|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
IP
|
$744.04
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.38 |
| Max. Negotiated Rate |
$669.64 |
| Rate for Payer: Aetna American Axle |
$483.63
|
| Rate for Payer: Aetna Commercial |
$632.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.63
|
| Rate for Payer: Cash Price |
$595.23
|
| Rate for Payer: Cofinity Commercial |
$520.83
|
| Rate for Payer: Cofinity Commercial |
$639.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.23
|
| Rate for Payer: Healthscope Commercial |
$669.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.43
|
| Rate for Payer: PHP Commercial |
$632.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.63
|
| Rate for Payer: Priority Health SBD |
$468.75
|
| Rate for Payer: UMR Bronson Commercial |
$327.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.03
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
OP
|
$744.04
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.29 |
| Max. Negotiated Rate |
$669.64 |
| Rate for Payer: Aetna American Axle |
$483.63
|
| Rate for Payer: Aetna Commercial |
$632.43
|
| Rate for Payer: Aetna Medicare |
$372.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.63
|
| Rate for Payer: BCBS Complete |
$297.62
|
| Rate for Payer: Cash Price |
$595.23
|
| Rate for Payer: Cofinity Commercial |
$520.83
|
| Rate for Payer: Cofinity Commercial |
$639.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.23
|
| Rate for Payer: Healthscope Commercial |
$669.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.43
|
| Rate for Payer: PHP Commercial |
$632.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.63
|
| Rate for Payer: Priority Health SBD |
$468.75
|
| Rate for Payer: UMR Bronson Commercial |
$275.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.03
|
|
|
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 |
$253.14
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Commercial |
$331.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.14
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cofinity Commercial |
$334.92
|
| Rate for Payer: Cofinity Commercial |
$272.61
|
| Rate for Payer: Cofinity Commercial |
$266.25
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Healthscope Commercial |
$350.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: PHP Commercial |
$331.02
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: Priority Health SBD |
$245.35
|
| Rate for Payer: UMR Bronson Commercial |
$167.36
|
| Rate for Payer: UMR Bronson Commercial |
$171.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.08
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$380.36
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.73 |
| Max. Negotiated Rate |
$342.32 |
| Rate for Payer: Aetna American Axle |
$247.23
|
| Rate for Payer: Aetna American Axle |
$253.14
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Commercial |
$331.02
|
| Rate for Payer: Aetna Medicare |
$190.18
|
| Rate for Payer: Aetna Medicare |
$194.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.14
|
| Rate for Payer: BCBS Complete |
$155.78
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Commercial |
$266.25
|
| Rate for Payer: Cofinity Commercial |
$272.61
|
| Rate for Payer: Cofinity Commercial |
$334.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Healthscope Commercial |
$350.50
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: PHP Commercial |
$331.02
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: Priority Health SBD |
$245.35
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: UMR Bronson Commercial |
$140.73
|
| Rate for Payer: UMR Bronson Commercial |
$144.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.27
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 46876000040
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00799000104
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00799000104
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 46876000040
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$34.75
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$17.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: BCBS Complete |
$13.90
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$31.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.54
|
| Rate for Payer: PHP Commercial |
$29.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.59
|
| Rate for Payer: Priority Health SBD |
$21.89
|
| Rate for Payer: UMR Bronson Commercial |
$12.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.06
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.75
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$31.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.54
|
| Rate for Payer: PHP Commercial |
$29.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.59
|
| Rate for Payer: Priority Health SBD |
$21.89
|
| Rate for Payer: UMR Bronson Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna American Axle |
$23.45
|
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: UMR Bronson Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna American Axle |
$23.45
|
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna Medicare |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: BCBS Complete |
$14.43
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: UMR Bronson Commercial |
$13.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.06
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna American Axle |
$26.79
|
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.79
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$28.85
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.79
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: UMR Bronson Commercial |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$41.21
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
116146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna American Axle |
$26.79
|
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.79
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cofinity Commercial |
$28.85
|
| Rate for Payer: Cofinity Commercial |
$35.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$37.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.03
|
| Rate for Payer: PHP Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.79
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.91
|
|
|
MEPIVACAINE 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$18.92
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
4914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$17.03 |
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.08
|
| Rate for Payer: PHP Commercial |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health SBD |
$11.92
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.19
|
|
|
MEPIVACAINE 1 % (10 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$18.92
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
4914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$17.03 |
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.08
|
| Rate for Payer: PHP Commercial |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health SBD |
$11.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.19
|
|
|
MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$18.03
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health SBD |
$15.81
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$16.32
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$15.81
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
105638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,943.89
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$7,149.50 |
| Rate for Payer: Aetna American Axle |
$5,163.53
|
| Rate for Payer: Aetna Commercial |
$6,752.31
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.09
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$31.27
|
| Rate for Payer: BCN Medicare Advantage |
$31.27
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$6,831.75
|
| Rate for Payer: Cofinity Commercial |
$5,560.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.27
|
| Rate for Payer: Healthscope Commercial |
$7,149.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,560.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.92
|
| Rate for Payer: Mclaren Medicaid |
$16.76
|
| Rate for Payer: Mclaren Medicare |
$31.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.83
|
| Rate for Payer: Meridian Medicaid |
$17.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.31
|
| Rate for Payer: PACE Medicare |
$29.71
|
| Rate for Payer: PACE SWMI |
$31.27
|
| Rate for Payer: PHP Commercial |
$6,752.31
|
| Rate for Payer: PHP Medicare Advantage |
$31.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.53
|
| Rate for Payer: Priority Health Medicare |
$31.27
|
| Rate for Payer: Priority Health SBD |
$5,004.65
|
| Rate for Payer: Railroad Medicare Medicare |
$31.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.27
|
| Rate for Payer: UHC Exchange |
$59.76
|
| Rate for Payer: UHC Medicare Advantage |
$31.27
|
| Rate for Payer: UHCCP Medicaid |
$16.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,939.24
|
| Rate for Payer: VA VA |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.92
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,943.89
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,495.31 |
| Max. Negotiated Rate |
$7,149.50 |
| Rate for Payer: Aetna American Axle |
$5,163.53
|
| Rate for Payer: Aetna Commercial |
$6,752.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.53
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$5,560.72
|
| Rate for Payer: Cofinity Commercial |
$6,831.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.11
|
| Rate for Payer: Healthscope Commercial |
$7,149.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,560.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.31
|
| Rate for Payer: PHP Commercial |
$6,752.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.53
|
| Rate for Payer: Priority Health SBD |
$5,004.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,495.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.92
|
|
|
MERCAPTOPURINE 50 MG TABLET
|
Facility
|
OP
|
$117.84
|
|
|
Service Code
|
NDC 00054458111
|
| Hospital Charge Code |
10531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$106.06 |
| Rate for Payer: Aetna American Axle |
$76.60
|
| Rate for Payer: Aetna Commercial |
$100.16
|
| Rate for Payer: Aetna Medicare |
$58.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.60
|
| Rate for Payer: BCBS Complete |
$47.14
|
| Rate for Payer: Cash Price |
$94.27
|
| Rate for Payer: Cofinity Commercial |
$101.34
|
| Rate for Payer: Cofinity Commercial |
$82.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.27
|
| Rate for Payer: Healthscope Commercial |
$106.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.16
|
| Rate for Payer: PHP Commercial |
$100.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.60
|
| Rate for Payer: Priority Health SBD |
$74.24
|
| Rate for Payer: UMR Bronson Commercial |
$43.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.38
|
|
