|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$10,290.69
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$9,800.66 |
| Max. Negotiated Rate |
$10,290.69 |
| Rate for Payer: BCBS Complete |
$10,290.69
|
| Rate for Payer: Mclaren Medicaid |
$9,800.66
|
| Rate for Payer: Meridian Medicaid |
$10,290.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,800.66
|
| Rate for Payer: UHC Medicaid |
$9,800.66
|
| Rate for Payer: UHCCP Medicaid |
$9,800.66
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$14,796.61
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$14,092.01 |
| Max. Negotiated Rate |
$14,796.61 |
| Rate for Payer: BCBS Complete |
$14,796.61
|
| Rate for Payer: Mclaren Medicaid |
$14,092.01
|
| Rate for Payer: Meridian Medicaid |
$14,796.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,092.01
|
| Rate for Payer: UHC Medicaid |
$14,092.01
|
| Rate for Payer: UHCCP Medicaid |
$14,092.01
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 50268052211
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.73
|
| 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: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.17
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.23
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PACE Senior Care Partners |
$1.11
|
| Rate for Payer: PACE SWMI |
$1.17
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: PHP Medicare Advantage |
$1.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.07
|
| Rate for Payer: Priority Health Medicare |
$1.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.12
|
| Rate for Payer: UHC Core |
$3.91
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UHC Medicaid |
$0.83
|
| Rate for Payer: UHC Medicare Advantage |
$1.17
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: VA VA |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$170.05
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.35 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: BCBS Trust/PPO |
$140.44
|
| Rate for Payer: BCN Commercial |
$140.44
|
| Rate for Payer: Cash Price |
$136.04
|
| 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: Lakeland Regional Health Systems Commercial |
$127.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.54
|
| Rate for Payer: Nomi Health Commercial |
$139.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.54
|
| Rate for Payer: PHP Commercial |
$144.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.64
|
| Rate for Payer: UHC Core |
$141.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.54
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 50268052211
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.90
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.97
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$170.05
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: Aetna Medicare |
$44.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.14
|
| Rate for Payer: BCBS Complete |
$31.48
|
| Rate for Payer: BCBS MAPPO |
$42.51
|
| Rate for Payer: BCBS Trust/PPO |
$139.80
|
| Rate for Payer: BCN Commercial |
$139.80
|
| Rate for Payer: BCN Medicare Advantage |
$42.51
|
| Rate for Payer: Cash Price |
$136.04
|
| Rate for Payer: Cofinity Commercial |
$146.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.51
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.54
|
| Rate for Payer: Mclaren Medicaid |
$29.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.64
|
| Rate for Payer: Meridian Medicaid |
$31.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.54
|
| Rate for Payer: Nomi Health Commercial |
$139.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.54
|
| Rate for Payer: PACE Senior Care Partners |
$40.39
|
| Rate for Payer: PACE SWMI |
$42.51
|
| Rate for Payer: PHP Commercial |
$144.54
|
| Rate for Payer: PHP Medicare Advantage |
$42.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.94
|
| Rate for Payer: Priority Health Medicare |
$42.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.35
|
| Rate for Payer: Railroad Medicare Medicare |
$42.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.64
|
| Rate for Payer: UHC Core |
$141.99
|
| Rate for Payer: UHC Exchange |
$42.51
|
| Rate for Payer: UHC Medicaid |
$29.98
|
| Rate for Payer: UHC Medicare Advantage |
$42.51
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: VA VA |
$42.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.54
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna Medicare |
$121.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.06
|
| Rate for Payer: BCBS Complete |
$86.52
|
| Rate for Payer: BCBS MAPPO |
$116.85
|
| Rate for Payer: BCBS Trust/PPO |
$384.25
|
| Rate for Payer: BCN Commercial |
$384.25
|
| Rate for Payer: BCN Medicare Advantage |
$116.85
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.85
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Mclaren Medicaid |
$82.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.69
|
| Rate for Payer: Meridian Medicaid |
$86.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Nomi Health Commercial |
$383.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PACE Senior Care Partners |
$111.01
|
| Rate for Payer: PACE SWMI |
$116.85
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: PHP Medicare Advantage |
$116.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.64
|
| Rate for Payer: Priority Health Medicare |
$118.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.31
|
| Rate for Payer: Railroad Medicare Medicare |
$116.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.31
|
| Rate for Payer: UHC Core |
$390.28
|
| Rate for Payer: UHC Exchange |
$116.85
|
| Rate for Payer: UHC Medicaid |
$82.40
|
| Rate for Payer: UHC Medicare Advantage |
$116.85
|
| Rate for Payer: UHCCP Medicaid |
$82.40
|
| Rate for Payer: VA VA |
$116.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$3.74
|
| 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: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.12
|
| Rate for Payer: UHC Core |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.31 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: BCBS Trust/PPO |
$386.03
|
| Rate for Payer: BCN Commercial |
$386.03
|
| Rate for Payer: Cash Price |
$373.92
|
| 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: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Nomi Health Commercial |
$383.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.31
|
| Rate for Payer: UHC Core |
$390.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$153.12
|
|
|
Service Code
|
NDC 60687073065
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$28.34
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$125.88
|
| Rate for Payer: BCN Commercial |
$125.88
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$131.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$137.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.84
|
| Rate for Payer: Mclaren Medicaid |
$27.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$28.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.15
|
| Rate for Payer: Nomi Health Commercial |
$125.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.84
|
| Rate for Payer: PACE Senior Care Partners |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$130.15
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.21
|
| Rate for Payer: Priority Health Medicare |
$38.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.57
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.75
|
| Rate for Payer: UHC Core |
$127.86
|
| Rate for Payer: UHC Exchange |
$38.28
|
| Rate for Payer: UHC Medicaid |
$27.00
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$27.00
|
| Rate for Payer: VA VA |
$38.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.84
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.34 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna Medicare |
$103.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.69
|
| Rate for Payer: BCBS Complete |
$73.85
|
| Rate for Payer: BCBS MAPPO |
$99.75
|
| Rate for Payer: BCBS Trust/PPO |
$328.02
|
| Rate for Payer: BCN Commercial |
$328.02
|
| Rate for Payer: BCN Medicare Advantage |
$99.75
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.75
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.25
|
| Rate for Payer: Mclaren Medicaid |
$70.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.74
|
| Rate for Payer: Meridian Medicaid |
$73.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Nomi Health Commercial |
$327.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PACE Senior Care Partners |
$94.76
|
| Rate for Payer: PACE SWMI |
$99.75
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: PHP Medicare Advantage |
$99.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$347.13
|
| Rate for Payer: Priority Health Medicare |
$100.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.70
|
| Rate for Payer: Railroad Medicare Medicare |
$99.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.12
|
| Rate for Payer: UHC Core |
$333.17
|
| Rate for Payer: UHC Exchange |
$99.75
|
| Rate for Payer: UHC Medicaid |
$70.34
|
| Rate for Payer: UHC Medicare Advantage |
$99.75
|
| Rate for Payer: UHCCP Medicaid |
$70.34
|
| Rate for Payer: VA VA |
$99.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.25
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.93
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicaid |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.14 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: BCBS Trust/PPO |
$314.63
|
| Rate for Payer: BCN Commercial |
$314.63
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.24
|
| Rate for Payer: UHC Core |
$318.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| 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 |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 65162044210
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.72
|
| Rate for Payer: BCBS Complete |
$77.43
|
| Rate for Payer: BCBS MAPPO |
$104.58
|
| Rate for Payer: BCBS Trust/PPO |
$343.88
|
| Rate for Payer: BCN Commercial |
$343.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.58
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.58
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: Mclaren Medicaid |
$73.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.80
|
| Rate for Payer: Meridian Medicaid |
$77.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PACE Senior Care Partners |
$99.35
|
| Rate for Payer: PACE SWMI |
$104.58
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: PHP Medicare Advantage |
$104.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Medicare |
$105.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.14
|
| Rate for Payer: Railroad Medicare Medicare |
$104.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: UHC Exchange |
$104.58
|
| Rate for Payer: UHC Medicaid |
$73.75
|
| Rate for Payer: UHC Medicare Advantage |
$104.58
|
| Rate for Payer: UHCCP Medicaid |
$73.75
|
| Rate for Payer: VA VA |
$104.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.73
|
| Rate for Payer: Nomi Health Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.86
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.61
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.73
|
| Rate for Payer: Nomi Health Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.82
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.86
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicaid |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: UHCCP Medicaid |
$0.77
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 65162044210
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.14 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$345.47
|
| Rate for Payer: BCN Commercial |
$345.47
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.14 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$345.47
|
| Rate for Payer: BCN Commercial |
$345.47
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$151.63 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Medicare |
$43.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.65
|
| Rate for Payer: BCBS Complete |
$31.19
|
| Rate for Payer: BCBS MAPPO |
$42.12
|
| Rate for Payer: BCBS Trust/PPO |
$138.51
|
| Rate for Payer: BCN Commercial |
$138.51
|
| Rate for Payer: BCN Medicare Advantage |
$42.12
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Commercial |
$144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.12
|
| Rate for Payer: Healthscope Commercial |
$151.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.36
|
| Rate for Payer: Mclaren Medicaid |
$29.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.23
|
| Rate for Payer: Meridian Medicaid |
$31.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Nomi Health Commercial |
$138.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: PACE Senior Care Partners |
$40.01
|
| Rate for Payer: PACE SWMI |
$42.12
|
| Rate for Payer: PHP Commercial |
$143.21
|
| Rate for Payer: PHP Medicare Advantage |
$42.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.58
|
| Rate for Payer: Priority Health Medicare |
$42.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.26
|
| Rate for Payer: Railroad Medicare Medicare |
$42.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.26
|
| Rate for Payer: UHC Core |
$140.68
|
| Rate for Payer: UHC Exchange |
$42.12
|
| Rate for Payer: UHC Medicaid |
$29.70
|
| Rate for Payer: UHC Medicare Advantage |
$42.12
|
| Rate for Payer: UHCCP Medicaid |
$29.70
|
| Rate for Payer: VA VA |
$42.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.36
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.72
|
| Rate for Payer: BCBS Complete |
$77.43
|
| Rate for Payer: BCBS MAPPO |
$104.58
|
| Rate for Payer: BCBS Trust/PPO |
$343.88
|
| Rate for Payer: BCN Commercial |
$343.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.58
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.58
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: Mclaren Medicaid |
$73.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.80
|
| Rate for Payer: Meridian Medicaid |
$77.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PACE Senior Care Partners |
$99.35
|
| Rate for Payer: PACE SWMI |
$104.58
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: PHP Medicare Advantage |
$104.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Medicare |
$105.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.14
|
| Rate for Payer: Railroad Medicare Medicare |
$104.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: UHC Exchange |
$104.58
|
| Rate for Payer: UHC Medicaid |
$73.75
|
| Rate for Payer: UHC Medicare Advantage |
$104.58
|
| Rate for Payer: UHCCP Medicaid |
$73.75
|
| Rate for Payer: VA VA |
$104.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$151.63 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: BCBS Trust/PPO |
$139.15
|
| Rate for Payer: BCN Commercial |
$139.15
|
| Rate for Payer: Cash Price |
$134.78
|
| 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: Lakeland Regional Health Systems Commercial |
$126.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Nomi Health Commercial |
$138.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: PHP Commercial |
$143.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.26
|
| Rate for Payer: UHC Core |
$140.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.36
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.70 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: BCBS Trust/PPO |
$329.53
|
| Rate for Payer: BCN Commercial |
$329.53
|
| Rate for Payer: Cash Price |
$319.20
|
| 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: Lakeland Regional Health Systems Commercial |
$299.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Nomi Health Commercial |
$327.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$347.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.12
|
| Rate for Payer: UHC Core |
$333.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.25
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$284.05
|
|
|
Service Code
|
NDC 42806001401
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.70 |
| Max. Negotiated Rate |
$255.65 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: BCBS Trust/PPO |
$234.60
|
| Rate for Payer: BCN Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$244.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Healthscope Commercial |
$255.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.04
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Core |
$237.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.04
|
|
