|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$19,262.37
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$8,200.42 |
| Max. Negotiated Rate |
$19,262.37 |
| Rate for Payer: Aetna Medicare |
$8,977.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,790.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,790.02
|
| Rate for Payer: BCBS MAPPO |
$8,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$19,262.37
|
| Rate for Payer: BCN Commercial |
$19,262.37
|
| Rate for Payer: BCN Medicare Advantage |
$8,632.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,632.02
|
| Rate for Payer: Mclaren Medicare |
$8,632.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,063.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,926.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,495.22
|
| Rate for Payer: Nomi Health Commercial |
$12,400.77
|
| Rate for Payer: PACE Medicare |
$8,200.42
|
| Rate for Payer: PACE SWMI |
$8,632.02
|
| Rate for Payer: PHP Medicare Advantage |
$8,632.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,498.21
|
| Rate for Payer: Priority Health Medicare |
$8,632.02
|
| Rate for Payer: Priority Health Tiered Network |
$12,398.57
|
| Rate for Payer: Railroad Medicare Medicare |
$8,632.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,669.19
|
| Rate for Payer: UHC Core |
$13,109.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,632.02
|
| Rate for Payer: UHC Exchange |
$10,706.00
|
| Rate for Payer: VA VA |
$8,632.02
|
|
|
MEDICAL MAGGOTS
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.43 |
| 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 Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$89.43
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Advantage |
$906.50
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| 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: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.75
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$815.85
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$479.15
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.25
|
|
|
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 Advantage |
$906.50
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| 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 Commercial |
$1,100.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| 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 41679036513
|
| 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 Advantage |
$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 Commercial |
$623.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.22
|
| Rate for Payer: PHP Commercial |
$623.59
|
| 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
|
OP
|
$733.63
|
|
|
Service Code
|
NDC 41679036513
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna Medicare |
$366.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: BCBS Complete |
$293.45
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$586.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.22
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.86
|
| Rate for Payer: UHC Core |
$382.22
|
| Rate for Payer: UHC Exchange |
$288.32
|
| Rate for Payer: UMR Bronson Commercial |
$271.44
|
| 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 41679036503
|
| 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 Advantage |
$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 Commercial |
$623.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.22
|
| Rate for Payer: PHP Commercial |
$623.59
|
| 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
|
OP
|
$733.63
|
|
|
Service Code
|
NDC 41679036503
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna Medicare |
$366.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: BCBS Complete |
$293.45
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$586.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.22
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.86
|
| Rate for Payer: UHC Core |
$382.22
|
| Rate for Payer: UHC Exchange |
$288.32
|
| Rate for Payer: UMR Bronson Commercial |
$271.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 59762374202
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.85
|
| Rate for Payer: UHC Core |
$108.89
|
| Rate for Payer: UHC Exchange |
$82.14
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 00555077902
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.02 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna American Axle |
$270.37
|
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: UMR Bronson Commercial |
$183.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 59762374202
|
| 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 Advantage |
$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 Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| 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
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 00555077902
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna American Axle |
$270.37
|
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna Medicare |
$207.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.37
|
| Rate for Payer: UHC Core |
$216.71
|
| Rate for Payer: UHC Exchange |
$163.47
|
| Rate for Payer: UMR Bronson Commercial |
$153.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$237.71
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
112224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.59 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna American Axle |
$154.51
|
| Rate for Payer: Aetna American Axle |
$130.74
|
| Rate for Payer: Aetna American Axle |
$155.39
|
| Rate for Payer: Aetna American Axle |
$123.64
|
| Rate for Payer: Aetna Commercial |
$203.20
|
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Commercial |
$161.68
|
| Rate for Payer: Aetna Commercial |
$170.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.64
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$160.91
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cofinity Advantage |
$140.80
|
| Rate for Payer: Cofinity Advantage |
$133.15
|
| Rate for Payer: Cofinity Advantage |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$167.34
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Commercial |
$163.58
|
| Rate for Payer: Cofinity Commercial |
$172.98
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.91
|
| Rate for Payer: Healthscope Commercial |
$181.03
|
| Rate for Payer: Healthscope Commercial |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$171.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.66
|
| Rate for Payer: PHP Commercial |
$161.68
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$170.97
|
| Rate for Payer: PHP Commercial |
$203.20
|
| Rate for Payer: Priority Health SBD |
$150.61
|
| Rate for Payer: Priority Health SBD |
$119.83
|
| Rate for Payer: Priority Health SBD |
$149.76
|
| Rate for Payer: Priority Health SBD |
$126.72
|
| Rate for Payer: UMR Bronson Commercial |
$88.50
|
| Rate for Payer: UMR Bronson Commercial |
$104.59
|
| Rate for Payer: UMR Bronson Commercial |
$83.69
|
| Rate for Payer: UMR Bronson Commercial |
$105.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.29
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$239.06
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
112224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$215.15 |
| Rate for Payer: Aetna American Axle |
$155.39
|
| Rate for Payer: Aetna American Axle |
$123.64
|
| Rate for Payer: Aetna American Axle |
$130.74
|
| Rate for Payer: Aetna American Axle |
$154.51
|
| Rate for Payer: Aetna Commercial |
$203.20
|
| Rate for Payer: Aetna Commercial |
$202.05
|
| Rate for Payer: Aetna Commercial |
$161.68
|
| Rate for Payer: Aetna Commercial |
$170.97
|
| Rate for Payer: Aetna Medicare |
$118.86
|
| Rate for Payer: Aetna Medicare |
$100.57
|
| Rate for Payer: Aetna Medicare |
$119.53
|
| Rate for Payer: Aetna Medicare |
$95.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.51
|
| Rate for Payer: BCBS Complete |
$76.08
|
| Rate for Payer: BCBS Complete |
$80.46
|
| Rate for Payer: BCBS Complete |
$95.08
|
| Rate for Payer: BCBS Complete |
$95.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cash Price |
$160.91
|
| Rate for Payer: Cash Price |
$160.91
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cofinity Advantage |
$167.34
|
| Rate for Payer: Cofinity Advantage |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$140.80
|
| Rate for Payer: Cofinity Advantage |
$133.15
|
| Rate for Payer: Cofinity Commercial |
$172.98
|
| Rate for Payer: Cofinity Commercial |
$204.43
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$163.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.17
|
| Rate for Payer: Healthscope Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$171.19
|
| Rate for Payer: Healthscope Commercial |
$181.03
|
| Rate for Payer: Healthscope Commercial |
$215.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.29
|
| Rate for Payer: PHP Commercial |
$161.68
|
| Rate for Payer: PHP Commercial |
$202.05
|
| Rate for Payer: PHP Commercial |
$203.20
|
| Rate for Payer: PHP Commercial |
$170.97
|
| Rate for Payer: Priority Health SBD |
$149.76
|
| Rate for Payer: Priority Health SBD |
$119.83
|
| Rate for Payer: Priority Health SBD |
$126.72
|
| Rate for Payer: Priority Health SBD |
$150.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$88.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$74.42
|
| Rate for Payer: UMR Bronson Commercial |
$87.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.29
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Advantage |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.47
|
| Rate for Payer: UHC Core |
$154.27
|
| Rate for Payer: UHC Exchange |
$116.37
|
| Rate for Payer: UMR Bronson Commercial |
$109.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Advantage |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$783.96
|
|
|
Service Code
|
NDC 49884090738
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.07 |
| Max. Negotiated Rate |
$705.56 |
| Rate for Payer: Aetna American Axle |
$509.57
|
| Rate for Payer: Aetna Commercial |
$666.37
|
| Rate for Payer: Aetna Medicare |
$391.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.57
|
| Rate for Payer: BCBS Complete |
$313.58
|
| Rate for Payer: Cash Price |
$627.17
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$627.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$587.97
|
| Rate for Payer: PHP Commercial |
$666.37
|
| Rate for Payer: Priority Health SBD |
$493.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.57
|
| Rate for Payer: UHC Core |
$408.44
|
| Rate for Payer: UHC Exchange |
$308.10
|
| Rate for Payer: UMR Bronson Commercial |
$290.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$587.97
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$783.96
|
|
|
Service Code
|
NDC 49884090738
|
| 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 Advantage |
$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 Commercial |
$666.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$587.97
|
| Rate for Payer: PHP Commercial |
$666.37
|
| 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
|
$710.64
|
|
|
Service Code
|
NDC 64380016001
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.68 |
| Max. Negotiated Rate |
$639.58 |
| Rate for Payer: Aetna American Axle |
$461.92
|
| Rate for Payer: Aetna Commercial |
$604.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.92
|
| Rate for Payer: Cash Price |
$568.51
|
| Rate for Payer: Cofinity Advantage |
$497.45
|
| Rate for Payer: Cofinity Commercial |
$611.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.51
|
| Rate for Payer: Healthscope Commercial |
$639.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.98
|
| Rate for Payer: PHP Commercial |
$604.04
|
| Rate for Payer: Priority Health SBD |
$447.70
|
| Rate for Payer: UMR Bronson Commercial |
$312.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.98
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$360.96
|
|
|
Service Code
|
NDC 00054354250
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.56 |
| Max. Negotiated Rate |
$324.86 |
| Rate for Payer: Aetna American Axle |
$234.62
|
| Rate for Payer: Aetna Commercial |
$306.82
|
| Rate for Payer: Aetna Medicare |
$180.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.62
|
| Rate for Payer: BCBS Complete |
$144.38
|
| Rate for Payer: Cash Price |
$288.77
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$288.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.72
|
| Rate for Payer: PHP Commercial |
$306.82
|
| Rate for Payer: Priority Health SBD |
$227.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.62
|
| Rate for Payer: UHC Core |
$188.06
|
| Rate for Payer: UHC Exchange |
$141.86
|
| Rate for Payer: UMR Bronson Commercial |
$133.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.72
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$659.88
|
|
|
Service Code
|
NDC 60432012608
|
| 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 Advantage |
$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 Commercial |
$560.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.91
|
| Rate for Payer: PHP Commercial |
$560.90
|
| 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
|
OP
|
$710.64
|
|
|
Service Code
|
NDC 64380016001
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.94 |
| Max. Negotiated Rate |
$639.58 |
| Rate for Payer: Aetna American Axle |
$461.92
|
| Rate for Payer: Aetna Commercial |
$604.04
|
| Rate for Payer: Aetna Medicare |
$355.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.92
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: Cash Price |
$568.51
|
| Rate for Payer: Cofinity Advantage |
$497.45
|
| Rate for Payer: Cofinity Commercial |
$611.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.51
|
| Rate for Payer: Healthscope Commercial |
$639.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.98
|
| Rate for Payer: PHP Commercial |
$604.04
|
| Rate for Payer: Priority Health SBD |
$447.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.92
|
| Rate for Payer: UHC Core |
$370.24
|
| Rate for Payer: UHC Exchange |
$279.28
|
| Rate for Payer: UMR Bronson Commercial |
$262.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.98
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$360.96
|
|
|
Service Code
|
NDC 00054354250
|
| 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 Advantage |
$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 Commercial |
$306.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.72
|
| Rate for Payer: PHP Commercial |
$306.82
|
| 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
|
OP
|
$659.88
|
|
|
Service Code
|
NDC 60432012608
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.16 |
| Max. Negotiated Rate |
$593.89 |
| Rate for Payer: Aetna American Axle |
$428.92
|
| Rate for Payer: Aetna Commercial |
$560.90
|
| Rate for Payer: Aetna Medicare |
$329.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.92
|
| Rate for Payer: BCBS Complete |
$263.95
|
| Rate for Payer: Cash Price |
$527.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$527.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.91
|
| Rate for Payer: PHP Commercial |
$560.90
|
| Rate for Payer: Priority Health SBD |
$415.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.92
|
| Rate for Payer: UHC Core |
$343.80
|
| Rate for Payer: UHC Exchange |
$259.33
|
| Rate for Payer: UMR Bronson Commercial |
$244.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.91
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$283.10
|
|
|
Service Code
|
NDC 64380015901
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna American Axle |
$184.01
|
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: Aetna Medicare |
$141.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.01
|
| Rate for Payer: BCBS Complete |
$113.24
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$226.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.32
|
| Rate for Payer: PHP Commercial |
$240.63
|
| Rate for Payer: Priority Health SBD |
$178.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.01
|
| Rate for Payer: UHC Core |
$147.50
|
| Rate for Payer: UHC Exchange |
$111.26
|
| Rate for Payer: UMR Bronson Commercial |
$104.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.32
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904723661
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.85
|
| Rate for Payer: UHC Core |
$108.89
|
| Rate for Payer: UHC Exchange |
$82.14
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
