|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
NDC 31722000532
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Aetna American Axle |
$5.90
|
| Rate for Payer: Aetna Commercial |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.90
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Advantage |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$8.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.81
|
| Rate for Payer: PHP Commercial |
$7.72
|
| Rate for Payer: Priority Health SBD |
$5.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.81
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$344.10
|
|
|
Service Code
|
NDC 16571024603
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.49
|
| Rate for Payer: Aetna Medicare |
$172.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Advantage |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.07
|
| Rate for Payer: PHP Commercial |
$292.49
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.66
|
| Rate for Payer: UHC Core |
$179.28
|
| Rate for Payer: UHC Exchange |
$135.23
|
| Rate for Payer: UMR Bronson Commercial |
$127.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.07
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3,997.67
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,479.14 |
| Max. Negotiated Rate |
$3,597.90 |
| Rate for Payer: Aetna American Axle |
$2,598.49
|
| Rate for Payer: Aetna Commercial |
$3,398.02
|
| Rate for Payer: Aetna Medicare |
$1,998.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.49
|
| Rate for Payer: BCBS Complete |
$1,599.07
|
| Rate for Payer: Cash Price |
$3,198.14
|
| Rate for Payer: Cofinity Advantage |
$2,798.37
|
| Rate for Payer: Cofinity Commercial |
$3,438.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.14
|
| Rate for Payer: Healthscope Commercial |
$3,597.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,798.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,998.25
|
| Rate for Payer: PHP Commercial |
$3,398.02
|
| Rate for Payer: Priority Health SBD |
$2,518.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,598.49
|
| Rate for Payer: UHC Core |
$2,082.79
|
| Rate for Payer: UHC Exchange |
$1,571.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,479.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.25
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$11.47
|
|
|
Service Code
|
NDC 16571024616
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna American Axle |
$7.46
|
| Rate for Payer: Aetna Commercial |
$9.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cofinity Advantage |
$8.03
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.18
|
| Rate for Payer: Healthscope Commercial |
$10.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.60
|
| Rate for Payer: PHP Commercial |
$9.75
|
| Rate for Payer: Priority Health SBD |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$344.10
|
|
|
Service Code
|
NDC 16571024603
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna Commercial |
$292.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Advantage |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.07
|
| Rate for Payer: PHP Commercial |
$292.49
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.07
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3,997.67
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
40369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,758.97 |
| Max. Negotiated Rate |
$3,597.90 |
| Rate for Payer: Aetna American Axle |
$2,598.49
|
| Rate for Payer: Aetna Commercial |
$3,398.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.49
|
| Rate for Payer: Cash Price |
$3,198.14
|
| Rate for Payer: Cofinity Advantage |
$2,798.37
|
| Rate for Payer: Cofinity Commercial |
$3,438.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.14
|
| Rate for Payer: Healthscope Commercial |
$3,597.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,798.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,998.25
|
| Rate for Payer: PHP Commercial |
$3,398.02
|
| Rate for Payer: Priority Health SBD |
$2,518.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,758.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.25
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,835.94
|
|
|
Service Code
|
NDC 68382071119
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$807.81 |
| Max. Negotiated Rate |
$1,652.35 |
| Rate for Payer: Aetna American Axle |
$1,193.36
|
| Rate for Payer: Aetna Commercial |
$1,560.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.36
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cofinity Advantage |
$1,285.16
|
| Rate for Payer: Cofinity Commercial |
$1,578.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.75
|
| Rate for Payer: Healthscope Commercial |
$1,652.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,285.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,376.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,560.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.95
|
| Rate for Payer: PHP Commercial |
$1,560.55
|
| Rate for Payer: Priority Health SBD |
$1,156.64
|
| Rate for Payer: UMR Bronson Commercial |
$807.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,376.95
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,865.02
|
|
|
Service Code
|
NDC 54092047612
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.06 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna American Axle |
$2,512.26
|
| Rate for Payer: Aetna Commercial |
$3,285.27
|
| Rate for Payer: Aetna Medicare |
$1,932.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.26
|
| Rate for Payer: BCBS Complete |
$1,546.01
|
| Rate for Payer: Cash Price |
$3,092.02
|
| Rate for Payer: Cofinity Advantage |
$2,705.51
|
| Rate for Payer: Cofinity Commercial |
$3,323.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,092.02
|
| Rate for Payer: Healthscope Commercial |
$3,478.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,705.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,898.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,092.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,898.76
|
| Rate for Payer: PHP Commercial |
$3,285.27
|
| Rate for Payer: Priority Health SBD |
$2,434.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,512.26
|
| Rate for Payer: UHC Core |
$2,013.68
|
| Rate for Payer: UHC Exchange |
$1,518.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,898.76
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,835.94
|
|
|
Service Code
|
NDC 68382071119
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$679.30 |
| Max. Negotiated Rate |
$1,652.35 |
| Rate for Payer: Aetna American Axle |
$1,193.36
|
| Rate for Payer: Aetna Commercial |
$1,560.55
|
| Rate for Payer: Aetna Medicare |
$917.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.36
|
| Rate for Payer: BCBS Complete |
$734.38
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cofinity Advantage |
$1,285.16
|
| Rate for Payer: Cofinity Commercial |
$1,578.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.75
|
| Rate for Payer: Healthscope Commercial |
$1,652.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,285.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,376.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,560.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.95
|
| Rate for Payer: PHP Commercial |
$1,560.55
|
| Rate for Payer: Priority Health SBD |
$1,156.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.36
|
| Rate for Payer: UHC Core |
$956.52
|
| Rate for Payer: UHC Exchange |
$721.52
|
| Rate for Payer: UMR Bronson Commercial |
$679.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,376.95
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,865.02
|
|
|
Service Code
|
NDC 54092047612
|
| Hospital Charge Code |
78310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,700.61 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna American Axle |
$2,512.26
|
| Rate for Payer: Aetna Commercial |
$3,285.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.26
|
| Rate for Payer: Cash Price |
$3,092.02
|
| Rate for Payer: Cofinity Advantage |
$2,705.51
|
| Rate for Payer: Cofinity Commercial |
$3,323.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,092.02
|
| Rate for Payer: Healthscope Commercial |
$3,478.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,705.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,898.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,898.76
|
| Rate for Payer: PHP Commercial |
$3,285.27
|
| Rate for Payer: Priority Health SBD |
$2,434.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,700.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,898.76
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
IP
|
$1,550.45
|
|
|
Service Code
|
NDC 59762011701
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$682.20 |
| Max. Negotiated Rate |
$1,395.40 |
| Rate for Payer: Aetna American Axle |
$1,007.79
|
| Rate for Payer: Aetna Commercial |
$1,317.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.79
|
| Rate for Payer: Cash Price |
$1,240.36
|
| Rate for Payer: Cofinity Advantage |
$1,085.32
|
| Rate for Payer: Cofinity Commercial |
$1,333.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.36
|
| Rate for Payer: Healthscope Commercial |
$1,395.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,085.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,162.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,317.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,162.84
|
| Rate for Payer: PHP Commercial |
$1,317.88
|
| Rate for Payer: Priority Health SBD |
$976.78
|
| Rate for Payer: UMR Bronson Commercial |
$682.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,162.84
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
OP
|
$2,402.93
|
|
|
Service Code
|
NDC 00023585318
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$889.08 |
| Max. Negotiated Rate |
$2,162.64 |
| Rate for Payer: Aetna American Axle |
$1,561.90
|
| Rate for Payer: Aetna Commercial |
$2,042.49
|
| Rate for Payer: Aetna Medicare |
$1,201.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,561.90
|
| Rate for Payer: BCBS Complete |
$961.17
|
| Rate for Payer: Cash Price |
$1,922.34
|
| Rate for Payer: Cofinity Advantage |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$2,066.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,922.34
|
| Rate for Payer: Healthscope Commercial |
$2,162.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,682.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,802.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,922.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,042.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,802.20
|
| Rate for Payer: PHP Commercial |
$2,042.49
|
| Rate for Payer: Priority Health SBD |
$1,513.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,561.90
|
| Rate for Payer: UHC Core |
$1,251.93
|
| Rate for Payer: UHC Exchange |
$944.35
|
| Rate for Payer: UMR Bronson Commercial |
$889.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,802.20
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
IP
|
$2,402.93
|
|
|
Service Code
|
NDC 00023585318
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,057.29 |
| Max. Negotiated Rate |
$2,162.64 |
| Rate for Payer: Aetna American Axle |
$1,561.90
|
| Rate for Payer: Aetna Commercial |
$2,042.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,561.90
|
| Rate for Payer: Cash Price |
$1,922.34
|
| Rate for Payer: Cofinity Advantage |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$2,066.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,922.34
|
| Rate for Payer: Healthscope Commercial |
$2,162.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,682.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,802.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,042.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,802.20
|
| Rate for Payer: PHP Commercial |
$2,042.49
|
| Rate for Payer: Priority Health SBD |
$1,513.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,802.20
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
OP
|
$1,550.45
|
|
|
Service Code
|
NDC 59762011701
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$573.67 |
| Max. Negotiated Rate |
$1,395.40 |
| Rate for Payer: Aetna American Axle |
$1,007.79
|
| Rate for Payer: Aetna Commercial |
$1,317.88
|
| Rate for Payer: Aetna Medicare |
$775.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.79
|
| Rate for Payer: BCBS Complete |
$620.18
|
| Rate for Payer: Cash Price |
$1,240.36
|
| Rate for Payer: Cofinity Advantage |
$1,085.32
|
| Rate for Payer: Cofinity Commercial |
$1,333.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.36
|
| Rate for Payer: Healthscope Commercial |
$1,395.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,085.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,162.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,240.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,317.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,162.84
|
| Rate for Payer: PHP Commercial |
$1,317.88
|
| Rate for Payer: Priority Health SBD |
$976.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.79
|
| Rate for Payer: UHC Core |
$807.78
|
| Rate for Payer: UHC Exchange |
$609.33
|
| Rate for Payer: UMR Bronson Commercial |
$573.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,162.84
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
OP
|
$1,473.20
|
|
|
Service Code
|
NDC 00093590786
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$545.08 |
| Max. Negotiated Rate |
$1,325.88 |
| Rate for Payer: Aetna American Axle |
$957.58
|
| Rate for Payer: Aetna Commercial |
$1,252.22
|
| Rate for Payer: Aetna Medicare |
$736.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.58
|
| Rate for Payer: BCBS Complete |
$589.28
|
| Rate for Payer: Cash Price |
$1,178.56
|
| Rate for Payer: Cofinity Advantage |
$1,031.24
|
| Rate for Payer: Cofinity Commercial |
$1,266.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.56
|
| Rate for Payer: Healthscope Commercial |
$1,325.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,031.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,178.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.90
|
| Rate for Payer: PHP Commercial |
$1,252.22
|
| Rate for Payer: Priority Health SBD |
$928.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.58
|
| Rate for Payer: UHC Core |
$767.54
|
| Rate for Payer: UHC Exchange |
$578.97
|
| Rate for Payer: UMR Bronson Commercial |
$545.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.90
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)
|
Facility
|
IP
|
$1,473.20
|
|
|
Service Code
|
NDC 00093590786
|
| Hospital Charge Code |
179241
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$648.21 |
| Max. Negotiated Rate |
$1,325.88 |
| Rate for Payer: Aetna American Axle |
$957.58
|
| Rate for Payer: Aetna Commercial |
$1,252.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.58
|
| Rate for Payer: Cash Price |
$1,178.56
|
| Rate for Payer: Cofinity Advantage |
$1,031.24
|
| Rate for Payer: Cofinity Commercial |
$1,266.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.56
|
| Rate for Payer: Healthscope Commercial |
$1,325.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,031.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.90
|
| Rate for Payer: PHP Commercial |
$1,252.22
|
| Rate for Payer: Priority Health SBD |
$928.12
|
| Rate for Payer: UMR Bronson Commercial |
$648.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.90
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
OP
|
$46.85
|
|
|
Service Code
|
NDC 62559042007
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna American Axle |
$30.45
|
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna Medicare |
$23.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.45
|
| Rate for Payer: BCBS Complete |
$18.74
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Advantage |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: Priority Health SBD |
$29.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.45
|
| Rate for Payer: UHC Core |
$24.41
|
| Rate for Payer: UHC Exchange |
$18.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.14
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
NDC 62559042007
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna American Axle |
$30.45
|
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.45
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Advantage |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: Priority Health SBD |
$29.52
|
| Rate for Payer: UMR Bronson Commercial |
$20.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.14
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
10535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.69
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: UHC Exchange |
$15.53
|
| Rate for Payer: UMR Bronson Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,595.40
|
|
|
Service Code
|
NDC 68382043528
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,700.30 |
| Max. Negotiated Rate |
$4,135.86 |
| Rate for Payer: Aetna American Axle |
$2,987.01
|
| Rate for Payer: Aetna Commercial |
$3,906.09
|
| Rate for Payer: Aetna Medicare |
$2,297.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,987.01
|
| Rate for Payer: BCBS Complete |
$1,838.16
|
| Rate for Payer: Cash Price |
$3,676.32
|
| Rate for Payer: Cofinity Advantage |
$3,216.78
|
| Rate for Payer: Cofinity Commercial |
$3,952.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,676.32
|
| Rate for Payer: Healthscope Commercial |
$4,135.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,216.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,446.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,676.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,906.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,446.55
|
| Rate for Payer: PHP Commercial |
$3,906.09
|
| Rate for Payer: Priority Health SBD |
$2,895.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,987.01
|
| Rate for Payer: UHC Core |
$2,394.20
|
| Rate for Payer: UHC Exchange |
$1,805.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,700.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,446.55
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,595.40
|
|
|
Service Code
|
NDC 68382043528
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,021.98 |
| Max. Negotiated Rate |
$4,135.86 |
| Rate for Payer: Aetna American Axle |
$2,987.01
|
| Rate for Payer: Aetna Commercial |
$3,906.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,987.01
|
| Rate for Payer: Cash Price |
$3,676.32
|
| Rate for Payer: Cofinity Advantage |
$3,216.78
|
| Rate for Payer: Cofinity Commercial |
$3,952.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,676.32
|
| Rate for Payer: Healthscope Commercial |
$4,135.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,216.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,446.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,906.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,446.55
|
| Rate for Payer: PHP Commercial |
$3,906.09
|
| Rate for Payer: Priority Health SBD |
$2,895.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,021.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,446.55
|
|
|
MESALAMINE ER 0.375 GRAM CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,756.02
|
|
|
Service Code
|
NDC 65649010302
|
| Hospital Charge Code |
95687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$649.73 |
| Max. Negotiated Rate |
$1,580.42 |
| Rate for Payer: Aetna American Axle |
$1,141.41
|
| Rate for Payer: Aetna Commercial |
$1,492.62
|
| Rate for Payer: Aetna Medicare |
$878.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.41
|
| Rate for Payer: BCBS Complete |
$702.41
|
| Rate for Payer: Cash Price |
$1,404.82
|
| Rate for Payer: Cofinity Advantage |
$1,229.21
|
| Rate for Payer: Cofinity Commercial |
$1,510.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.82
|
| Rate for Payer: Healthscope Commercial |
$1,580.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,404.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,317.02
|
| Rate for Payer: PHP Commercial |
$1,492.62
|
| Rate for Payer: Priority Health SBD |
$1,106.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.41
|
| Rate for Payer: UHC Core |
$914.89
|
| Rate for Payer: UHC Exchange |
$690.12
|
| Rate for Payer: UMR Bronson Commercial |
$649.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.02
|
|
|
MESALAMINE ER 0.375 GRAM CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,756.02
|
|
|
Service Code
|
NDC 65649010302
|
| Hospital Charge Code |
95687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$772.65 |
| Max. Negotiated Rate |
$1,580.42 |
| Rate for Payer: Aetna American Axle |
$1,141.41
|
| Rate for Payer: Aetna Commercial |
$1,492.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.41
|
| Rate for Payer: Cash Price |
$1,404.82
|
| Rate for Payer: Cofinity Advantage |
$1,229.21
|
| Rate for Payer: Cofinity Commercial |
$1,510.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.82
|
| Rate for Payer: Healthscope Commercial |
$1,580.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,317.02
|
| Rate for Payer: PHP Commercial |
$1,492.62
|
| Rate for Payer: Priority Health SBD |
$1,106.29
|
| Rate for Payer: UMR Bronson Commercial |
$772.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.02
|
|
|
MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$2,507.72
|
|
|
Service Code
|
NDC 54092018981
|
| Hospital Charge Code |
10533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,103.40 |
| Max. Negotiated Rate |
$2,256.95 |
| Rate for Payer: Aetna American Axle |
$1,630.02
|
| Rate for Payer: Aetna Commercial |
$2,131.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.02
|
| Rate for Payer: Cash Price |
$2,006.18
|
| Rate for Payer: Cofinity Advantage |
$1,755.40
|
| Rate for Payer: Cofinity Commercial |
$2,156.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.18
|
| Rate for Payer: Healthscope Commercial |
$2,256.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,755.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.79
|
| Rate for Payer: PHP Commercial |
$2,131.56
|
| Rate for Payer: Priority Health SBD |
$1,579.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.79
|
|
