|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE
|
Facility
|
IP
|
$451.44
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
10724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$451.44 |
| Rate for Payer: Aetna Commercial |
$406.30
|
| Rate for Payer: ASR ASR |
$437.90
|
| Rate for Payer: ASR Commercial |
$437.90
|
| Rate for Payer: BCBS Trust/PPO |
$367.88
|
| Rate for Payer: BCN Commercial |
$350.00
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$424.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.15
|
| Rate for Payer: Healthscope Commercial |
$451.44
|
| Rate for Payer: Healthscope Whirlpool |
$437.90
|
| Rate for Payer: Mclaren Commercial |
$406.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.72
|
| Rate for Payer: Nomi Health Commercial |
$370.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.27
|
|
|
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 |
$572.87 |
| Max. Negotiated Rate |
$881.34 |
| Rate for Payer: Aetna Commercial |
$793.21
|
| Rate for Payer: ASR ASR |
$854.90
|
| Rate for Payer: ASR Commercial |
$854.90
|
| Rate for Payer: BCBS Trust/PPO |
$718.20
|
| Rate for Payer: BCN Commercial |
$683.30
|
| 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 |
$881.34
|
| Rate for Payer: Healthscope Whirlpool |
$854.90
|
| 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: Priority Health Cigna Priority Health |
$572.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.58
|
|
|
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 |
$70.39 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: ASR Commercial |
$105.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.25
|
| Rate for Payer: BCN Commercial |
$83.96
|
| 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 |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.05
|
| 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: Priority Health Cigna Priority Health |
$70.39
|
| 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 |
$43.32 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: Aetna Medicare |
$54.15
|
| Rate for Payer: ASR ASR |
$105.05
|
| Rate for Payer: ASR Commercial |
$105.05
|
| Rate for Payer: BCBS Complete |
$43.32
|
| Rate for Payer: BCBS Trust/PPO |
$88.69
|
| Rate for Payer: BCN Commercial |
$83.96
|
| 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 |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.05
|
| 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: Priority Health Cigna Priority Health |
$70.39
|
| Rate for Payer: 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
|
IP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$99.94 |
| Rate for Payer: Aetna Commercial |
$89.95
|
| Rate for Payer: ASR ASR |
$96.94
|
| Rate for Payer: ASR Commercial |
$96.94
|
| Rate for Payer: BCBS Trust/PPO |
$81.44
|
| Rate for Payer: BCN Commercial |
$77.48
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$93.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$99.94
|
| Rate for Payer: Healthscope Whirlpool |
$96.94
|
| Rate for Payer: Mclaren Commercial |
$89.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: Nomi Health Commercial |
$81.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.95
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$110.02
|
|
|
Service Code
|
NDC 68382031030
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.01 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna Commercial |
$99.02
|
| Rate for Payer: Aetna Medicare |
$55.01
|
| Rate for Payer: ASR ASR |
$106.72
|
| Rate for Payer: ASR Commercial |
$106.72
|
| Rate for Payer: BCBS Complete |
$44.01
|
| Rate for Payer: BCBS Trust/PPO |
$90.10
|
| Rate for Payer: BCN Commercial |
$85.30
|
| Rate for Payer: Cash Price |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$110.02
|
| Rate for Payer: Healthscope Whirlpool |
$106.72
|
| Rate for Payer: Mclaren Commercial |
$99.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.52
|
| Rate for Payer: Nomi Health Commercial |
$90.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.40
|
| Rate for Payer: Priority Health Narrow Network |
$77.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.82
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.33
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: ASR ASR |
$3.23
|
| Rate for Payer: ASR Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Healthscope Whirlpool |
$3.23
|
| Rate for Payer: Mclaren Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.83
|
| Rate for Payer: Nomi Health Commercial |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.92
|
| Rate for Payer: Priority Health Narrow Network |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.93
|
|
|
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 |
$71.14 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$89.18
|
| Rate for Payer: BCN Commercial |
$84.85
|
| 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 |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| 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: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 68382031001
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.22
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$110.02
|
|
|
Service Code
|
NDC 68382031030
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.51 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna Commercial |
$99.02
|
| Rate for Payer: ASR ASR |
$106.72
|
| Rate for Payer: ASR Commercial |
$106.72
|
| Rate for Payer: BCBS Trust/PPO |
$89.66
|
| Rate for Payer: BCN Commercial |
$85.30
|
| Rate for Payer: Cash Price |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$110.02
|
| Rate for Payer: Healthscope Whirlpool |
$106.72
|
| Rate for Payer: Mclaren Commercial |
$99.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.52
|
| Rate for Payer: Nomi Health Commercial |
$90.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.82
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
NDC 00378911293
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$99.94 |
| Rate for Payer: Aetna Commercial |
$89.95
|
| Rate for Payer: Aetna Medicare |
$49.97
|
| Rate for Payer: ASR ASR |
$96.94
|
| Rate for Payer: ASR Commercial |
$96.94
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$81.84
|
| Rate for Payer: BCN Commercial |
$77.48
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cofinity Commercial |
$93.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.95
|
| Rate for Payer: Healthscope Commercial |
$99.94
|
| Rate for Payer: Healthscope Whirlpool |
$96.94
|
| Rate for Payer: Mclaren Commercial |
$89.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.95
|
| Rate for Payer: Nomi Health Commercial |
$81.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.57
|
| Rate for Payer: Priority Health Narrow Network |
$70.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.95
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 00378911216
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: ASR ASR |
$3.23
|
| Rate for Payer: ASR Commercial |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Healthscope Whirlpool |
$3.23
|
| Rate for Payer: Mclaren Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.83
|
| Rate for Payer: Nomi Health Commercial |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.93
|
|
|
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 |
$43.78 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: Aetna Medicare |
$54.72
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: BCBS Complete |
$43.78
|
| Rate for Payer: BCBS Trust/PPO |
$89.62
|
| Rate for Payer: BCN Commercial |
$84.85
|
| 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 |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| 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: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: 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
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 68382031001
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 70756001402
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043611
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.60
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: Aetna Medicare |
$66.23
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: ASR Commercial |
$128.49
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: BCBS Trust/PPO |
$108.47
|
| Rate for Payer: BCN Commercial |
$102.70
|
| 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 |
$132.46
|
| Rate for Payer: Healthscope Whirlpool |
$128.49
|
| 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: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: 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
|
$132.46
|
|
|
Service Code
|
NDC 00071041813
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: ASR Commercial |
$128.49
|
| Rate for Payer: BCBS Trust/PPO |
$107.94
|
| Rate for Payer: BCN Commercial |
$102.70
|
| 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 |
$132.46
|
| Rate for Payer: Healthscope Whirlpool |
$128.49
|
| 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: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 70756001405
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598043635
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: ASR Commercial |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.60
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$89.50
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$89.50 |
| Rate for Payer: Aetna Commercial |
$80.55
|
| Rate for Payer: ASR ASR |
$86.81
|
| Rate for Payer: ASR Commercial |
$86.81
|
| Rate for Payer: BCBS Trust/PPO |
$72.93
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cofinity Commercial |
$84.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.60
|
| Rate for Payer: Healthscope Commercial |
$89.50
|
| Rate for Payer: Healthscope Whirlpool |
$86.81
|
| Rate for Payer: Mclaren Commercial |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.08
|
| Rate for Payer: Nomi Health Commercial |
$73.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.76
|
|
