|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 7733351625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health SBD |
$2.40
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 5026852411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.77
|
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.77
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.62
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$146.64
|
|
|
Service Code
|
NDC 3160402741
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna American Axle |
$95.32
|
| Rate for Payer: Aetna Commercial |
$124.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.32
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Cofinity Commercial |
$126.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.31
|
| Rate for Payer: Healthscope Commercial |
$131.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.64
|
| Rate for Payer: PHP Commercial |
$124.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.65
|
| Rate for Payer: Priority Health SBD |
$92.38
|
| Rate for Payer: UMR Bronson Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.98
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 5026852415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna American Axle |
$138.24
|
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.24
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$148.88
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.78
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.88
|
| Rate for Payer: Priority Health SBD |
$133.99
|
| Rate for Payer: UMR Bronson Commercial |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 7733351610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UMR Bronson Commercial |
$167.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 5199101406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 2055503600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna American Axle |
$80.20
|
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.20
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.87
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.37
|
| Rate for Payer: Priority Health SBD |
$77.73
|
| Rate for Payer: UMR Bronson Commercial |
$54.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.54
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 69097-158-07
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 63739-701-10
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.14
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2,550.41
|
|
|
Service Code
|
NDC 0456-3210-63
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,122.18 |
| Max. Negotiated Rate |
$2,295.37 |
| Rate for Payer: Aetna American Axle |
$1,657.77
|
| Rate for Payer: Aetna Commercial |
$2,167.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.77
|
| Rate for Payer: Cash Price |
$2,040.33
|
| Rate for Payer: Cofinity Commercial |
$1,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,193.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.33
|
| Rate for Payer: Healthscope Commercial |
$2,295.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,785.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,167.85
|
| Rate for Payer: PHP Commercial |
$2,167.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,785.29
|
| Rate for Payer: Priority Health SBD |
$1,606.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,122.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 0904-6506-61
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.51
|
|
|
Service Code
|
NDC 0456-3210-11
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.13
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 0591-3870-44
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.94
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 0591-3870-45
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.91
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
IP
|
$702.08
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.92 |
| Max. Negotiated Rate |
$631.87 |
| Rate for Payer: Aetna American Axle |
$456.35
|
| Rate for Payer: Aetna Commercial |
$596.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.35
|
| Rate for Payer: Cash Price |
$561.66
|
| Rate for Payer: Cofinity Commercial |
$491.46
|
| Rate for Payer: Cofinity Commercial |
$603.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.66
|
| Rate for Payer: Healthscope Commercial |
$631.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$596.77
|
| Rate for Payer: PHP Commercial |
$596.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.46
|
| Rate for Payer: Priority Health SBD |
$442.31
|
| Rate for Payer: UMR Bronson Commercial |
$308.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.56
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$378.18
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$340.36 |
| Rate for Payer: Aetna American Axle |
$245.82
|
| Rate for Payer: Aetna Commercial |
$321.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.82
|
| Rate for Payer: Cash Price |
$302.54
|
| Rate for Payer: Cofinity Commercial |
$264.73
|
| Rate for Payer: Cofinity Commercial |
$325.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.54
|
| Rate for Payer: Healthscope Commercial |
$340.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.45
|
| Rate for Payer: PHP Commercial |
$321.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.73
|
| Rate for Payer: Priority Health SBD |
$238.25
|
| Rate for Payer: UMR Bronson Commercial |
$166.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.64
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$17,110.34
|
|
|
Service Code
|
MS-DRG 760
|
| Min. Negotiated Rate |
$7,773.78 |
| Max. Negotiated Rate |
$17,110.34 |
| Rate for Payer: Aetna Medicare |
$8,510.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,228.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,228.66
|
| Rate for Payer: BCBS MAPPO |
$8,182.93
|
| Rate for Payer: BCBS Trust/PPO |
$17,110.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,182.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,182.93
|
| Rate for Payer: Mclaren Medicare |
$8,182.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,592.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,410.37
|
| Rate for Payer: PACE Medicare |
$7,773.78
|
| Rate for Payer: PACE SWMI |
$8,182.93
|
| Rate for Payer: PHP Medicare Advantage |
$8,182.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,283.91
|
| Rate for Payer: Priority Health Medicare |
$8,182.93
|
| Rate for Payer: Priority Health Narrow Network |
$11,427.13
|
| Rate for Payer: Railroad Medicare Medicare |
$8,182.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,183.83
|
| Rate for Payer: UHC Core |
$12,450.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,182.93
|
| Rate for Payer: UHC Exchange |
$9,898.26
|
| Rate for Payer: UHC Medicare Advantage |
$8,428.42
|
| Rate for Payer: VA VA |
$8,182.93
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,410.94
|
|
|
Service Code
|
MS-DRG 761
|
| Min. Negotiated Rate |
$4,920.16 |
| Max. Negotiated Rate |
$10,410.94 |
| Rate for Payer: Aetna Medicare |
$5,386.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,473.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,473.90
|
| Rate for Payer: BCBS MAPPO |
$5,179.12
|
| Rate for Payer: BCBS Trust/PPO |
$10,410.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,179.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,179.12
|
| Rate for Payer: Mclaren Medicare |
$5,179.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,438.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,955.99
|
| Rate for Payer: PACE Medicare |
$4,920.16
|
| Rate for Payer: PACE SWMI |
$5,179.12
|
| Rate for Payer: PHP Medicare Advantage |
$5,179.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,690.31
|
| Rate for Payer: Priority Health Medicare |
$5,179.12
|
| Rate for Payer: Priority Health Narrow Network |
$6,952.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5,179.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,237.82
|
| Rate for Payer: UHC Core |
$7,574.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,179.12
|
| Rate for Payer: UHC Exchange |
$6,022.09
|
| Rate for Payer: UHC Medicare Advantage |
$5,334.49
|
| Rate for Payer: VA VA |
$5,179.12
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 4687600040
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.16
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 0799-0001-04
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.23
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
MEPERIDINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$371.56
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.49 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Aetna American Axle |
$241.51
|
| Rate for Payer: Aetna Commercial |
$315.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.51
|
| Rate for Payer: Cash Price |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$260.09
|
| Rate for Payer: Cofinity Commercial |
$319.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.25
|
| Rate for Payer: Healthscope Commercial |
$334.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.83
|
| Rate for Payer: PHP Commercial |
$315.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.09
|
| Rate for Payer: Priority Health SBD |
$234.08
|
| Rate for Payer: UMR Bronson Commercial |
$163.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.67
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.75
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.54
|
| Rate for Payer: PHP Commercial |
$29.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health SBD |
$21.89
|
| Rate for Payer: UMR Bronson Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna American Axle |
$23.45
|
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.67
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$38.15
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna American Axle |
$24.80
|
| Rate for Payer: Aetna Commercial |
$32.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$32.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.43
|
| Rate for Payer: PHP Commercial |
$32.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.70
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UMR Bronson Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
|
|
MEPIVACAINE 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$18.92
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
4914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$17.03 |
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.08
|
| Rate for Payer: PHP Commercial |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.24
|
| Rate for Payer: Priority Health SBD |
$11.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.19
|
|
