24
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Healthscope Whirlpool |
$72.80
|
| Rate for Payer: Mclaren Commercial |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.88
|
| Rate for Payer: Nomi Health Commercial |
$59.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.79
|
| Rate for Payer: Priority Health Narrow Network |
$51.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.06
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$10.66
|
| Rate for Payer: ASR ASR |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.72
|
| Rate for Payer: BCN Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$9.47
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Whirlpool |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.42
|
|
