|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 51079008620
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$104.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.58
|
| Rate for Payer: BCBS Complete |
$74.38
|
| Rate for Payer: BCBS MAPPO |
$100.46
|
| Rate for Payer: BCBS Trust/PPO |
$330.36
|
| Rate for Payer: BCN Commercial |
$330.36
|
| Rate for Payer: BCN Medicare Advantage |
$100.46
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.46
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Mclaren Medicaid |
$70.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.49
|
| Rate for Payer: Meridian Medicaid |
$74.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PACE Senior Care Partners |
$95.44
|
| Rate for Payer: PACE SWMI |
$100.46
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: PHP Medicare Advantage |
$100.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$349.61
|
| Rate for Payer: Priority Health Medicare |
$101.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.69
|
| Rate for Payer: Railroad Medicare Medicare |
$100.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.63
|
| Rate for Payer: UHC Core |
$335.54
|
| Rate for Payer: UHC Exchange |
$100.46
|
| Rate for Payer: UHC Medicaid |
$70.85
|
| Rate for Payer: UHC Medicare Advantage |
$100.46
|
| Rate for Payer: UHCCP Medicaid |
$70.85
|
| Rate for Payer: VA VA |
$100.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$10.85
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna Commercial |
$9.22
|
| Rate for Payer: Aetna Medicare |
$2.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.39
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$8.92
|
| Rate for Payer: BCN Commercial |
$8.92
|
| Rate for Payer: BCN Medicare Advantage |
$2.71
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$9.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Mclaren Medicaid |
$1.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.85
|
| Rate for Payer: Meridian Medicaid |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.22
|
| Rate for Payer: Nomi Health Commercial |
$8.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: PACE Senior Care Partners |
$2.58
|
| Rate for Payer: PACE SWMI |
$2.71
|
| Rate for Payer: PHP Commercial |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.44
|
| Rate for Payer: Priority Health Medicare |
$2.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.55
|
| Rate for Payer: UHC Core |
$9.06
|
| Rate for Payer: UHC Exchange |
$2.71
|
| Rate for Payer: UHC Medicaid |
$1.91
|
| Rate for Payer: UHC Medicare Advantage |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$1.91
|
| Rate for Payer: VA VA |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$325.46
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$292.91 |
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna Medicare |
$84.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.71
|
| Rate for Payer: BCBS Complete |
$60.24
|
| Rate for Payer: BCBS MAPPO |
$81.36
|
| Rate for Payer: BCBS Trust/PPO |
$267.56
|
| Rate for Payer: BCN Commercial |
$267.56
|
| Rate for Payer: BCN Medicare Advantage |
$81.36
|
| Rate for Payer: Cash Price |
$260.37
|
| Rate for Payer: Cofinity Commercial |
$279.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.36
|
| Rate for Payer: Healthscope Commercial |
$292.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.09
|
| Rate for Payer: Mclaren Medicaid |
$57.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.43
|
| Rate for Payer: Meridian Medicaid |
$60.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.64
|
| Rate for Payer: Nomi Health Commercial |
$266.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.09
|
| Rate for Payer: PACE Senior Care Partners |
$77.30
|
| Rate for Payer: PACE SWMI |
$81.36
|
| Rate for Payer: PHP Commercial |
$276.64
|
| Rate for Payer: PHP Medicare Advantage |
$81.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.15
|
| Rate for Payer: Priority Health Medicare |
$82.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.52
|
| Rate for Payer: Railroad Medicare Medicare |
$81.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.40
|
| Rate for Payer: UHC Core |
$271.76
|
| Rate for Payer: UHC Exchange |
$81.36
|
| Rate for Payer: UHC Medicaid |
$57.38
|
| Rate for Payer: UHC Medicare Advantage |
$81.36
|
| Rate for Payer: UHCCP Medicaid |
$57.38
|
| Rate for Payer: VA VA |
$81.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.09
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$282.10
|
|
|
Service Code
|
NDC 57664051083
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.34 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$239.78
|
| Rate for Payer: BCBS Trust/PPO |
$232.99
|
| Rate for Payer: BCN Commercial |
$232.99
|
| Rate for Payer: Cash Price |
$225.68
|
| Rate for Payer: Cofinity Commercial |
$242.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.68
|
| Rate for Payer: Healthscope Commercial |
$253.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.78
|
| Rate for Payer: Nomi Health Commercial |
$231.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.57
|
| Rate for Payer: PHP Commercial |
$239.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.25
|
| Rate for Payer: UHC Core |
$235.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.57
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$282.10
|
|
|
Service Code
|
NDC 57664051083
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$239.78
|
| Rate for Payer: Aetna Medicare |
$73.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.16
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$70.53
|
| Rate for Payer: BCBS Trust/PPO |
$231.91
|
| Rate for Payer: BCN Commercial |
$231.91
|
| Rate for Payer: BCN Medicare Advantage |
$70.53
|
| Rate for Payer: Cash Price |
$225.68
|
| Rate for Payer: Cofinity Commercial |
$242.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$253.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.57
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.05
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.78
|
| Rate for Payer: Nomi Health Commercial |
$231.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.57
|
| Rate for Payer: PACE Senior Care Partners |
$67.00
|
| Rate for Payer: PACE SWMI |
$70.53
|
| Rate for Payer: PHP Commercial |
$239.78
|
| Rate for Payer: PHP Medicare Advantage |
$70.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.43
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.34
|
| Rate for Payer: Railroad Medicare Medicare |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.25
|
| Rate for Payer: UHC Core |
$235.55
|
| Rate for Payer: UHC Exchange |
$70.53
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHC Medicare Advantage |
$70.53
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$70.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.57
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$10.85
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna Commercial |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$9.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.68
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.22
|
| Rate for Payer: Nomi Health Commercial |
$8.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: PHP Commercial |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.55
|
| Rate for Payer: UHC Core |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$325.46
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.52 |
| Max. Negotiated Rate |
$292.91 |
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: BCBS Trust/PPO |
$268.80
|
| Rate for Payer: BCN Commercial |
$268.80
|
| Rate for Payer: Cash Price |
$260.37
|
| Rate for Payer: Cofinity Commercial |
$279.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.37
|
| Rate for Payer: Healthscope Commercial |
$292.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.64
|
| Rate for Payer: Nomi Health Commercial |
$266.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.09
|
| Rate for Payer: PHP Commercial |
$276.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.40
|
| Rate for Payer: UHC Core |
$271.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.09
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$46.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.35
|
| Rate for Payer: BCBS Complete |
$32.78
|
| Rate for Payer: BCBS MAPPO |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$145.61
|
| Rate for Payer: BCN Commercial |
$145.61
|
| Rate for Payer: BCN Medicare Advantage |
$44.28
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.28
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Mclaren Medicaid |
$31.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.49
|
| Rate for Payer: Meridian Medicaid |
$32.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.84
|
| Rate for Payer: PACE Senior Care Partners |
$42.07
|
| Rate for Payer: PACE SWMI |
$44.28
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: PHP Medicare Advantage |
$44.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.28
|
| Rate for Payer: Railroad Medicare Medicare |
$44.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.87
|
| Rate for Payer: UHC Core |
$147.90
|
| Rate for Payer: UHC Exchange |
$44.28
|
| Rate for Payer: UHC Medicaid |
$31.23
|
| Rate for Payer: UHC Medicare Advantage |
$44.28
|
| Rate for Payer: UHCCP Medicaid |
$31.23
|
| Rate for Payer: VA VA |
$44.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.28 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: BCBS Trust/PPO |
$146.28
|
| Rate for Payer: BCN Commercial |
$146.28
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.84
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.87
|
| Rate for Payer: UHC Core |
$147.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: BCBS Trust/PPO |
$146.52
|
| Rate for Payer: BCN Commercial |
$146.52
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Nomi Health Commercial |
$145.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.12
|
| Rate for Payer: UHC Core |
$148.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna Medicare |
$46.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.44
|
| Rate for Payer: BCBS Complete |
$32.84
|
| Rate for Payer: BCBS MAPPO |
$44.35
|
| Rate for Payer: BCBS Trust/PPO |
$145.85
|
| Rate for Payer: BCN Commercial |
$145.85
|
| Rate for Payer: BCN Medicare Advantage |
$44.35
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.35
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Mclaren Medicaid |
$31.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.57
|
| Rate for Payer: Meridian Medicaid |
$32.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Nomi Health Commercial |
$145.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PACE Senior Care Partners |
$42.13
|
| Rate for Payer: PACE SWMI |
$44.35
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: PHP Medicare Advantage |
$44.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.35
|
| Rate for Payer: Priority Health Medicare |
$44.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.48
|
| Rate for Payer: Railroad Medicare Medicare |
$44.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.12
|
| Rate for Payer: UHC Core |
$148.14
|
| Rate for Payer: UHC Exchange |
$44.35
|
| Rate for Payer: UHC Medicaid |
$31.28
|
| Rate for Payer: UHC Medicare Advantage |
$44.35
|
| Rate for Payer: UHCCP Medicaid |
$31.28
|
| Rate for Payer: VA VA |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$241.68
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.21 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$205.43
|
| Rate for Payer: BCBS Trust/PPO |
$199.60
|
| Rate for Payer: BCN Commercial |
$199.60
|
| Rate for Payer: Cash Price |
$193.34
|
| Rate for Payer: Cofinity Commercial |
$207.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.34
|
| Rate for Payer: Healthscope Commercial |
$217.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.43
|
| Rate for Payer: Nomi Health Commercial |
$198.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.26
|
| Rate for Payer: PHP Commercial |
$205.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.68
|
| Rate for Payer: UHC Core |
$201.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.26
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$241.68
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$205.43
|
| Rate for Payer: Aetna Medicare |
$62.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.53
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS MAPPO |
$60.42
|
| Rate for Payer: BCBS Trust/PPO |
$198.69
|
| Rate for Payer: BCN Commercial |
$198.69
|
| Rate for Payer: BCN Medicare Advantage |
$60.42
|
| Rate for Payer: Cash Price |
$193.34
|
| Rate for Payer: Cofinity Commercial |
$207.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$217.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.26
|
| Rate for Payer: Mclaren Medicaid |
$42.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.44
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.43
|
| Rate for Payer: Nomi Health Commercial |
$198.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.26
|
| Rate for Payer: PACE Senior Care Partners |
$57.40
|
| Rate for Payer: PACE SWMI |
$60.42
|
| Rate for Payer: PHP Commercial |
$205.43
|
| Rate for Payer: PHP Medicare Advantage |
$60.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.26
|
| Rate for Payer: Priority Health Medicare |
$61.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.21
|
| Rate for Payer: Railroad Medicare Medicare |
$60.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.68
|
| Rate for Payer: UHC Core |
$201.80
|
| Rate for Payer: UHC Exchange |
$60.42
|
| Rate for Payer: UHC Medicaid |
$42.61
|
| Rate for Payer: UHC Medicare Advantage |
$60.42
|
| Rate for Payer: UHCCP Medicaid |
$42.61
|
| Rate for Payer: VA VA |
$60.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.26
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$12,407.72
|
|
|
Service Code
|
APR-DRG 7933
|
| Min. Negotiated Rate |
$11,816.88 |
| Max. Negotiated Rate |
$12,407.72 |
| Rate for Payer: BCBS Complete |
$12,407.72
|
| Rate for Payer: Mclaren Medicaid |
$11,816.88
|
| Rate for Payer: Meridian Medicaid |
$12,407.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,816.88
|
| Rate for Payer: UHC Medicaid |
$11,816.88
|
| Rate for Payer: UHCCP Medicaid |
$11,816.88
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$6,503.59
|
|
|
Service Code
|
APR-DRG 7931
|
| Min. Negotiated Rate |
$6,193.89 |
| Max. Negotiated Rate |
$6,503.59 |
| Rate for Payer: BCBS Complete |
$6,503.59
|
| Rate for Payer: Mclaren Medicaid |
$6,193.89
|
| Rate for Payer: Meridian Medicaid |
$6,503.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,193.89
|
| Rate for Payer: UHC Medicaid |
$6,193.89
|
| Rate for Payer: UHCCP Medicaid |
$6,193.89
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$21,643.05
|
|
|
Service Code
|
APR-DRG 7934
|
| Min. Negotiated Rate |
$20,612.43 |
| Max. Negotiated Rate |
$21,643.05 |
| Rate for Payer: BCBS Complete |
$21,643.05
|
| Rate for Payer: Mclaren Medicaid |
$20,612.43
|
| Rate for Payer: Meridian Medicaid |
$21,643.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,612.43
|
| Rate for Payer: UHC Medicaid |
$20,612.43
|
| Rate for Payer: UHCCP Medicaid |
$20,612.43
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$8,573.30
|
|
|
Service Code
|
APR-DRG 7932
|
| Min. Negotiated Rate |
$8,165.04 |
| Max. Negotiated Rate |
$8,573.30 |
| Rate for Payer: BCBS Complete |
$8,573.30
|
| Rate for Payer: Mclaren Medicaid |
$8,165.04
|
| Rate for Payer: Meridian Medicaid |
$8,573.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,165.04
|
| Rate for Payer: UHC Medicaid |
$8,165.04
|
| Rate for Payer: UHCCP Medicaid |
$8,165.04
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$12,742.15
|
|
|
Service Code
|
APR-DRG 9513
|
| Min. Negotiated Rate |
$12,135.39 |
| Max. Negotiated Rate |
$12,742.15 |
| Rate for Payer: BCBS Complete |
$12,742.15
|
| Rate for Payer: Mclaren Medicaid |
$12,135.39
|
| Rate for Payer: Meridian Medicaid |
$12,742.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,135.39
|
| Rate for Payer: UHC Medicaid |
$12,135.39
|
| Rate for Payer: UHCCP Medicaid |
$12,135.39
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$6,965.80
|
|
|
Service Code
|
APR-DRG 9511
|
| Min. Negotiated Rate |
$6,634.10 |
| Max. Negotiated Rate |
$6,965.80 |
| Rate for Payer: BCBS Complete |
$6,965.80
|
| Rate for Payer: Mclaren Medicaid |
$6,634.10
|
| Rate for Payer: Meridian Medicaid |
$6,965.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,634.10
|
| Rate for Payer: UHC Medicaid |
$6,634.10
|
| Rate for Payer: UHCCP Medicaid |
$6,634.10
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$9,226.39
|
|
|
Service Code
|
APR-DRG 9512
|
| Min. Negotiated Rate |
$8,787.04 |
| Max. Negotiated Rate |
$9,226.39 |
| Rate for Payer: BCBS Complete |
$9,226.39
|
| Rate for Payer: Mclaren Medicaid |
$8,787.04
|
| Rate for Payer: Meridian Medicaid |
$9,226.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,787.04
|
| Rate for Payer: UHC Medicaid |
$8,787.04
|
| Rate for Payer: UHCCP Medicaid |
$8,787.04
|
|
|
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$20,785.93
|
|
|
Service Code
|
APR-DRG 9514
|
| Min. Negotiated Rate |
$19,796.12 |
| Max. Negotiated Rate |
$20,785.93 |
| Rate for Payer: BCBS Complete |
$20,785.93
|
| Rate for Payer: Mclaren Medicaid |
$19,796.12
|
| Rate for Payer: Meridian Medicaid |
$20,785.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,796.12
|
| Rate for Payer: UHC Medicaid |
$19,796.12
|
| Rate for Payer: UHCCP Medicaid |
$19,796.12
|
|
|
MOLASSES
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.02
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.62
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Mclaren Medicaid |
$1.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.70
|
| Rate for Payer: Meridian Medicaid |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PACE Senior Care Partners |
$1.54
|
| Rate for Payer: PACE SWMI |
$1.62
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UHC Medicaid |
$1.14
|
| Rate for Payer: UHC Medicare Advantage |
$1.62
|
| Rate for Payer: UHCCP Medicaid |
$1.14
|
| Rate for Payer: VA VA |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
MOLASSES
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.48
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PACE Senior Care Partners |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$19.99
|
| Rate for Payer: UHC Exchange |
$5.99
|
| Rate for Payer: UHC Medicaid |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
MOLASSES
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.35
|
| Rate for Payer: BCN Commercial |
$5.35
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
MOLASSES
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$19.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
