|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$11.76
|
|
|
Service Code
|
NDC 09900001928
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health SBD |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$96.48
|
|
|
Service Code
|
NDC 58438000571
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$86.83 |
| Rate for Payer: Aetna American Axle |
$62.71
|
| Rate for Payer: Aetna Commercial |
$82.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.71
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$82.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.18
|
| Rate for Payer: Healthscope Commercial |
$86.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.01
|
| Rate for Payer: PHP Commercial |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.71
|
| Rate for Payer: Priority Health SBD |
$60.78
|
| Rate for Payer: UMR Bronson Commercial |
$42.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.36
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$75.76
|
|
|
Service Code
|
NDC 30768016836
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$68.18 |
| Rate for Payer: Aetna American Axle |
$49.24
|
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$37.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.24
|
| Rate for Payer: BCBS Complete |
$30.30
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$53.03
|
| Rate for Payer: Cofinity Commercial |
$65.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.61
|
| Rate for Payer: Healthscope Commercial |
$68.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.40
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.24
|
| Rate for Payer: Priority Health SBD |
$47.73
|
| Rate for Payer: UMR Bronson Commercial |
$28.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$11.76
|
|
|
Service Code
|
NDC 09900001928
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health SBD |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$74.73
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna American Axle |
$48.57
|
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.57
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$52.31
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health SBD |
$47.08
|
| Rate for Payer: UMR Bronson Commercial |
$32.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$175.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna American Axle |
$48.57
|
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$37.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.57
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$52.31
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health SBD |
$47.08
|
| Rate for Payer: UMR Bronson Commercial |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna American Axle |
$1.58
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$121.03
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$108.93 |
| Rate for Payer: Aetna American Axle |
$78.67
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.67
|
| Rate for Payer: BCBS Complete |
$48.41
|
| Rate for Payer: Cash Price |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$84.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.82
|
| Rate for Payer: Healthscope Commercial |
$108.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.67
|
| Rate for Payer: Priority Health SBD |
$76.25
|
| Rate for Payer: UMR Bronson Commercial |
$44.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.77
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$121.03
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$108.93 |
| Rate for Payer: Aetna American Axle |
$78.67
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.67
|
| Rate for Payer: Cash Price |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$84.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.82
|
| Rate for Payer: Healthscope Commercial |
$108.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.67
|
| Rate for Payer: Priority Health SBD |
$76.25
|
| Rate for Payer: UMR Bronson Commercial |
$53.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.77
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna Medicare |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$147.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$146.64
|
|
|
Service Code
|
NDC 31604002741
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna American Axle |
$95.32
|
| Rate for Payer: Aetna Commercial |
$124.64
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.32
|
| Rate for Payer: BCBS Complete |
$58.66
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Cofinity Commercial |
$126.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.31
|
| Rate for Payer: Healthscope Commercial |
$131.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.64
|
| Rate for Payer: PHP Commercial |
$124.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.32
|
| Rate for Payer: Priority Health SBD |
$92.38
|
| Rate for Payer: UMR Bronson Commercial |
$54.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.98
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna American Axle |
$1.58
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$48.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$146.64
|
|
|
Service Code
|
NDC 31604002741
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna American Axle |
$95.32
|
| Rate for Payer: Aetna Commercial |
$124.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.32
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Cofinity Commercial |
$126.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.31
|
| Rate for Payer: Healthscope Commercial |
$131.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.64
|
| Rate for Payer: PHP Commercial |
$124.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.32
|
| Rate for Payer: Priority Health SBD |
$92.38
|
| Rate for Payer: UMR Bronson Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.98
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MELOXICAM 7.5 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 69097015807
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.08
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.51
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.13
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2,550.41
|
|
|
Service Code
|
NDC 00456321063
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,122.18 |
| Max. Negotiated Rate |
$2,295.37 |
| Rate for Payer: Aetna American Axle |
$1,657.77
|
| Rate for Payer: Aetna Commercial |
$2,167.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.77
|
| Rate for Payer: Cash Price |
$2,040.33
|
| Rate for Payer: Cofinity Commercial |
$1,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,193.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.33
|
| Rate for Payer: Healthscope Commercial |
$2,295.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,785.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.85
|
| Rate for Payer: PHP Commercial |
$2,167.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.77
|
| Rate for Payer: Priority Health SBD |
$1,606.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,122.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$2,550.41
|
|
|
Service Code
|
NDC 00456321063
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$943.65 |
| Max. Negotiated Rate |
$2,295.37 |
| Rate for Payer: Aetna American Axle |
$1,657.77
|
| Rate for Payer: Aetna Commercial |
$2,167.85
|
| Rate for Payer: Aetna Medicare |
$1,275.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.77
|
| Rate for Payer: BCBS Complete |
$1,020.16
|
| Rate for Payer: Cash Price |
$2,040.33
|
| Rate for Payer: Cofinity Commercial |
$1,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,193.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.33
|
| Rate for Payer: Healthscope Commercial |
$2,295.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,785.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.85
|
| Rate for Payer: PHP Commercial |
$2,167.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.77
|
| Rate for Payer: Priority Health SBD |
$1,606.76
|
| Rate for Payer: UMR Bronson Commercial |
$943.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$99.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$25.51
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.13
|
|
