|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.53 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$73.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.86
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS MAPPO |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$233.76
|
| Rate for Payer: BCN Commercial |
$221.08
|
| Rate for Payer: BCN Medicare Advantage |
$71.09
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.09
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: PACE Senior Care Partners |
$67.53
|
| Rate for Payer: PACE SWMI |
$71.09
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Medicare |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| Rate for Payer: Railroad Medicare Medicare |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.09
|
| Rate for Payer: UHC Exchange |
$71.09
|
| Rate for Payer: UHC Medicare Advantage |
$71.09
|
| Rate for Payer: VA VA |
$71.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.90
|
| Rate for Payer: BCBS Complete |
$15.23
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$31.30
|
| Rate for Payer: BCN Commercial |
$29.60
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: Nomi Health Commercial |
$31.22
|
| Rate for Payer: PACE Senior Care Partners |
$9.04
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$33.12
|
| Rate for Payer: Priority Health Medicare |
$9.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.50
|
| Rate for Payer: UHC Core |
$31.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Exchange |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.52
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$282.10
|
|
|
Service Code
|
NDC 57664051083
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.00 |
| 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 |
$112.84
|
| Rate for Payer: BCBS MAPPO |
$70.52
|
| Rate for Payer: BCBS Trust/PPO |
$231.91
|
| Rate for Payer: BCN Commercial |
$219.33
|
| Rate for Payer: BCN Medicare Advantage |
$70.52
|
| 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 |
$70.52
|
| Rate for Payer: Healthscope Commercial |
$253.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.78
|
| Rate for Payer: Nomi Health Commercial |
$231.32
|
| Rate for Payer: PACE Senior Care Partners |
$67.00
|
| Rate for Payer: PACE SWMI |
$70.52
|
| Rate for Payer: PHP Commercial |
$239.78
|
| Rate for Payer: PHP Medicare Advantage |
$70.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.36
|
| Rate for Payer: Priority Health HMO/PPO |
$245.43
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.01
|
| Rate for Payer: Railroad Medicare Medicare |
$70.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.25
|
| Rate for Payer: UHC Core |
$235.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.52
|
| Rate for Payer: UHC Exchange |
$70.52
|
| Rate for Payer: UHC Medicare Advantage |
$70.52
|
| Rate for Payer: VA VA |
$70.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.58
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$8.47
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.62 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.65
|
| Rate for Payer: BCBS Complete |
$3.39
|
| Rate for Payer: BCBS MAPPO |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$6.96
|
| Rate for Payer: BCN Commercial |
$6.59
|
| Rate for Payer: BCN Medicare Advantage |
$2.12
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.20
|
| Rate for Payer: Nomi Health Commercial |
$6.95
|
| Rate for Payer: PACE Senior Care Partners |
$2.01
|
| Rate for Payer: PACE SWMI |
$2.12
|
| Rate for Payer: PHP Commercial |
$7.20
|
| Rate for Payer: PHP Medicare Advantage |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.51
|
| Rate for Payer: Priority Health HMO/PPO |
$7.37
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.67
|
| Rate for Payer: Railroad Medicare Medicare |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.45
|
| Rate for Payer: UHC Core |
$7.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.12
|
| Rate for Payer: UHC Exchange |
$2.12
|
| Rate for Payer: UHC Medicare Advantage |
$2.12
|
| Rate for Payer: VA VA |
$2.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.35
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: BCBS Trust/PPO |
$207.23
|
| Rate for Payer: BCN Commercial |
$196.18
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.33
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$63.46
|
| Rate for Payer: BCBS Trust/PPO |
$208.70
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: BCN Medicare Advantage |
$63.46
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.46
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: PACE Senior Care Partners |
$60.29
|
| Rate for Payer: PACE SWMI |
$63.46
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: PHP Medicare Advantage |
$63.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Medicare |
$64.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.09
|
| Rate for Payer: Railroad Medicare Medicare |
$63.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.46
|
| Rate for Payer: UHC Exchange |
$63.46
|
| Rate for Payer: UHC Medicare Advantage |
$63.46
|
| Rate for Payer: VA VA |
$63.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$282.10
|
|
|
Service Code
|
NDC 57664051083
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$253.89 |
| Rate for Payer: Aetna Commercial |
$239.78
|
| Rate for Payer: BCBS Trust/PPO |
$230.28
|
| Rate for Payer: BCN Commercial |
$218.01
|
| 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 |
$211.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.78
|
| Rate for Payer: Nomi Health Commercial |
$231.32
|
| Rate for Payer: PHP Commercial |
$239.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.36
|
| Rate for Payer: Priority Health HMO/PPO |
$245.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.01
|
| 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 |
$211.58
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$8.47
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$7.62 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.91
|
| Rate for Payer: BCN Commercial |
$6.55
|
| Rate for Payer: Cash Price |
$6.78
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.78
|
| Rate for Payer: Healthscope Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.20
|
| Rate for Payer: Nomi Health Commercial |
$6.95
|
| Rate for Payer: PHP Commercial |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.51
|
| Rate for Payer: Priority Health HMO/PPO |
$7.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.45
|
| Rate for Payer: UHC Core |
$7.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.35
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$200.07
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$180.06 |
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: BCBS Trust/PPO |
$163.32
|
| Rate for Payer: BCN Commercial |
$154.61
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$172.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.06
|
| Rate for Payer: Healthscope Commercial |
$180.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.06
|
| Rate for Payer: Nomi Health Commercial |
$164.06
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.05
|
| Rate for Payer: Priority Health HMO/PPO |
$174.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.06
|
| Rate for Payer: UHC Core |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.05
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.13 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: BCBS Trust/PPO |
$144.58
|
| Rate for Payer: BCN Commercial |
$136.88
|
| 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: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.67
|
| 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
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.07 |
| 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 |
$70.85
|
| Rate for Payer: BCBS MAPPO |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$145.61
|
| Rate for Payer: BCN Commercial |
$137.71
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| 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 Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.67
|
| 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 Dual Complete DSNP |
$44.28
|
| Rate for Payer: UHC Exchange |
$44.28
|
| Rate for Payer: UHC Medicare Advantage |
$44.28
|
| Rate for Payer: VA VA |
$44.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$200.07
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$180.06 |
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: Aetna Medicare |
$52.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.52
|
| Rate for Payer: BCBS Complete |
$80.03
|
| Rate for Payer: BCBS MAPPO |
$50.02
|
| Rate for Payer: BCBS Trust/PPO |
$164.48
|
| Rate for Payer: BCN Commercial |
$155.55
|
| Rate for Payer: BCN Medicare Advantage |
$50.02
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$172.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.02
|
| Rate for Payer: Healthscope Commercial |
$180.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.06
|
| Rate for Payer: Nomi Health Commercial |
$164.06
|
| Rate for Payer: PACE Senior Care Partners |
$47.52
|
| Rate for Payer: PACE SWMI |
$50.02
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicare Advantage |
$50.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.05
|
| Rate for Payer: Priority Health HMO/PPO |
$174.06
|
| Rate for Payer: Priority Health Medicare |
$50.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.05
|
| Rate for Payer: Railroad Medicare Medicare |
$50.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.06
|
| Rate for Payer: UHC Core |
$167.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.02
|
| Rate for Payer: UHC Exchange |
$50.02
|
| Rate for Payer: UHC Medicare Advantage |
$50.02
|
| Rate for Payer: VA VA |
$50.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.05
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.13 |
| 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 |
$70.96
|
| Rate for Payer: BCBS MAPPO |
$44.35
|
| Rate for Payer: BCBS Trust/PPO |
$145.85
|
| Rate for Payer: BCN Commercial |
$137.94
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Nomi Health Commercial |
$145.48
|
| 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 Cigna Priority Health |
$115.32
|
| Rate for Payer: Priority Health HMO/PPO |
$154.35
|
| Rate for Payer: Priority Health Medicare |
$44.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.86
|
| 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 Dual Complete DSNP |
$44.35
|
| Rate for Payer: UHC Exchange |
$44.35
|
| Rate for Payer: UHC Medicare Advantage |
$44.35
|
| Rate for Payer: VA VA |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: BCBS Trust/PPO |
$144.82
|
| Rate for Payer: BCN Commercial |
$137.10
|
| 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: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.32
|
| Rate for Payer: Priority Health HMO/PPO |
$154.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.86
|
| 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
|
|
|
MOLASSES
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| 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 |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| 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 |
$5.98
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE Senior Care Partners |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$19.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
| Rate for Payer: VA VA |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.96
|
|
|
MOLASSES
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.01
|
| 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: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| 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 |
$15.56 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCN Commercial |
$18.50
|
| 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 |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.04
|
| 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 |
$17.96
|
|
|
MOLASSES
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| 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 |
$2.59
|
| Rate for Payer: BCBS MAPPO |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Nomi Health Commercial |
$5.31
|
| 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 Cigna Priority Health |
$4.21
|
| Rate for Payer: Priority Health HMO/PPO |
$5.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.34
|
| 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 Dual Complete DSNP |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UHC Medicare Advantage |
$1.62
|
| Rate for Payer: VA VA |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
MONALISA TOUCH, SERIES, UP TO 3 VISITS
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00561
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00562
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$393.39
|
|
|
Service Code
|
NDC 13668008190
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.70 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: Aetna Commercial |
$334.38
|
| Rate for Payer: BCBS Trust/PPO |
$321.12
|
| Rate for Payer: BCN Commercial |
$304.01
|
| Rate for Payer: Cash Price |
$314.71
|
| Rate for Payer: Cofinity Commercial |
$338.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.71
|
| Rate for Payer: Healthscope Commercial |
$354.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.38
|
| Rate for Payer: Nomi Health Commercial |
$322.58
|
| Rate for Payer: PHP Commercial |
$334.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.70
|
| Rate for Payer: Priority Health HMO/PPO |
$342.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.18
|
| Rate for Payer: UHC Core |
$328.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.04
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Medicare |
$62.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.11
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: BCBS MAPPO |
$60.09
|
| Rate for Payer: BCBS Trust/PPO |
$197.59
|
| Rate for Payer: BCN Commercial |
$186.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.09
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.09
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: PACE Senior Care Partners |
$57.08
|
| Rate for Payer: PACE SWMI |
$60.09
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: PHP Medicare Advantage |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Medicare |
$60.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.03
|
| Rate for Payer: Railroad Medicare Medicare |
$60.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.09
|
| Rate for Payer: UHC Exchange |
$60.09
|
| Rate for Payer: UHC Medicare Advantage |
$60.09
|
| Rate for Payer: VA VA |
$60.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$393.39
|
|
|
Service Code
|
NDC 13668008190
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: Aetna Commercial |
$334.38
|
| Rate for Payer: Aetna Medicare |
$102.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.93
|
| Rate for Payer: BCBS Complete |
$157.36
|
| Rate for Payer: BCBS MAPPO |
$98.35
|
| Rate for Payer: BCBS Trust/PPO |
$323.41
|
| Rate for Payer: BCN Commercial |
$305.86
|
| Rate for Payer: BCN Medicare Advantage |
$98.35
|
| Rate for Payer: Cash Price |
$314.71
|
| Rate for Payer: Cofinity Commercial |
$338.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.35
|
| Rate for Payer: Healthscope Commercial |
$354.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.38
|
| Rate for Payer: Nomi Health Commercial |
$322.58
|
| Rate for Payer: PACE Senior Care Partners |
$93.43
|
| Rate for Payer: PACE SWMI |
$98.35
|
| Rate for Payer: PHP Commercial |
$334.38
|
| Rate for Payer: PHP Medicare Advantage |
$98.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.70
|
| Rate for Payer: Priority Health HMO/PPO |
$342.25
|
| Rate for Payer: Priority Health Medicare |
$99.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.57
|
| Rate for Payer: Railroad Medicare Medicare |
$98.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.18
|
| Rate for Payer: UHC Core |
$328.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.35
|
| Rate for Payer: UHC Exchange |
$98.35
|
| Rate for Payer: UHC Medicare Advantage |
$98.35
|
| Rate for Payer: VA VA |
$98.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.04
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: BCBS Trust/PPO |
$196.20
|
| Rate for Payer: BCN Commercial |
$185.74
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO |
$209.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.31
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$66.59
|
| Rate for Payer: BCN Commercial |
$62.98
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.27
|
| Rate for Payer: Railroad Medicare Medicare |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.25
|
| Rate for Payer: UHC Exchange |
$20.25
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: VA VA |
$20.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
