|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$344.10
|
|
|
Service Code
|
NDC 64980028203
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna Commercial |
$292.49
|
| Rate for Payer: Aetna Medicare |
$172.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Advantage |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.07
|
| Rate for Payer: PHP Commercial |
$292.49
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.66
|
| Rate for Payer: UHC Core |
$179.28
|
| Rate for Payer: UHC Exchange |
$135.23
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,865.02
|
|
|
Service Code
|
NDC 54092047612
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,434.96 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,285.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.26
|
| Rate for Payer: Cash Price |
$3,092.02
|
| Rate for Payer: Cofinity Advantage |
$2,705.51
|
| Rate for Payer: Cofinity Commercial |
$3,323.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,092.02
|
| Rate for Payer: Healthscope Commercial |
$3,478.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,898.76
|
| Rate for Payer: PHP Commercial |
$3,285.27
|
| Rate for Payer: Priority Health SBD |
$2,434.96
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,155.96
|
|
|
Service Code
|
NDC 00904683204
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.29 |
| Max. Negotiated Rate |
$1,040.36 |
| Rate for Payer: Aetna Commercial |
$982.57
|
| Rate for Payer: Aetna Medicare |
$577.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.37
|
| Rate for Payer: BCBS Complete |
$462.38
|
| Rate for Payer: Cash Price |
$924.77
|
| Rate for Payer: Cofinity Advantage |
$809.17
|
| Rate for Payer: Cofinity Commercial |
$994.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.77
|
| Rate for Payer: Healthscope Commercial |
$1,040.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$924.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.97
|
| Rate for Payer: PHP Commercial |
$982.57
|
| Rate for Payer: Priority Health SBD |
$728.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.37
|
| Rate for Payer: UHC Core |
$602.26
|
| Rate for Payer: UHC Exchange |
$454.29
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,835.94
|
|
|
Service Code
|
NDC 68382071119
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,156.64 |
| Max. Negotiated Rate |
$1,652.35 |
| Rate for Payer: Aetna Commercial |
$1,560.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.36
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cofinity Advantage |
$1,285.16
|
| Rate for Payer: Cofinity Commercial |
$1,578.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.75
|
| Rate for Payer: Healthscope Commercial |
$1,652.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,560.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.95
|
| Rate for Payer: PHP Commercial |
$1,560.55
|
| Rate for Payer: Priority Health SBD |
$1,156.64
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,865.02
|
|
|
Service Code
|
NDC 54092047612
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,518.95 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,285.27
|
| Rate for Payer: Aetna Medicare |
$1,932.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.26
|
| Rate for Payer: BCBS Complete |
$1,546.01
|
| Rate for Payer: Cash Price |
$3,092.02
|
| Rate for Payer: Cofinity Advantage |
$2,705.51
|
| Rate for Payer: Cofinity Commercial |
$3,323.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,092.02
|
| Rate for Payer: Healthscope Commercial |
$3,478.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,092.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,898.76
|
| Rate for Payer: PHP Commercial |
$3,285.27
|
| Rate for Payer: Priority Health SBD |
$2,434.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,512.26
|
| Rate for Payer: UHC Core |
$2,013.68
|
| Rate for Payer: UHC Exchange |
$1,518.95
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,835.94
|
|
|
Service Code
|
NDC 68382071119
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$721.52 |
| Max. Negotiated Rate |
$1,652.35 |
| Rate for Payer: Aetna Commercial |
$1,560.55
|
| Rate for Payer: Aetna Medicare |
$917.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.36
|
| Rate for Payer: BCBS Complete |
$734.38
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cofinity Advantage |
$1,285.16
|
| Rate for Payer: Cofinity Commercial |
$1,578.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.75
|
| Rate for Payer: Healthscope Commercial |
$1,652.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,560.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.95
|
| Rate for Payer: PHP Commercial |
$1,560.55
|
| Rate for Payer: Priority Health SBD |
$1,156.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.36
|
| Rate for Payer: UHC Core |
$956.52
|
| Rate for Payer: UHC Exchange |
$721.52
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,155.96
|
|
|
Service Code
|
NDC 00904683204
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$728.25 |
| Max. Negotiated Rate |
$1,040.36 |
| Rate for Payer: Aetna Commercial |
$982.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.37
|
| Rate for Payer: Cash Price |
$924.77
|
| Rate for Payer: Cofinity Advantage |
$809.17
|
| Rate for Payer: Cofinity Commercial |
$994.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.77
|
| Rate for Payer: Healthscope Commercial |
$1,040.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.97
|
| Rate for Payer: PHP Commercial |
$982.57
|
| Rate for Payer: Priority Health SBD |
$728.25
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.69
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: UHC Exchange |
$15.53
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$24.90
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,595.40
|
|
|
Service Code
|
NDC 68382043528
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,805.99 |
| Max. Negotiated Rate |
$4,135.86 |
| Rate for Payer: Aetna Commercial |
$3,906.09
|
| Rate for Payer: Aetna Medicare |
$2,297.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,987.01
|
| Rate for Payer: BCBS Complete |
$1,838.16
|
| Rate for Payer: Cash Price |
$3,676.32
|
| Rate for Payer: Cofinity Advantage |
$3,216.78
|
| Rate for Payer: Cofinity Commercial |
$3,952.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,676.32
|
| Rate for Payer: Healthscope Commercial |
$4,135.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,676.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,906.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,446.55
|
| Rate for Payer: PHP Commercial |
$3,906.09
|
| Rate for Payer: Priority Health SBD |
$2,895.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,987.01
|
| Rate for Payer: UHC Core |
$2,394.20
|
| Rate for Payer: UHC Exchange |
$1,805.99
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
NDC 60687040895
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,570.10
|
|
|
Service Code
|
NDC 60687040825
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$617.05 |
| Max. Negotiated Rate |
$1,413.09 |
| Rate for Payer: Aetna Commercial |
$1,334.59
|
| Rate for Payer: Aetna Medicare |
$785.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.57
|
| Rate for Payer: BCBS Complete |
$628.04
|
| Rate for Payer: Cash Price |
$1,256.08
|
| Rate for Payer: Cofinity Advantage |
$1,099.07
|
| Rate for Payer: Cofinity Commercial |
$1,350.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.08
|
| Rate for Payer: Healthscope Commercial |
$1,413.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,256.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,177.58
|
| Rate for Payer: PHP Commercial |
$1,334.59
|
| Rate for Payer: Priority Health SBD |
$989.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,020.57
|
| Rate for Payer: UHC Core |
$818.02
|
| Rate for Payer: UHC Exchange |
$617.05
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,570.10
|
|
|
Service Code
|
NDC 60687040825
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$989.16 |
| Max. Negotiated Rate |
$1,413.09 |
| Rate for Payer: Aetna Commercial |
$1,334.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.57
|
| Rate for Payer: Cash Price |
$1,256.08
|
| Rate for Payer: Cofinity Advantage |
$1,099.07
|
| Rate for Payer: Cofinity Commercial |
$1,350.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.08
|
| Rate for Payer: Healthscope Commercial |
$1,413.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,177.58
|
| Rate for Payer: PHP Commercial |
$1,334.59
|
| Rate for Payer: Priority Health SBD |
$989.16
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
NDC 60687040895
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$26.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: BCBS Complete |
$20.94
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$27.27
|
| Rate for Payer: UHC Exchange |
$20.57
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,595.40
|
|
|
Service Code
|
NDC 68382043528
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,895.10 |
| Max. Negotiated Rate |
$4,135.86 |
| Rate for Payer: Aetna Commercial |
$3,906.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,987.01
|
| Rate for Payer: Cash Price |
$3,676.32
|
| Rate for Payer: Cofinity Advantage |
$3,216.78
|
| Rate for Payer: Cofinity Commercial |
$3,952.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,676.32
|
| Rate for Payer: Healthscope Commercial |
$4,135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,906.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,446.55
|
| Rate for Payer: PHP Commercial |
$3,906.09
|
| Rate for Payer: Priority Health SBD |
$2,895.10
|
|
|
MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$2,507.72
|
|
|
Service Code
|
NDC 54092018981
|
| Hospital Charge Code |
10533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,579.86 |
| Max. Negotiated Rate |
$2,256.95 |
| Rate for Payer: Aetna Commercial |
$2,131.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.02
|
| Rate for Payer: Cash Price |
$2,006.18
|
| Rate for Payer: Cofinity Advantage |
$1,755.40
|
| Rate for Payer: Cofinity Commercial |
$2,156.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.18
|
| Rate for Payer: Healthscope Commercial |
$2,256.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.79
|
| Rate for Payer: PHP Commercial |
$2,131.56
|
| Rate for Payer: Priority Health SBD |
$1,579.86
|
|
|
MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$2,507.72
|
|
|
Service Code
|
NDC 54092018981
|
| Hospital Charge Code |
10533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$985.53 |
| Max. Negotiated Rate |
$2,256.95 |
| Rate for Payer: Aetna Commercial |
$2,131.56
|
| Rate for Payer: Aetna Medicare |
$1,253.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.02
|
| Rate for Payer: BCBS Complete |
$1,003.09
|
| Rate for Payer: Cash Price |
$2,006.18
|
| Rate for Payer: Cofinity Advantage |
$1,755.40
|
| Rate for Payer: Cofinity Commercial |
$2,156.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.18
|
| Rate for Payer: Healthscope Commercial |
$2,256.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,006.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.79
|
| Rate for Payer: PHP Commercial |
$2,131.56
|
| Rate for Payer: Priority Health SBD |
$1,579.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.02
|
| Rate for Payer: UHC Core |
$1,306.52
|
| Rate for Payer: UHC Exchange |
$985.53
|
|
|
MESALAMINE RECTAL SUSP ENEMA WITH CLEANSING WIPES 4 GRAM/60 ML KIT
|
Facility
|
OP
|
$445.41
|
|
|
Service Code
|
NDC 45802092341
|
| Hospital Charge Code |
92860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$400.87 |
| Rate for Payer: Aetna Commercial |
$378.60
|
| Rate for Payer: Aetna Medicare |
$222.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.52
|
| Rate for Payer: BCBS Complete |
$178.16
|
| Rate for Payer: Cash Price |
$356.33
|
| Rate for Payer: Cofinity Advantage |
$311.79
|
| Rate for Payer: Cofinity Commercial |
$383.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.33
|
| Rate for Payer: Healthscope Commercial |
$400.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.06
|
| Rate for Payer: PHP Commercial |
$378.60
|
| Rate for Payer: Priority Health SBD |
$280.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$232.06
|
| Rate for Payer: UHC Exchange |
$175.05
|
|
|
MESALAMINE RECTAL SUSP ENEMA WITH CLEANSING WIPES 4 GRAM/60 ML KIT
|
Facility
|
IP
|
$445.41
|
|
|
Service Code
|
NDC 45802092341
|
| Hospital Charge Code |
92860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.61 |
| Max. Negotiated Rate |
$400.87 |
| Rate for Payer: Aetna Commercial |
$378.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.52
|
| Rate for Payer: Cash Price |
$356.33
|
| Rate for Payer: Cofinity Advantage |
$311.79
|
| Rate for Payer: Cofinity Commercial |
$383.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.33
|
| Rate for Payer: Healthscope Commercial |
$400.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.06
|
| Rate for Payer: PHP Commercial |
$378.60
|
| Rate for Payer: Priority Health SBD |
$280.61
|
|
|
MESNA 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.88 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Advantage |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.48
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health SBD |
$123.88
|
|
|
MESNA 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.26
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Advantage |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.48
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health SBD |
$123.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Exchange |
$2.81
|
|
|
METFORMIN 1,000 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 60687016201
|
| Hospital Charge Code |
24398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.96
|
| Rate for Payer: UHC Core |
$176.31
|
| Rate for Payer: UHC Exchange |
$132.99
|
|
|
METFORMIN 1,000 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687016211
|
| Hospital Charge Code |
24398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.33
|
|
|
METFORMIN 1,000 MG TABLET
|
Facility
|
IP
|
$256.15
|
|
|
Service Code
|
NDC 00904716461
|
| Hospital Charge Code |
24398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.37 |
| Max. Negotiated Rate |
$230.53 |
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.50
|
| Rate for Payer: Cash Price |
$204.92
|
| Rate for Payer: Cofinity Advantage |
$179.31
|
| Rate for Payer: Cofinity Commercial |
$220.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.92
|
| Rate for Payer: Healthscope Commercial |
$230.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.11
|
| Rate for Payer: PHP Commercial |
$217.73
|
| Rate for Payer: Priority Health SBD |
$161.37
|
|
|
METFORMIN 1,000 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 60687016201
|
| Hospital Charge Code |
24398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
|
