|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.86
|
| Rate for Payer: UHC Core |
$238.75
|
| Rate for Payer: UHC Exchange |
$180.09
|
| Rate for Payer: UMR Bronson Commercial |
$169.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.44
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$69.09
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$62.18 |
| Rate for Payer: Aetna American Axle |
$44.91
|
| Rate for Payer: Aetna Commercial |
$58.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.91
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Cofinity Advantage |
$48.36
|
| Rate for Payer: Cofinity Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.27
|
| Rate for Payer: Healthscope Commercial |
$62.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.82
|
| Rate for Payer: PHP Commercial |
$58.73
|
| Rate for Payer: Priority Health SBD |
$43.53
|
| Rate for Payer: UMR Bronson Commercial |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.08
|
| Rate for Payer: UHC Core |
$25.71
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$492.20
|
|
|
Service Code
|
HCPCS J9245
|
| Hospital Charge Code |
10522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.11 |
| Max. Negotiated Rate |
$442.98 |
| Rate for Payer: Aetna American Axle |
$319.93
|
| Rate for Payer: Aetna Commercial |
$418.37
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.84
|
| Rate for Payer: BCBS Complete |
$66.27
|
| Rate for Payer: BCBS MAPPO |
$120.67
|
| Rate for Payer: BCBS Trust/PPO |
$281.91
|
| Rate for Payer: BCN Commercial |
$281.91
|
| Rate for Payer: BCN Medicare Advantage |
$120.67
|
| Rate for Payer: Cash Price |
$393.76
|
| Rate for Payer: Cash Price |
$393.76
|
| Rate for Payer: Cofinity Advantage |
$344.54
|
| Rate for Payer: Cofinity Commercial |
$423.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.67
|
| Rate for Payer: Healthscope Commercial |
$442.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.15
|
| Rate for Payer: Mclaren Medicaid |
$120.67
|
| Rate for Payer: Mclaren Medicare |
$120.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.70
|
| Rate for Payer: Meridian Medicaid |
$126.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$132.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.37
|
| Rate for Payer: Nomi Health Commercial |
$362.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.15
|
| Rate for Payer: PACE Medicare |
$114.64
|
| Rate for Payer: PACE SWMI |
$120.67
|
| Rate for Payer: PHP Commercial |
$418.37
|
| Rate for Payer: PHP Medicare Advantage |
$120.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.48
|
| Rate for Payer: Priority Health Medicare |
$120.67
|
| Rate for Payer: Priority Health SBD |
$310.09
|
| Rate for Payer: Priority Health Tiered Network |
$241.98
|
| Rate for Payer: Railroad Medicare Medicare |
$120.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.45
|
| Rate for Payer: UHC Core |
$143.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$120.67
|
| Rate for Payer: UHC Exchange |
$143.45
|
| Rate for Payer: UHC Medicaid |
$63.11
|
| Rate for Payer: UHCCP Medicaid |
$63.11
|
| Rate for Payer: UMR Bronson Commercial |
$182.11
|
| Rate for Payer: VA VA |
$120.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.15
|
|
|
MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$492.20
|
|
|
Service Code
|
HCPCS J9245
|
| Hospital Charge Code |
10522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.57 |
| Max. Negotiated Rate |
$442.98 |
| Rate for Payer: Aetna American Axle |
$319.93
|
| Rate for Payer: Aetna Commercial |
$418.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.93
|
| Rate for Payer: Cash Price |
$393.76
|
| Rate for Payer: Cofinity Advantage |
$344.54
|
| Rate for Payer: Cofinity Commercial |
$423.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.76
|
| Rate for Payer: Healthscope Commercial |
$442.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.15
|
| Rate for Payer: PHP Commercial |
$418.37
|
| Rate for Payer: Priority Health SBD |
$310.09
|
| Rate for Payer: UMR Bronson Commercial |
$216.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.15
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2,550.41
|
|
|
Service Code
|
NDC 00456321063
|
| 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 Advantage |
$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 Commercial |
$2,167.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.81
|
| Rate for Payer: PHP Commercial |
$2,167.85
|
| 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
|
OP
|
$2,550.41
|
|
|
Service Code
|
NDC 00456321063
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$943.65 |
| 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 Medicare |
$1,275.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.77
|
| Rate for Payer: BCBS Complete |
$1,020.16
|
| Rate for Payer: Cash Price |
$2,040.33
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2,040.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.81
|
| Rate for Payer: PHP Commercial |
$2,167.85
|
| Rate for Payer: Priority Health SBD |
$1,606.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,657.77
|
| Rate for Payer: UHC Core |
$1,328.76
|
| Rate for Payer: UHC Exchange |
$1,002.31
|
| Rate for Payer: UMR Bronson Commercial |
$943.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.51
|
|
|
Service Code
|
NDC 00456321011
|
| 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 Advantage |
$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 Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.13
|
| Rate for Payer: PHP Commercial |
$21.68
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.07
|
| Rate for Payer: UHC Core |
$143.54
|
| Rate for Payer: UHC Exchange |
$108.27
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$25.51
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.13
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.58
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.13
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$368.60
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna American Axle |
$239.59
|
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna Medicare |
$184.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: BCBS Complete |
$147.44
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Advantage |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health SBD |
$232.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.59
|
| Rate for Payer: UHC Core |
$192.04
|
| Rate for Payer: UHC Exchange |
$144.86
|
| Rate for Payer: UMR Bronson Commercial |
$136.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.18 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna American Axle |
$239.59
|
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Advantage |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health SBD |
$232.22
|
| Rate for Payer: UMR Bronson Commercial |
$162.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
OP
|
$579.14
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$754.69 |
| Rate for Payer: Aetna American Axle |
$376.44
|
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Aetna Medicare |
$289.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.44
|
| Rate for Payer: BCBS Complete |
$231.66
|
| Rate for Payer: BCBS Trust/PPO |
$754.69
|
| Rate for Payer: BCN Commercial |
$754.69
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cofinity Advantage |
$405.40
|
| Rate for Payer: Cofinity Commercial |
$498.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.31
|
| Rate for Payer: Healthscope Commercial |
$521.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$463.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.36
|
| Rate for Payer: PHP Commercial |
$492.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$270.18
|
| Rate for Payer: Priority Health SBD |
$364.86
|
| Rate for Payer: Priority Health Tiered Network |
$216.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.34
|
| Rate for Payer: UHC Core |
$497.34
|
| Rate for Payer: UHC Exchange |
$497.34
|
| Rate for Payer: UMR Bronson Commercial |
$214.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.36
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
IP
|
$579.14
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.82 |
| Max. Negotiated Rate |
$521.23 |
| Rate for Payer: Aetna American Axle |
$376.44
|
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.44
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cofinity Advantage |
$405.40
|
| Rate for Payer: Cofinity Commercial |
$498.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.31
|
| Rate for Payer: Healthscope Commercial |
$521.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.36
|
| Rate for Payer: PHP Commercial |
$492.27
|
| Rate for Payer: Priority Health SBD |
$364.86
|
| Rate for Payer: UMR Bronson Commercial |
$254.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.36
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$401.05
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$563.67 |
| Rate for Payer: Aetna American Axle |
$260.68
|
| Rate for Payer: Aetna American Axle |
$247.23
|
| Rate for Payer: Aetna Commercial |
$340.89
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Medicare |
$200.53
|
| Rate for Payer: Aetna Medicare |
$190.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.68
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS Trust/PPO |
$563.67
|
| Rate for Payer: BCBS Trust/PPO |
$563.67
|
| Rate for Payer: BCN Commercial |
$563.67
|
| Rate for Payer: BCN Commercial |
$563.67
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cofinity Advantage |
$280.74
|
| Rate for Payer: Cofinity Advantage |
$266.25
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Commercial |
$344.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Healthscope Commercial |
$360.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: PHP Commercial |
$340.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.76
|
| Rate for Payer: Priority Health SBD |
$252.66
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: Priority Health Tiered Network |
$161.41
|
| Rate for Payer: Priority Health Tiered Network |
$161.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.43
|
| Rate for Payer: UHC Core |
$350.43
|
| Rate for Payer: UHC Core |
$350.43
|
| Rate for Payer: UHC Exchange |
$350.43
|
| Rate for Payer: UHC Exchange |
$350.43
|
| Rate for Payer: UMR Bronson Commercial |
$140.73
|
| Rate for Payer: UMR Bronson Commercial |
$148.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.79
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$380.36
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.36 |
| Max. Negotiated Rate |
$342.32 |
| Rate for Payer: Aetna American Axle |
$247.23
|
| Rate for Payer: Aetna American Axle |
$260.68
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Commercial |
$340.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.68
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cofinity Advantage |
$280.74
|
| Rate for Payer: Cofinity Advantage |
$266.25
|
| Rate for Payer: Cofinity Commercial |
$344.90
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Healthscope Commercial |
$360.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.79
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: PHP Commercial |
$340.89
|
| Rate for Payer: Priority Health SBD |
$252.66
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: UMR Bronson Commercial |
$167.36
|
| Rate for Payer: UMR Bronson Commercial |
$176.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.79
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$2,443.09
|
|
|
Service Code
|
APR-DRG 5321
|
| Min. Negotiated Rate |
$2,326.75 |
| Max. Negotiated Rate |
$2,443.09 |
| Rate for Payer: BCBS Complete |
$2,443.09
|
| Rate for Payer: Mclaren Medicaid |
$2,326.75
|
| Rate for Payer: Meridian Medicaid |
$2,443.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,326.75
|
| Rate for Payer: UHC Medicaid |
$2,326.75
|
| Rate for Payer: UHCCP Medicaid |
$2,326.75
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$3,370.45
|
|
|
Service Code
|
APR-DRG 5322
|
| Min. Negotiated Rate |
$3,209.95 |
| Max. Negotiated Rate |
$3,370.45 |
| Rate for Payer: BCBS Complete |
$3,370.45
|
| Rate for Payer: Mclaren Medicaid |
$3,209.95
|
| Rate for Payer: Meridian Medicaid |
$3,370.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,209.95
|
| Rate for Payer: UHC Medicaid |
$3,209.95
|
| Rate for Payer: UHCCP Medicaid |
$3,209.95
|
|
