|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$132.81
|
|
|
Service Code
|
NDC 29300017116
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.54 |
| 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 |
$53.12
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.18
|
| Rate for Payer: BCN Commercial |
$103.26
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: Nomi Health Commercial |
$108.90
|
| 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 Cigna Priority Health |
$86.33
|
| Rate for Payer: Priority Health HMO/PPO |
$115.54
|
| Rate for Payer: Priority Health Medicare |
$33.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.98
|
| 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 Dual Complete DSNP |
$33.20
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$33.20
|
| Rate for Payer: VA VA |
$33.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: BCBS Trust/PPO |
$198.52
|
| Rate for Payer: BCN Commercial |
$187.94
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.69
|
| Rate for Payer: BCN Commercial |
$207.03
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: BCBS Trust/PPO |
$33.64
|
| Rate for Payer: BCN Commercial |
$31.85
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: Nomi Health Commercial |
$33.79
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.79
|
| Rate for Payer: Priority Health HMO/PPO |
$35.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.26
|
| Rate for Payer: UHC Core |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.88
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: BCBS MAPPO |
$10.30
|
| Rate for Payer: BCBS Trust/PPO |
$33.88
|
| Rate for Payer: BCN Commercial |
$32.04
|
| Rate for Payer: BCN Medicare Advantage |
$10.30
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: Nomi Health Commercial |
$33.79
|
| Rate for Payer: PACE Senior Care Partners |
$9.79
|
| Rate for Payer: PACE SWMI |
$10.30
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: PHP Medicare Advantage |
$10.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.79
|
| Rate for Payer: Priority Health HMO/PPO |
$35.85
|
| Rate for Payer: Priority Health Medicare |
$10.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.61
|
| Rate for Payer: Railroad Medicare Medicare |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.26
|
| Rate for Payer: UHC Core |
$34.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.30
|
| Rate for Payer: UHC Exchange |
$10.30
|
| Rate for Payer: UHC Medicare Advantage |
$10.30
|
| Rate for Payer: VA VA |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$20.14
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.48
|
| Rate for Payer: UHC Exchange |
$6.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.48
|
| Rate for Payer: VA VA |
$6.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.14
|
| Rate for Payer: BCN Commercial |
$20.02
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
MEROPENEM 1 GRAM/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.77
|
|
|
Service Code
|
HCPCS J2184
|
| Hospital Charge Code |
175972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna Commercial |
$68.65
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.24
|
| Rate for Payer: BCBS Complete |
$32.31
|
| Rate for Payer: BCBS MAPPO |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$66.40
|
| Rate for Payer: BCN Commercial |
$62.80
|
| Rate for Payer: BCN Medicare Advantage |
$20.19
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cofinity Commercial |
$69.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.19
|
| Rate for Payer: Healthscope Commercial |
$72.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.65
|
| Rate for Payer: Nomi Health Commercial |
$66.23
|
| Rate for Payer: PACE Senior Care Partners |
$19.18
|
| Rate for Payer: PACE SWMI |
$20.19
|
| Rate for Payer: PHP Commercial |
$68.65
|
| Rate for Payer: PHP Medicare Advantage |
$20.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO |
$70.27
|
| Rate for Payer: Priority Health Medicare |
$20.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.12
|
| Rate for Payer: Railroad Medicare Medicare |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.08
|
| Rate for Payer: UHC Core |
$67.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.19
|
| Rate for Payer: UHC Exchange |
$20.19
|
| Rate for Payer: UHC Medicare Advantage |
$20.19
|
| Rate for Payer: VA VA |
$20.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.58
|
|
|
MEROPENEM 1 GRAM/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.77
|
|
|
Service Code
|
HCPCS J2184
|
| Hospital Charge Code |
175972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna Commercial |
$68.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.93
|
| Rate for Payer: BCN Commercial |
$62.42
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cofinity Commercial |
$69.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.62
|
| Rate for Payer: Healthscope Commercial |
$72.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.65
|
| Rate for Payer: Nomi Health Commercial |
$66.23
|
| Rate for Payer: PHP Commercial |
$68.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO |
$70.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.08
|
| Rate for Payer: UHC Core |
$67.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.58
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.97
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$18.52
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$19.66
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health HMO/PPO |
$20.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.01
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$9.59
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.37
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE Senior Care Partners |
$5.69
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health HMO/PPO |
$20.85
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Medicare |
$6.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Core |
$20.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Exchange |
$5.99
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: VA VA |
$5.99
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$47.03
|
|
|
Service Code
|
NDC 60687040895
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$42.33 |
| Rate for Payer: Aetna Commercial |
$39.98
|
| Rate for Payer: Aetna Medicare |
$12.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.70
|
| Rate for Payer: BCBS Complete |
$18.81
|
| Rate for Payer: BCBS MAPPO |
$11.76
|
| Rate for Payer: BCBS Trust/PPO |
$38.66
|
| Rate for Payer: BCN Commercial |
$36.57
|
| Rate for Payer: BCN Medicare Advantage |
$11.76
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$40.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.76
|
| Rate for Payer: Healthscope Commercial |
$42.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.98
|
| Rate for Payer: Nomi Health Commercial |
$38.56
|
| Rate for Payer: PACE Senior Care Partners |
$11.17
|
| Rate for Payer: PACE SWMI |
$11.76
|
| Rate for Payer: PHP Commercial |
$39.98
|
| Rate for Payer: PHP Medicare Advantage |
$11.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.57
|
| Rate for Payer: Priority Health HMO/PPO |
$40.92
|
| Rate for Payer: Priority Health Medicare |
$11.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.51
|
| Rate for Payer: Railroad Medicare Medicare |
$11.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.39
|
| Rate for Payer: UHC Core |
$39.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.76
|
| Rate for Payer: UHC Exchange |
$11.76
|
| Rate for Payer: UHC Medicare Advantage |
$11.76
|
| Rate for Payer: VA VA |
$11.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.27
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,410.81
|
|
|
Service Code
|
NDC 60687040825
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$917.03 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.64
|
| Rate for Payer: BCN Commercial |
$1,090.27
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.19
|
| Rate for Payer: Nomi Health Commercial |
$1,156.86
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,227.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$945.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.51
|
| Rate for Payer: UHC Core |
$1,178.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,410.81
|
|
|
Service Code
|
NDC 60687040825
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.07 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: Aetna Medicare |
$366.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.88
|
| Rate for Payer: BCBS Complete |
$564.32
|
| Rate for Payer: BCBS MAPPO |
$352.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.83
|
| Rate for Payer: BCN Commercial |
$1,096.90
|
| Rate for Payer: BCN Medicare Advantage |
$352.70
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.70
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.19
|
| Rate for Payer: Nomi Health Commercial |
$1,156.86
|
| Rate for Payer: PACE Senior Care Partners |
$335.07
|
| Rate for Payer: PACE SWMI |
$352.70
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: PHP Medicare Advantage |
$352.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,227.40
|
| Rate for Payer: Priority Health Medicare |
$356.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$945.24
|
| Rate for Payer: Railroad Medicare Medicare |
$352.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.51
|
| Rate for Payer: UHC Core |
$1,178.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.70
|
| Rate for Payer: UHC Exchange |
$352.70
|
| Rate for Payer: UHC Medicare Advantage |
$352.70
|
| Rate for Payer: VA VA |
$352.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$47.03
|
|
|
Service Code
|
NDC 60687040895
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$42.33 |
| Rate for Payer: Aetna Commercial |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$36.34
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$40.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$42.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.98
|
| Rate for Payer: Nomi Health Commercial |
$38.56
|
| Rate for Payer: PHP Commercial |
$39.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.57
|
| Rate for Payer: Priority Health HMO/PPO |
$40.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.39
|
| Rate for Payer: UHC Core |
$39.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.27
|
|
|
METATARSECTOMY
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$64.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.11
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: BCBS MAPPO |
$61.69
|
| Rate for Payer: BCBS Trust/PPO |
$202.85
|
| Rate for Payer: BCN Commercial |
$191.85
|
| Rate for Payer: BCN Medicare Advantage |
$61.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.69
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: PACE Senior Care Partners |
$58.60
|
| Rate for Payer: PACE SWMI |
$61.69
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: PHP Medicare Advantage |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health HMO/PPO |
$214.67
|
| Rate for Payer: Priority Health Medicare |
$62.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.32
|
| Rate for Payer: Railroad Medicare Medicare |
$61.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.14
|
| Rate for Payer: UHC Core |
$206.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.69
|
| Rate for Payer: UHC Exchange |
$61.69
|
| Rate for Payer: UHC Medicare Advantage |
$61.69
|
| Rate for Payer: VA VA |
$61.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 70010006301
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.22
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: BCBS MAPPO |
$10.58
|
| Rate for Payer: BCBS Trust/PPO |
$34.77
|
| Rate for Payer: BCN Commercial |
$32.89
|
| Rate for Payer: BCN Medicare Advantage |
$10.58
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.96
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: PACE Senior Care Partners |
$10.05
|
| Rate for Payer: PACE SWMI |
$10.58
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: Priority Health HMO/PPO |
$36.80
|
| Rate for Payer: Priority Health Medicare |
$10.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.58
|
| Rate for Payer: UHC Exchange |
$10.58
|
| Rate for Payer: UHC Medicare Advantage |
$10.58
|
| Rate for Payer: VA VA |
$10.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.18
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.66
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
