|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 60687077511
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna American Axle |
$303.81
|
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Advantage |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UMR Bronson Commercial |
$205.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.35 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.35
|
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.35
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Advantage |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.02
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.94 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna American Axle |
$303.81
|
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna Medicare |
$233.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: BCBS Complete |
$186.96
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Advantage |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.55
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.81
|
| Rate for Payer: UHC Core |
$243.52
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UMR Bronson Commercial |
$172.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 16571082401
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.24
|
| Rate for Payer: UHC Core |
$33.06
|
| Rate for Payer: UHC Exchange |
$24.94
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
NDC 65197027508
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Advantage |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.25
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
OP
|
$21.66
|
|
|
Service Code
|
NDC 65197027508
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$10.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Advantage |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.25
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$11.28
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 16571082401
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.62 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Advantage |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$167.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$256.15
|
|
|
Service Code
|
NDC 53746044201
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.71 |
| Max. Negotiated Rate |
$230.53 |
| Rate for Payer: Aetna American Axle |
$166.50
|
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.50
|
| Rate for Payer: Cash Price |
$204.92
|
| Rate for Payer: Cofinity Advantage |
$179.31
|
| Rate for Payer: Cofinity Commercial |
$220.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.92
|
| Rate for Payer: Healthscope Commercial |
$230.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.11
|
| Rate for Payer: PHP Commercial |
$217.73
|
| Rate for Payer: Priority Health SBD |
$161.37
|
| Rate for Payer: UMR Bronson Commercial |
$112.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.11
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 68084049101
|
| 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 Advantage |
$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 Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| 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
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 68084049101
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$212.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.54
|
| Rate for Payer: UHC Core |
$138.29
|
| Rate for Payer: UHC Exchange |
$104.32
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084049111
|
| 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 Advantage |
$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 Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| 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
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.89
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.89
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Advantage |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.89
|
| Rate for Payer: UHC Core |
$217.93
|
| Rate for Payer: UHC Exchange |
$164.39
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Advantage |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Exchange |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 68084049111
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$438.90
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.39 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna American Axle |
$285.29
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna Medicare |
$219.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.29
|
| Rate for Payer: BCBS Complete |
$175.56
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Advantage |
$307.23
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.18
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health SBD |
$276.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.29
|
| Rate for Payer: UHC Core |
$228.67
|
| Rate for Payer: UHC Exchange |
$172.49
|
| Rate for Payer: UMR Bronson Commercial |
$162.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Advantage |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 51079051120
|
| 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 Advantage |
$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 Commercial |
$208.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.32
|
| Rate for Payer: PHP Commercial |
$208.90
|
| 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
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna Medicare |
$190.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Advantage |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.62
|
| Rate for Payer: UHC Core |
$198.47
|
| Rate for Payer: UHC Exchange |
$149.71
|
| Rate for Payer: UMR Bronson Commercial |
$140.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$438.90
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.12 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna American Axle |
$285.29
|
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.29
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Advantage |
$307.23
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.18
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health SBD |
$276.51
|
| Rate for Payer: UMR Bronson Commercial |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$245.76
|
|
|
Service Code
|
NDC 51079051120
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$122.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: BCBS Complete |
$98.30
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$196.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.32
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.74
|
| Rate for Payer: UHC Core |
$128.04
|
| Rate for Payer: UHC Exchange |
$96.58
|
| Rate for Payer: UMR Bronson Commercial |
$90.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.89
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.89
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Advantage |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.73
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.73
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$256.15
|
|
|
Service Code
|
NDC 53746044201
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$230.53 |
| Rate for Payer: Aetna American Axle |
$166.50
|
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Aetna Medicare |
$128.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.50
|
| Rate for Payer: BCBS Complete |
$102.46
|
| Rate for Payer: Cash Price |
$204.92
|
| Rate for Payer: Cofinity Advantage |
$179.31
|
| Rate for Payer: Cofinity Commercial |
$220.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.92
|
| Rate for Payer: Healthscope Commercial |
$230.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.11
|
| Rate for Payer: PHP Commercial |
$217.73
|
| Rate for Payer: Priority Health SBD |
$161.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.50
|
| Rate for Payer: UHC Core |
$133.45
|
| Rate for Payer: UHC Exchange |
$100.67
|
| Rate for Payer: UMR Bronson Commercial |
$94.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.11
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$33,503.95
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$13,879.19 |
| Max. Negotiated Rate |
$33,503.95 |
| Rate for Payer: Aetna Medicare |
$15,194.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,262.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,262.09
|
| Rate for Payer: BCBS MAPPO |
$14,609.67
|
| Rate for Payer: BCBS Trust/PPO |
$33,503.95
|
| Rate for Payer: BCN Commercial |
$33,503.95
|
| Rate for Payer: BCN Medicare Advantage |
$14,609.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,609.67
|
| Rate for Payer: Mclaren Medicare |
$14,609.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,340.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,801.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,070.64
|
| Rate for Payer: Nomi Health Commercial |
$21,621.69
|
| Rate for Payer: PACE Medicare |
$13,879.19
|
| Rate for Payer: PACE SWMI |
$14,609.67
|
| Rate for Payer: PHP Medicare Advantage |
$14,609.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,022.32
|
| Rate for Payer: Priority Health Medicare |
$14,609.67
|
| Rate for Payer: Priority Health Tiered Network |
$21,617.85
|
| Rate for Payer: Railroad Medicare Medicare |
$14,609.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,320.43
|
| Rate for Payer: UHC Core |
$22,856.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,609.67
|
| Rate for Payer: UHC Exchange |
$18,666.73
|
| Rate for Payer: VA VA |
$14,609.67
|
|
