|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.59 |
| Max. Negotiated Rate |
$130.08 |
| Rate for Payer: Aetna Commercial |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$119.37
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$124.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$130.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Nomi Health Commercial |
$118.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.40
|
| Rate for Payer: PHP Commercial |
$122.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.19
|
| Rate for Payer: UHC Core |
$120.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.40
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$309.11
|
| Rate for Payer: BCN Commercial |
$309.11
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Mclaren Medicaid |
$66.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: Meridian Medicaid |
$69.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PACE Senior Care Partners |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$327.12
|
| Rate for Payer: Priority Health Medicare |
$94.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.70
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: UHC Exchange |
$94.00
|
| Rate for Payer: UHC Medicaid |
$66.29
|
| Rate for Payer: UHC Medicare Advantage |
$94.00
|
| Rate for Payer: UHCCP Medicaid |
$66.29
|
| Rate for Payer: VA VA |
$94.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.65 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$70.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.45
|
| Rate for Payer: BCBS Complete |
$50.02
|
| Rate for Payer: BCBS MAPPO |
$67.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$222.17
|
| Rate for Payer: BCN Medicare Advantage |
$67.56
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.56
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Mclaren Medicaid |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.94
|
| Rate for Payer: Meridian Medicaid |
$50.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PACE Senior Care Partners |
$64.18
|
| Rate for Payer: PACE SWMI |
$67.56
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: PHP Medicare Advantage |
$67.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| Rate for Payer: Railroad Medicare Medicare |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: UHC Exchange |
$67.56
|
| Rate for Payer: UHC Medicaid |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$67.56
|
| Rate for Payer: UHCCP Medicaid |
$47.65
|
| Rate for Payer: VA VA |
$67.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.31
|
| Rate for Payer: UHC Core |
$3.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 68094011059
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: BCBS Trust/PPO |
$40.76
|
| Rate for Payer: BCN Commercial |
$40.76
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Nomi Health Commercial |
$40.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.43
|
| Rate for Payer: UHC Core |
$41.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$160.98
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$144.88 |
| Rate for Payer: Aetna Commercial |
$136.83
|
| Rate for Payer: BCBS Trust/PPO |
$132.95
|
| Rate for Payer: BCN Commercial |
$132.95
|
| Rate for Payer: Cash Price |
$128.78
|
| Rate for Payer: Cofinity Commercial |
$138.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.78
|
| Rate for Payer: Healthscope Commercial |
$144.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.83
|
| Rate for Payer: Nomi Health Commercial |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.73
|
| Rate for Payer: PHP Commercial |
$136.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.66
|
| Rate for Payer: UHC Core |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.73
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Mclaren Medicaid |
$0.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: Meridian Medicaid |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicaid |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: UHCCP Medicaid |
$0.57
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.42
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: BCBS MAPPO |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCN Commercial |
$40.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.34
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.34
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Mclaren Medicaid |
$8.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.95
|
| Rate for Payer: Meridian Medicaid |
$9.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Nomi Health Commercial |
$40.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PACE Senior Care Partners |
$11.72
|
| Rate for Payer: PACE SWMI |
$12.34
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.93
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.43
|
| Rate for Payer: UHC Core |
$41.21
|
| Rate for Payer: UHC Exchange |
$12.34
|
| Rate for Payer: UHC Medicaid |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: UHCCP Medicaid |
$8.70
|
| Rate for Payer: VA VA |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$160.98
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$144.88 |
| Rate for Payer: Aetna Commercial |
$136.83
|
| Rate for Payer: Aetna Medicare |
$41.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.31
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$40.24
|
| Rate for Payer: BCBS Trust/PPO |
$132.34
|
| Rate for Payer: BCN Commercial |
$132.34
|
| Rate for Payer: BCN Medicare Advantage |
$40.24
|
| Rate for Payer: Cash Price |
$128.78
|
| Rate for Payer: Cofinity Commercial |
$138.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.24
|
| Rate for Payer: Healthscope Commercial |
$144.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.73
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.26
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.83
|
| Rate for Payer: Nomi Health Commercial |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.73
|
| Rate for Payer: PACE Senior Care Partners |
$38.23
|
| Rate for Payer: PACE SWMI |
$40.24
|
| Rate for Payer: PHP Commercial |
$136.83
|
| Rate for Payer: PHP Medicare Advantage |
$40.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.05
|
| Rate for Payer: Priority Health Medicare |
$40.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.04
|
| Rate for Payer: Railroad Medicare Medicare |
$40.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.66
|
| Rate for Payer: UHC Core |
$134.42
|
| Rate for Payer: UHC Exchange |
$40.24
|
| Rate for Payer: UHC Medicaid |
$28.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.24
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$40.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.73
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.25
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Mclaren Medicaid |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: Meridian Medicaid |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.21
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.25
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicaid |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: UHCCP Medicaid |
$0.65
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$71.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.09
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$68.88
|
| Rate for Payer: BCBS Trust/PPO |
$226.49
|
| Rate for Payer: BCN Commercial |
$226.49
|
| Rate for Payer: BCN Medicare Advantage |
$68.88
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.88
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Mclaren Medicaid |
$48.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.32
|
| Rate for Payer: Meridian Medicaid |
$51.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PACE Senior Care Partners |
$65.43
|
| Rate for Payer: PACE SWMI |
$68.88
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: PHP Medicare Advantage |
$68.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.69
|
| Rate for Payer: Priority Health Medicare |
$69.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.75
|
| Rate for Payer: Railroad Medicare Medicare |
$68.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.44
|
| Rate for Payer: UHC Core |
$230.04
|
| Rate for Payer: UHC Exchange |
$68.88
|
| Rate for Payer: UHC Medicaid |
$48.57
|
| Rate for Payer: UHC Medicare Advantage |
$68.88
|
| Rate for Payer: UHCCP Medicaid |
$48.57
|
| Rate for Payer: VA VA |
$68.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: BCBS Trust/PPO |
$227.54
|
| Rate for Payer: BCN Commercial |
$227.54
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.44
|
| Rate for Payer: UHC Core |
$230.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$368.60
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna Medicare |
$95.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.19
|
| Rate for Payer: BCBS Complete |
$68.23
|
| Rate for Payer: BCBS MAPPO |
$92.15
|
| Rate for Payer: BCBS Trust/PPO |
$303.03
|
| Rate for Payer: BCN Commercial |
$303.03
|
| Rate for Payer: BCN Medicare Advantage |
$92.15
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.15
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Mclaren Medicaid |
$64.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.76
|
| Rate for Payer: Meridian Medicaid |
$68.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Nomi Health Commercial |
$302.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PACE Senior Care Partners |
$87.54
|
| Rate for Payer: PACE SWMI |
$92.15
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: PHP Medicare Advantage |
$92.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.68
|
| Rate for Payer: Priority Health Medicare |
$93.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.55
|
| Rate for Payer: Railroad Medicare Medicare |
$92.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.37
|
| Rate for Payer: UHC Core |
$307.78
|
| Rate for Payer: UHC Exchange |
$92.15
|
| Rate for Payer: UHC Medicaid |
$64.98
|
| Rate for Payer: UHC Medicare Advantage |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$64.98
|
| Rate for Payer: VA VA |
$92.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.55 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: BCBS Trust/PPO |
$304.43
|
| Rate for Payer: BCN Commercial |
$304.43
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Nomi Health Commercial |
$302.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.37
|
| Rate for Payer: UHC Core |
$307.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$132.81
|
|
|
Service Code
|
NDC 29300017116
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: BCBS Trust/PPO |
$109.69
|
| Rate for Payer: BCN Commercial |
$109.69
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: Nomi Health Commercial |
$108.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.61
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.87
|
| Rate for Payer: UHC Core |
$110.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$132.81
|
|
|
Service Code
|
NDC 29300017116
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: Aetna Medicare |
$34.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.50
|
| Rate for Payer: BCBS Complete |
$24.58
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.18
|
| Rate for Payer: BCN Commercial |
$109.18
|
| Rate for Payer: BCN Medicare Advantage |
$33.20
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.20
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Mclaren Medicaid |
$23.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: Meridian Medicaid |
$24.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: Nomi Health Commercial |
$108.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.61
|
| Rate for Payer: PACE Senior Care Partners |
$31.54
|
| Rate for Payer: PACE SWMI |
$33.20
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: PHP Medicare Advantage |
$33.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.54
|
| Rate for Payer: Priority Health Medicare |
$33.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.44
|
| Rate for Payer: Railroad Medicare Medicare |
$33.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.87
|
| Rate for Payer: UHC Core |
$110.90
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicaid |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$33.20
|
| Rate for Payer: UHCCP Medicaid |
$23.41
|
| Rate for Payer: VA VA |
$33.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.55 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: BCBS Trust/PPO |
$304.43
|
| Rate for Payer: BCN Commercial |
$304.43
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Nomi Health Commercial |
$302.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.37
|
| Rate for Payer: UHC Core |
$307.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.25
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$247.95
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.57 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: BCBS Trust/PPO |
$204.78
|
| Rate for Payer: BCN Commercial |
$204.78
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Nomi Health Commercial |
$203.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.96
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.20
|
| Rate for Payer: UHC Core |
$207.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.96
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Mclaren Medicaid |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: Meridian Medicaid |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.21
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.25
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicaid |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: UHCCP Medicaid |
$0.65
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$247.95
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: Aetna Medicare |
$64.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.48
|
| Rate for Payer: BCBS Complete |
$45.90
|
| Rate for Payer: BCBS MAPPO |
$61.99
|
| Rate for Payer: BCBS Trust/PPO |
$203.84
|
| Rate for Payer: BCN Commercial |
$203.84
|
| Rate for Payer: BCN Medicare Advantage |
$61.99
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.99
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.96
|
| Rate for Payer: Mclaren Medicaid |
$43.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.09
|
| Rate for Payer: Meridian Medicaid |
$45.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Nomi Health Commercial |
$203.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.96
|
| Rate for Payer: PACE Senior Care Partners |
$58.89
|
| Rate for Payer: PACE SWMI |
$61.99
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: PHP Medicare Advantage |
$61.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.72
|
| Rate for Payer: Priority Health Medicare |
$62.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.57
|
| Rate for Payer: Railroad Medicare Medicare |
$61.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.20
|
| Rate for Payer: UHC Core |
$207.04
|
| Rate for Payer: UHC Exchange |
$61.99
|
| Rate for Payer: UHC Medicaid |
$43.71
|
| Rate for Payer: UHC Medicare Advantage |
$61.99
|
| Rate for Payer: UHCCP Medicaid |
$43.71
|
| Rate for Payer: VA VA |
$61.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.96
|
|
