|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 51079-511-20
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.03
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$108.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 68084-491-01
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.81
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084-491-11
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 39402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,521.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.26
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$389.33
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$30,669.94
|
|
|
Service Code
|
MS-DRG 551
|
| Min. Negotiated Rate |
$12,945.88 |
| Max. Negotiated Rate |
$30,669.94 |
| Rate for Payer: Aetna Medicare |
$14,172.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,034.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,034.05
|
| Rate for Payer: BCBS MAPPO |
$13,627.24
|
| Rate for Payer: BCBS Trust/PPO |
$30,669.94
|
| Rate for Payer: BCN Medicare Advantage |
$13,627.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,627.24
|
| Rate for Payer: Mclaren Medicare |
$13,627.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,308.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,671.33
|
| Rate for Payer: PACE Medicare |
$12,945.88
|
| Rate for Payer: PACE SWMI |
$13,627.24
|
| Rate for Payer: PHP Medicare Advantage |
$13,627.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,422.13
|
| Rate for Payer: Priority Health Medicare |
$13,627.24
|
| Rate for Payer: Priority Health Narrow Network |
$19,537.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13,627.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,960.78
|
| Rate for Payer: UHC Core |
$21,287.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,627.24
|
| Rate for Payer: UHC Exchange |
$16,923.69
|
| Rate for Payer: UHC Medicare Advantage |
$14,036.06
|
| Rate for Payer: VA VA |
$13,627.24
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$17,633.02
|
|
|
Service Code
|
MS-DRG 552
|
| Min. Negotiated Rate |
$7,560.76 |
| Max. Negotiated Rate |
$17,633.02 |
| Rate for Payer: Aetna Medicare |
$8,277.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,948.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,948.36
|
| Rate for Payer: BCBS MAPPO |
$7,958.69
|
| Rate for Payer: BCBS Trust/PPO |
$17,633.02
|
| Rate for Payer: BCN Medicare Advantage |
$7,958.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,958.69
|
| Rate for Payer: Mclaren Medicare |
$7,958.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,356.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,152.49
|
| Rate for Payer: PACE Medicare |
$7,560.76
|
| Rate for Payer: PACE SWMI |
$7,958.69
|
| Rate for Payer: PHP Medicare Advantage |
$7,958.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,866.33
|
| Rate for Payer: Priority Health Medicare |
$7,958.69
|
| Rate for Payer: Priority Health Narrow Network |
$11,093.06
|
| Rate for Payer: Railroad Medicare Medicare |
$7,958.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,739.94
|
| Rate for Payer: UHC Core |
$12,086.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,958.69
|
| Rate for Payer: UHC Exchange |
$9,608.89
|
| Rate for Payer: UHC Medicare Advantage |
$8,197.45
|
| Rate for Payer: VA VA |
$7,958.69
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna American Axle |
$841.75
|
| Rate for Payer: Aetna Commercial |
$1,100.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Cofinity Commercial |
$906.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Healthscope Commercial |
$1,165.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$906.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$971.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,100.75
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.50
|
| Rate for Payer: Priority Health SBD |
$815.85
|
| Rate for Payer: UMR Bronson Commercial |
$569.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.25
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
IP
|
$733.63
|
|
|
Service Code
|
NDC 4167936503
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.54
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$322.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
IP
|
$733.63
|
|
|
Service Code
|
NDC 4167936513
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.54
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$322.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 59762-3742-2
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 0555-0779-02
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.82
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$191.53
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
112224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna American Axle |
$117.92
|
| Rate for Payer: Aetna American Axle |
$154.51
|
| Rate for Payer: Aetna American Axle |
$155.39
|
| Rate for Payer: Aetna Commercial |
$203.20
|
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna Commercial |
$154.20
|
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.92
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cash Price |
$145.13
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$167.34
|
| Rate for Payer: Cofinity Commercial |
$126.99
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Commercial |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$156.01
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.13
|
| Rate for Payer: Healthscope Commercial |
$163.27
|
| Rate for Payer: Healthscope Commercial |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.20
|
| Rate for Payer: PHP Commercial |
$203.20
|
| Rate for Payer: PHP Commercial |
$154.20
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.99
|
| Rate for Payer: Priority Health SBD |
$114.29
|
| Rate for Payer: Priority Health SBD |
$149.76
|
| Rate for Payer: Priority Health SBD |
$150.61
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$79.82
|
| Rate for Payer: UMR Bronson Commercial |
$84.27
|
| Rate for Payer: UMR Bronson Commercial |
$104.59
|
| Rate for Payer: UMR Bronson Commercial |
$105.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.30
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 0555-0872-02
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$783.96
|
|
|
Service Code
|
NDC 49884-907-38
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.94 |
| Max. Negotiated Rate |
$705.56 |
| Rate for Payer: Aetna American Axle |
$509.57
|
| Rate for Payer: Aetna Commercial |
$666.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.57
|
| Rate for Payer: Cash Price |
$627.17
|
| Rate for Payer: Cofinity Commercial |
$548.77
|
| Rate for Payer: Cofinity Commercial |
$674.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.17
|
| Rate for Payer: Healthscope Commercial |
$705.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$548.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$587.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$666.37
|
| Rate for Payer: PHP Commercial |
$666.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.77
|
| Rate for Payer: Priority Health SBD |
$493.89
|
| Rate for Payer: UMR Bronson Commercial |
$344.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$587.97
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$659.88
|
|
|
Service Code
|
NDC 60432-126-08
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.35 |
| Max. Negotiated Rate |
$593.89 |
| Rate for Payer: Aetna American Axle |
$428.92
|
| Rate for Payer: Aetna Commercial |
$560.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.92
|
| Rate for Payer: Cash Price |
$527.90
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Cofinity Commercial |
$567.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.90
|
| Rate for Payer: Healthscope Commercial |
$593.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$560.90
|
| Rate for Payer: PHP Commercial |
$560.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.92
|
| Rate for Payer: Priority Health SBD |
$415.72
|
| Rate for Payer: UMR Bronson Commercial |
$290.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.91
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$360.96
|
|
|
Service Code
|
NDC 0054-3542-50
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.82 |
| Max. Negotiated Rate |
$324.86 |
| Rate for Payer: Aetna American Axle |
$234.62
|
| Rate for Payer: Aetna Commercial |
$306.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.62
|
| Rate for Payer: Cash Price |
$288.77
|
| Rate for Payer: Cofinity Commercial |
$252.67
|
| Rate for Payer: Cofinity Commercial |
$310.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.77
|
| Rate for Payer: Healthscope Commercial |
$324.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.82
|
| Rate for Payer: PHP Commercial |
$306.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.67
|
| Rate for Payer: Priority Health SBD |
$227.40
|
| Rate for Payer: UMR Bronson Commercial |
$158.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.72
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$693.72
|
|
|
Service Code
|
NDC 64380-160-01
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.24 |
| Max. Negotiated Rate |
$624.35 |
| Rate for Payer: Aetna American Axle |
$450.92
|
| Rate for Payer: Aetna Commercial |
$589.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.92
|
| Rate for Payer: Cash Price |
$554.98
|
| Rate for Payer: Cofinity Commercial |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$596.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.98
|
| Rate for Payer: Healthscope Commercial |
$624.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$589.66
|
| Rate for Payer: PHP Commercial |
$589.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.60
|
| Rate for Payer: Priority Health SBD |
$437.04
|
| Rate for Payer: UMR Bronson Commercial |
$305.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.29
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$283.10
|
|
|
Service Code
|
NDC 64380-159-01
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.56 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna American Axle |
$184.02
|
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.02
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Commercial |
$198.17
|
| Rate for Payer: Cofinity Commercial |
$243.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$254.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.64
|
| Rate for Payer: PHP Commercial |
$240.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.17
|
| Rate for Payer: Priority Health SBD |
$178.35
|
| Rate for Payer: UMR Bronson Commercial |
$124.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.32
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 0904-7236-61
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$297.74
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UMR Bronson Commercial |
$187.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 63739-165-10
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$413.60
|
|
|
Service Code
|
NDC 0555-0607-02
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.98 |
| Max. Negotiated Rate |
$372.24 |
| Rate for Payer: Aetna American Axle |
$268.84
|
| Rate for Payer: Aetna Commercial |
$351.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.84
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$355.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.88
|
| Rate for Payer: Healthscope Commercial |
$372.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.56
|
| Rate for Payer: PHP Commercial |
$351.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.52
|
| Rate for Payer: Priority Health SBD |
$260.57
|
| Rate for Payer: UMR Bronson Commercial |
$181.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.20
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 0904-3571-61
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.19 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna American Axle |
$278.00
|
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$269.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$92.88
|
|
|
Service Code
|
NDC 5843800571
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna American Axle |
$60.37
|
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.37
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$79.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.30
|
| Rate for Payer: Healthscope Commercial |
$83.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.95
|
| Rate for Payer: PHP Commercial |
$78.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.02
|
| Rate for Payer: Priority Health SBD |
$58.51
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.66
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$75.76
|
|
|
Service Code
|
NDC 3076816836
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$68.18 |
| Rate for Payer: Aetna American Axle |
$49.24
|
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.24
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$53.03
|
| Rate for Payer: Cofinity Commercial |
$65.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.61
|
| Rate for Payer: Healthscope Commercial |
$68.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.40
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.03
|
| Rate for Payer: Priority Health SBD |
$47.73
|
| Rate for Payer: UMR Bronson Commercial |
$33.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$11.76
|
|
|
Service Code
|
NDC 9900-0019-28
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.00
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.23
|
| Rate for Payer: Priority Health SBD |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.82
|
|
