|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 16571082401
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 53746044201
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna American Axle |
$164.97
|
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UMR Bronson Commercial |
$111.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084049111
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 68084049111
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 68084049101
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$430.35
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna American Axle |
$279.73
|
| Rate for Payer: Aetna Commercial |
$365.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.73
|
| Rate for Payer: Cash Price |
$344.28
|
| Rate for Payer: Cofinity Commercial |
$301.24
|
| Rate for Payer: Cofinity Commercial |
$370.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.28
|
| Rate for Payer: Healthscope Commercial |
$387.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.80
|
| Rate for Payer: PHP Commercial |
$365.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.73
|
| Rate for Payer: Priority Health SBD |
$271.12
|
| Rate for Payer: UMR Bronson Commercial |
$189.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.76
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$245.76
|
|
|
Service Code
|
NDC 51079051120
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$122.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: BCBS Complete |
$98.30
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$90.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$430.35
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.23 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna American Axle |
$279.73
|
| Rate for Payer: Aetna Commercial |
$365.80
|
| Rate for Payer: Aetna Medicare |
$215.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.73
|
| Rate for Payer: BCBS Complete |
$172.14
|
| Rate for Payer: Cash Price |
$344.28
|
| Rate for Payer: Cofinity Commercial |
$301.24
|
| Rate for Payer: Cofinity Commercial |
$370.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.28
|
| Rate for Payer: Healthscope Commercial |
$387.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.80
|
| Rate for Payer: PHP Commercial |
$365.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.73
|
| Rate for Payer: Priority Health SBD |
$271.12
|
| Rate for Payer: UMR Bronson Commercial |
$159.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.76
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.62 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$266.66
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$167.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 53746044201
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna American Axle |
$164.97
|
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UMR Bronson Commercial |
$93.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 51079051120
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$108.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna Medicare |
$190.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$266.66
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$140.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 68084049101
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 39402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$390.91 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,790.90
|
| Rate for Payer: BCN Commercial |
$5,790.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.00
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$390.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: Aetna American Axle |
$841.75
|
| Rate for Payer: Aetna Commercial |
$1,100.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Cofinity Commercial |
$906.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$906.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Healthscope Commercial |
$1,165.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$906.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$971.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.75
|
| Rate for Payer: Priority Health SBD |
$815.85
|
| Rate for Payer: UMR Bronson Commercial |
$569.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.25
|
|
|
MEDICAL MAGGOTS
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna American Axle |
$841.75
|
| Rate for Payer: Aetna Commercial |
$1,100.75
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.03
|
| Rate for Payer: BCN Commercial |
$74.03
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$906.50
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$906.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$1,165.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$906.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$971.25
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.75
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$1,100.75
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$815.85
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: UMR Bronson Commercial |
$479.15
|
| Rate for Payer: VA VA |
$194.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$971.25
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
OP
|
$733.63
|
|
|
Service Code
|
NDC 41679036513
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna Medicare |
$366.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: BCBS Complete |
$293.45
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.86
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$271.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
IP
|
$733.63
|
|
|
Service Code
|
NDC 41679036503
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.86
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$322.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
IP
|
$733.63
|
|
|
Service Code
|
NDC 41679036513
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.86
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$322.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL
|
Facility
|
OP
|
$733.63
|
|
|
Service Code
|
NDC 41679036503
|
| Hospital Charge Code |
10518
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$660.27 |
| Rate for Payer: Aetna American Axle |
$476.86
|
| Rate for Payer: Aetna Commercial |
$623.59
|
| Rate for Payer: Aetna Medicare |
$366.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.86
|
| Rate for Payer: BCBS Complete |
$293.45
|
| Rate for Payer: Cash Price |
$586.90
|
| Rate for Payer: Cofinity Commercial |
$513.54
|
| Rate for Payer: Cofinity Commercial |
$630.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.90
|
| Rate for Payer: Healthscope Commercial |
$660.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.59
|
| Rate for Payer: PHP Commercial |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.86
|
| Rate for Payer: Priority Health SBD |
$462.19
|
| Rate for Payer: UMR Bronson Commercial |
$271.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.22
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 59762374202
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
