|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.69 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna Medicare |
$233.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: BCBS Complete |
$186.96
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Advantage |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.81
|
| Rate for Payer: UHC Core |
$243.52
|
| Rate for Payer: UHC Exchange |
$183.69
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.46 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Advantage |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health SBD |
$294.46
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.02 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.35
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Advantage |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.02
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$170.05
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: Aetna Medicare |
$85.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.53
|
| Rate for Payer: BCBS Complete |
$68.02
|
| Rate for Payer: Cash Price |
$136.04
|
| Rate for Payer: Cofinity Advantage |
$119.03
|
| Rate for Payer: Cofinity Commercial |
$146.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.04
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.54
|
| Rate for Payer: PHP Commercial |
$144.54
|
| Rate for Payer: Priority Health SBD |
$107.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.53
|
| Rate for Payer: UHC Core |
$88.60
|
| Rate for Payer: UHC Exchange |
$66.83
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$1.84
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 50268052211
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.34
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 50268052211
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$170.05
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.53
|
| Rate for Payer: Cash Price |
$136.04
|
| Rate for Payer: Cofinity Advantage |
$119.03
|
| Rate for Payer: Cofinity Commercial |
$146.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.04
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.54
|
| Rate for Payer: PHP Commercial |
$144.54
|
| Rate for Payer: Priority Health SBD |
$107.13
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$366.70
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.11 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Medicare |
$183.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.35
|
| Rate for Payer: BCBS Complete |
$146.68
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Advantage |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.02
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.35
|
| Rate for Payer: UHC Core |
$191.05
|
| Rate for Payer: UHC Exchange |
$144.11
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 00536129701
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$64.89
|
| Rate for Payer: UHC Exchange |
$48.95
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 00536129701
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$151.63 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Medicare |
$84.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.51
|
| Rate for Payer: BCBS Complete |
$67.39
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Advantage |
$117.94
|
| Rate for Payer: Cofinity Commercial |
$144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$151.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: PHP Commercial |
$143.21
|
| Rate for Payer: Priority Health SBD |
$106.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.51
|
| Rate for Payer: UHC Core |
$87.78
|
| Rate for Payer: UHC Exchange |
$66.21
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.12
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.32
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$151.63 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.51
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Advantage |
$117.94
|
| Rate for Payer: Cofinity Commercial |
$144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$151.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: PHP Commercial |
$143.21
|
| Rate for Payer: Priority Health SBD |
$106.14
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.81 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna Medicare |
$199.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Advantage |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health SBD |
$251.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.35
|
| Rate for Payer: UHC Core |
$207.88
|
| Rate for Payer: UHC Exchange |
$156.81
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Advantage |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health SBD |
$251.37
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$28,569.46
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$12,855.67 |
| Max. Negotiated Rate |
$28,569.46 |
| Rate for Payer: Aetna Medicare |
$14,073.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,915.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,915.35
|
| Rate for Payer: BCBS MAPPO |
$13,532.28
|
| Rate for Payer: BCBS Trust/PPO |
$28,569.46
|
| Rate for Payer: BCN Commercial |
$28,569.46
|
| Rate for Payer: BCN Medicare Advantage |
$13,532.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,532.28
|
| Rate for Payer: Mclaren Medicare |
$13,532.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,208.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,562.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,885.51
|
| Rate for Payer: Nomi Health Commercial |
$21,621.69
|
| Rate for Payer: PACE Medicare |
$12,855.67
|
| Rate for Payer: PACE SWMI |
$13,532.28
|
| Rate for Payer: PHP Medicare Advantage |
$13,532.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,022.32
|
| Rate for Payer: Priority Health Medicare |
$13,532.28
|
| Rate for Payer: Priority Health Tiered Network |
$21,617.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13,532.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,320.43
|
| Rate for Payer: UHC Core |
$22,856.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,532.28
|
| Rate for Payer: UHC Exchange |
$18,666.73
|
| Rate for Payer: VA VA |
$13,532.28
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$16,425.39
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$7,607.73 |
| Max. Negotiated Rate |
$16,425.39 |
| Rate for Payer: Aetna Medicare |
$8,328.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,010.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,010.17
|
| Rate for Payer: BCBS MAPPO |
$8,008.14
|
| Rate for Payer: BCBS Trust/PPO |
$16,425.39
|
| Rate for Payer: BCN Commercial |
$16,425.39
|
| Rate for Payer: BCN Medicare Advantage |
$8,008.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,008.14
|
| Rate for Payer: Mclaren Medicare |
$8,008.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,408.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,209.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,808.95
|
| Rate for Payer: Nomi Health Commercial |
$12,400.77
|
| Rate for Payer: PACE Medicare |
$7,607.73
|
| Rate for Payer: PACE SWMI |
$8,008.14
|
| Rate for Payer: PHP Medicare Advantage |
$8,008.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,498.21
|
| Rate for Payer: Priority Health Medicare |
$8,008.14
|
| Rate for Payer: Priority Health Tiered Network |
$12,398.57
|
| Rate for Payer: Railroad Medicare Medicare |
$8,008.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,669.19
|
| Rate for Payer: UHC Core |
$13,109.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,008.14
|
| Rate for Payer: UHC Exchange |
$10,706.00
|
| Rate for Payer: VA VA |
$8,008.14
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$815.85 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna Commercial |
$1,100.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Advantage |
$906.50
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Healthscope Commercial |
$1,165.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: Priority Health SBD |
$815.85
|
|
|
MEDICAL MAGGOTS
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.42 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna Commercial |
$1,100.75
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Advantage |
$906.50
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$1,165.50
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.75
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$815.85
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 60687010511
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.36
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cofinity Advantage |
$4.69
|
| Rate for Payer: Cofinity Commercial |
$5.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.03
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: Priority Health SBD |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$3.49
|
| Rate for Payer: UHC Exchange |
$2.63
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 59762374202
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.85
|
| Rate for Payer: UHC Core |
$108.89
|
| Rate for Payer: UHC Exchange |
$82.14
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
OP
|
$200.88
|
|
|
Service Code
|
NDC 60687010521
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$180.79 |
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: Aetna Medicare |
$100.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.57
|
| Rate for Payer: BCBS Complete |
$80.35
|
| Rate for Payer: Cash Price |
$160.70
|
| Rate for Payer: Cofinity Advantage |
$140.62
|
| Rate for Payer: Cofinity Commercial |
$172.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.66
|
| Rate for Payer: PHP Commercial |
$170.75
|
| Rate for Payer: Priority Health SBD |
$126.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.57
|
| Rate for Payer: UHC Core |
$104.66
|
| Rate for Payer: UHC Exchange |
$78.95
|
|
