|
MELOXICAM 15 MG TABLET
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 60687019911
|
| Hospital Charge Code |
20580
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Nomi Health Commercial |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.28
|
| Rate for Payer: Priority Health HMO/PPO |
$3.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.63
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$123.38
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: Aetna Medicare |
$32.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.56
|
| Rate for Payer: BCBS Complete |
$49.35
|
| Rate for Payer: BCBS MAPPO |
$30.84
|
| Rate for Payer: BCBS Trust/PPO |
$101.43
|
| Rate for Payer: BCN Commercial |
$95.93
|
| Rate for Payer: BCN Medicare Advantage |
$30.84
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.84
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$101.17
|
| Rate for Payer: PACE Senior Care Partners |
$29.30
|
| Rate for Payer: PACE SWMI |
$30.84
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.20
|
| Rate for Payer: Priority Health HMO/PPO |
$107.34
|
| Rate for Payer: Priority Health Medicare |
$31.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.66
|
| Rate for Payer: Railroad Medicare Medicare |
$30.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.57
|
| Rate for Payer: UHC Core |
$103.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.84
|
| Rate for Payer: UHC Exchange |
$30.84
|
| Rate for Payer: UHC Medicare Advantage |
$30.84
|
| Rate for Payer: VA VA |
$30.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.53
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.72 |
| 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 |
$19.74
|
| Rate for Payer: BCBS MAPPO |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCN Commercial |
$38.37
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Nomi Health Commercial |
$40.47
|
| 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 Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health HMO/PPO |
$42.93
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.06
|
| 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 Dual Complete DSNP |
$12.34
|
| Rate for Payer: UHC Exchange |
$12.34
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
20566
|
|
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
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$100.72
|
| Rate for Payer: BCN Commercial |
$95.35
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$101.17
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.20
|
| Rate for Payer: Priority Health HMO/PPO |
$107.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.57
|
| Rate for Payer: UHC Core |
$103.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.53
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 50268052511
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.62
|
| 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: Health Alliance Plan Medicare Advantage |
$0.62
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.62
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: Railroad Medicare Medicare |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.62
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: BCBS Trust/PPO |
$40.28
|
| Rate for Payer: BCN Commercial |
$38.14
|
| 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: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health HMO/PPO |
$42.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.06
|
| 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
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: BCBS Trust/PPO |
$219.46
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$295.45
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.04 |
| Max. Negotiated Rate |
$265.90 |
| Rate for Payer: Aetna Commercial |
$251.13
|
| Rate for Payer: BCBS Trust/PPO |
$241.18
|
| Rate for Payer: BCN Commercial |
$228.32
|
| Rate for Payer: Cash Price |
$236.36
|
| Rate for Payer: Cofinity Commercial |
$254.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.36
|
| Rate for Payer: Healthscope Commercial |
$265.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.13
|
| Rate for Payer: Nomi Health Commercial |
$242.27
|
| Rate for Payer: PHP Commercial |
$251.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.04
|
| Rate for Payer: Priority Health HMO/PPO |
$257.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.00
|
| Rate for Payer: UHC Core |
$246.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$295.45
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$265.90 |
| Rate for Payer: Aetna Commercial |
$251.13
|
| Rate for Payer: Aetna Medicare |
$76.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.33
|
| Rate for Payer: BCBS Complete |
$118.18
|
| Rate for Payer: BCBS MAPPO |
$73.86
|
| Rate for Payer: BCBS Trust/PPO |
$242.89
|
| Rate for Payer: BCN Commercial |
$229.71
|
| Rate for Payer: BCN Medicare Advantage |
$73.86
|
| Rate for Payer: Cash Price |
$236.36
|
| Rate for Payer: Cofinity Commercial |
$254.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.86
|
| Rate for Payer: Healthscope Commercial |
$265.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.13
|
| Rate for Payer: Nomi Health Commercial |
$242.27
|
| Rate for Payer: PACE Senior Care Partners |
$70.17
|
| Rate for Payer: PACE SWMI |
$73.86
|
| Rate for Payer: PHP Commercial |
$251.13
|
| Rate for Payer: PHP Medicare Advantage |
$73.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.04
|
| Rate for Payer: Priority Health HMO/PPO |
$257.04
|
| Rate for Payer: Priority Health Medicare |
$74.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.95
|
| Rate for Payer: Railroad Medicare Medicare |
$73.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.00
|
| Rate for Payer: UHC Core |
$246.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.86
|
| Rate for Payer: UHC Exchange |
$73.86
|
| Rate for Payer: UHC Medicare Advantage |
$73.86
|
| Rate for Payer: VA VA |
$73.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: PACE Senior Care Partners |
$0.70
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.74
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.22
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$69.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.02
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS MAPPO |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$221.02
|
| Rate for Payer: BCN Commercial |
$209.03
|
| Rate for Payer: BCN Medicare Advantage |
$67.21
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PACE Senior Care Partners |
$63.85
|
| Rate for Payer: PACE SWMI |
$67.21
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: PHP Medicare Advantage |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Medicare |
$67.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: Railroad Medicare Medicare |
$67.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.21
|
| Rate for Payer: UHC Exchange |
$67.21
|
| Rate for Payer: UHC Medicare Advantage |
$67.21
|
| Rate for Payer: VA VA |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.22
|
|
|
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
|
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
|
$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
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.72
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS MAPPO |
$66.97
|
| Rate for Payer: BCBS Trust/PPO |
$220.24
|
| Rate for Payer: BCN Commercial |
$208.29
|
| Rate for Payer: BCN Medicare Advantage |
$66.97
|
| 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: Health Alliance Plan Medicare Advantage |
$66.97
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PACE Senior Care Partners |
$63.63
|
| Rate for Payer: PACE SWMI |
$66.97
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Medicare |
$67.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: Railroad Medicare Medicare |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.97
|
| Rate for Payer: UHC Exchange |
$66.97
|
| Rate for Payer: UHC Medicare Advantage |
$66.97
|
| Rate for Payer: VA VA |
$66.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
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
|
$132.81
|
|
|
Service Code
|
NDC 29300017116
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: BCBS Trust/PPO |
$108.41
|
| Rate for Payer: BCN Commercial |
$102.64
|
| 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: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.33
|
| Rate for Payer: Priority Health HMO/PPO |
$115.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.98
|
| 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
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.13 |
| 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 |
$200.93
|
| 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 |
$174.13
|
| 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 |
$200.93
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.76 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna Medicare |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.00
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: BCBS MAPPO |
$60.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.93
|
| Rate for Payer: BCN Commercial |
$189.09
|
| Rate for Payer: BCN Medicare Advantage |
$60.80
|
| 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: Health Alliance Plan Medicare Advantage |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: PACE Senior Care Partners |
$57.76
|
| Rate for Payer: PACE SWMI |
$60.80
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: PHP Medicare Advantage |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO |
$211.58
|
| Rate for Payer: Priority Health Medicare |
$61.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.02
|
| Rate for Payer: UHC Core |
$203.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.80
|
| Rate for Payer: UHC Exchange |
$60.80
|
| Rate for Payer: UHC Medicare Advantage |
$60.80
|
| Rate for Payer: VA VA |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
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
|
|
|
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
|
|
|
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 |
$19.43
|
| 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 |
$19.43
|
|
|
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 |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$20.14
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| 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 |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| 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 |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| 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 |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
