Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MECLIZINE 12.5 MG TABLET

Facility

$366.70

Service Code	NDC 00904651661
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$146.68
Max. Negotiated Rate	$330.03
Rate for Payer: Aetna Commercial	$311.69
Rate for Payer: Aetna Medicare	$183.35
Rate for Payer: Aetna New Business (MI Preferred)	$238.35
Rate for Payer: BCBS Complete	$146.68
Rate for Payer: Cash Price	$293.36
Rate for Payer: Cofinity Commercial	$256.69
Rate for Payer: Cofinity Commercial	$315.36
Rate for Payer: Cofinity Medicare Advantage	$256.69
Rate for Payer: Encore Health Key Benefits Commercial	$293.36
Rate for Payer: Healthscope Commercial	$330.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.69
Rate for Payer: PHP Commercial	$311.69
Rate for Payer: Priority Health Cigna Priority Health	$238.35
Rate for Payer: Priority Health SBD	$231.02

MECLIZINE 12.5 MG TABLET

Facility

$163.40

Service Code	NDC 50268052215
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$102.94
Max. Negotiated Rate	$147.06
Rate for Payer: Aetna Commercial	$138.89
Rate for Payer: Aetna New Business (MI Preferred)	$106.21
Rate for Payer: Cash Price	$130.72
Rate for Payer: Cofinity Commercial	$114.38
Rate for Payer: Cofinity Commercial	$140.52
Rate for Payer: Cofinity Medicare Advantage	$114.38
Rate for Payer: Encore Health Key Benefits Commercial	$130.72
Rate for Payer: Healthscope Commercial	$147.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.89
Rate for Payer: PHP Commercial	$138.89
Rate for Payer: Priority Health Cigna Priority Health	$106.21
Rate for Payer: Priority Health SBD	$102.94

MECLIZINE 12.5 MG TABLET

Facility

$4.68

Service Code	NDC 51079042301
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.98
Rate for Payer: PHP Commercial	$3.98
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.95

MECLIZINE 12.5 MG TABLET

Facility

$4.68

Service Code	NDC 51079042301
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare	$2.34
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: BCBS Complete	$1.87
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.98
Rate for Payer: PHP Commercial	$3.98
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.95

MECLIZINE 12.5 MG TABLET

Facility

$3.27

Service Code	NDC 50268052211
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.78
Rate for Payer: Aetna New Business (MI Preferred)	$2.13
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cofinity Commercial	$2.29
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Cofinity Medicare Advantage	$2.29
Rate for Payer: Encore Health Key Benefits Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.78
Rate for Payer: PHP Commercial	$2.78
Rate for Payer: Priority Health Cigna Priority Health	$2.13
Rate for Payer: Priority Health SBD	$2.06

MECLIZINE 12.5 MG TABLET

Facility

$467.40

Service Code	NDC 51079042320
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$294.46
Max. Negotiated Rate	$420.66
Rate for Payer: Aetna Commercial	$397.29
Rate for Payer: Aetna New Business (MI Preferred)	$303.81
Rate for Payer: Cash Price	$373.92
Rate for Payer: Cofinity Commercial	$327.18
Rate for Payer: Cofinity Commercial	$401.96
Rate for Payer: Cofinity Medicare Advantage	$327.18
Rate for Payer: Encore Health Key Benefits Commercial	$373.92
Rate for Payer: Healthscope Commercial	$420.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.29
Rate for Payer: PHP Commercial	$397.29
Rate for Payer: Priority Health Cigna Priority Health	$303.81
Rate for Payer: Priority Health SBD	$294.46

MECLIZINE 25 MG TABLET

Facility

$140.64

Service Code	NDC 50268052315
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$126.58
Rate for Payer: Aetna Commercial	$119.54
Rate for Payer: Aetna Medicare	$70.32
Rate for Payer: Aetna New Business (MI Preferred)	$91.42
Rate for Payer: BCBS Complete	$56.26
Rate for Payer: Cash Price	$112.51
Rate for Payer: Cofinity Commercial	$120.95
Rate for Payer: Cofinity Commercial	$98.45
Rate for Payer: Cofinity Medicare Advantage	$98.45
Rate for Payer: Encore Health Key Benefits Commercial	$112.51
Rate for Payer: Healthscope Commercial	$126.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.54
Rate for Payer: PHP Commercial	$119.54
Rate for Payer: Priority Health Cigna Priority Health	$91.42
Rate for Payer: Priority Health SBD	$88.60

MECLIZINE 25 MG TABLET

Facility

$140.64

Service Code	NDC 50268052315
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$88.60
Max. Negotiated Rate	$126.58
Rate for Payer: Aetna Commercial	$119.54
Rate for Payer: Aetna New Business (MI Preferred)	$91.42
Rate for Payer: Cash Price	$112.51
Rate for Payer: Cofinity Commercial	$120.95
Rate for Payer: Cofinity Commercial	$98.45
Rate for Payer: Cofinity Medicare Advantage	$98.45
Rate for Payer: Encore Health Key Benefits Commercial	$112.51
Rate for Payer: Healthscope Commercial	$126.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.54
Rate for Payer: PHP Commercial	$119.54
Rate for Payer: Priority Health Cigna Priority Health	$91.42
Rate for Payer: Priority Health SBD	$88.60

MECLIZINE 25 MG TABLET

Facility

$2.82

Service Code	NDC 50268052311
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare	$1.41
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: BCBS Complete	$1.13
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.78

MECLIZINE 25 MG TABLET

Facility

$391.40

Service Code	NDC 00904737661
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$156.56
Max. Negotiated Rate	$352.26
Rate for Payer: Aetna Commercial	$332.69
Rate for Payer: Aetna Medicare	$195.70
Rate for Payer: Aetna New Business (MI Preferred)	$254.41
Rate for Payer: BCBS Complete	$156.56
Rate for Payer: Cash Price	$313.12
Rate for Payer: Cofinity Commercial	$273.98
Rate for Payer: Cofinity Commercial	$336.60
Rate for Payer: Cofinity Medicare Advantage	$273.98
Rate for Payer: Encore Health Key Benefits Commercial	$313.12
Rate for Payer: Healthscope Commercial	$352.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.69
Rate for Payer: PHP Commercial	$332.69
Rate for Payer: Priority Health Cigna Priority Health	$254.41
Rate for Payer: Priority Health SBD	$246.58

MECLIZINE 25 MG TABLET

Facility

$391.40

Service Code	NDC 00904737661
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$246.58
Max. Negotiated Rate	$352.26
Rate for Payer: Aetna Commercial	$332.69
Rate for Payer: Aetna New Business (MI Preferred)	$254.41
Rate for Payer: Cash Price	$313.12
Rate for Payer: Cofinity Commercial	$273.98
Rate for Payer: Cofinity Commercial	$336.60
Rate for Payer: Cofinity Medicare Advantage	$273.98
Rate for Payer: Encore Health Key Benefits Commercial	$313.12
Rate for Payer: Healthscope Commercial	$352.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.69
Rate for Payer: PHP Commercial	$332.69
Rate for Payer: Priority Health Cigna Priority Health	$254.41
Rate for Payer: Priority Health SBD	$246.58

MECLIZINE 25 MG TABLET

Facility

$2.82

Service Code	NDC 50268052311
Hospital Charge Code	12025
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.78

MEDICAL MAGGOTS

Facility

$1,295.00

Service Code	HCPCS 97602
Hospital Charge Code	300255
Hospital Revenue Code	636
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$1,165.50
Rate for Payer: Aetna Commercial	$1,100.75
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Aetna New Business (MI Preferred)	$841.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
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	$193.79
Rate for Payer: Healthscope Commercial	$1,165.50
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,100.75
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Commercial	$1,100.75
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$841.75
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Priority Health SBD	$815.85
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

MEDICAL MAGGOTS

Facility

$1,295.00

Service Code	HCPCS 97602
Hospital Charge Code	300255
Hospital Revenue Code	636
Min. Negotiated Rate	$815.85
Max. Negotiated Rate	$1,165.50
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: Multiplan/Beech St/PHCS Commercial	$1,100.75
Rate for Payer: PHP Commercial	$1,100.75
Rate for Payer: Priority Health Cigna Priority Health	$841.75
Rate for Payer: Priority Health SBD	$815.85

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$6.24

Service Code	NDC 60687010511
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna New Business (MI Preferred)	$4.06
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$4.37
Rate for Payer: Cofinity Commercial	$5.37
Rate for Payer: Cofinity Medicare Advantage	$4.37
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.30
Rate for Payer: PHP Commercial	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.06
Rate for Payer: Priority Health SBD	$3.93

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$209.00

Service Code	NDC 59762374202
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$104.50
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: BCBS Complete	$83.60
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: 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

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$187.06

Service Code	NDC 60687010521
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$117.85
Max. Negotiated Rate	$168.35
Rate for Payer: Aetna Commercial	$159.00
Rate for Payer: Aetna New Business (MI Preferred)	$121.59
Rate for Payer: Cash Price	$149.65
Rate for Payer: Cofinity Commercial	$130.94
Rate for Payer: Cofinity Commercial	$160.87
Rate for Payer: Cofinity Medicare Advantage	$130.94
Rate for Payer: Encore Health Key Benefits Commercial	$149.65
Rate for Payer: Healthscope Commercial	$168.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.00
Rate for Payer: PHP Commercial	$159.00
Rate for Payer: Priority Health Cigna Priority Health	$121.59
Rate for Payer: Priority Health SBD	$117.85

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$6.24

Service Code	NDC 60687010511
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna Medicare	$3.12
Rate for Payer: Aetna New Business (MI Preferred)	$4.06
Rate for Payer: BCBS Complete	$2.50
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$4.37
Rate for Payer: Cofinity Commercial	$5.37
Rate for Payer: Cofinity Medicare Advantage	$4.37
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.30
Rate for Payer: PHP Commercial	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.06
Rate for Payer: Priority Health SBD	$3.93

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$187.06

Service Code	NDC 60687010521
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$74.82
Max. Negotiated Rate	$168.35
Rate for Payer: Aetna Commercial	$159.00
Rate for Payer: Aetna Medicare	$93.53
Rate for Payer: Aetna New Business (MI Preferred)	$121.59
Rate for Payer: BCBS Complete	$74.82
Rate for Payer: Cash Price	$149.65
Rate for Payer: Cofinity Commercial	$130.94
Rate for Payer: Cofinity Commercial	$160.87
Rate for Payer: Cofinity Medicare Advantage	$130.94
Rate for Payer: Encore Health Key Benefits Commercial	$149.65
Rate for Payer: Healthscope Commercial	$168.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.00
Rate for Payer: PHP Commercial	$159.00
Rate for Payer: Priority Health Cigna Priority Health	$121.59
Rate for Payer: Priority Health SBD	$117.85

MEDROXYPROGESTERONE 10 MG TABLET

Facility

$209.00

Service Code	NDC 59762374202
Hospital Charge Code	4854
Hospital Revenue Code	637
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$188.10
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: 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

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE

Facility

$239.06

Service Code	HCPCS J1050
Hospital Charge Code	112224
Hospital Revenue Code	636
Min. Negotiated Rate	$150.61
Max. Negotiated Rate	$215.15
Rate for Payer: Aetna Commercial	$203.20
Rate for Payer: Aetna Commercial	$161.68
Rate for Payer: Aetna Commercial	$47.93
Rate for Payer: Aetna Commercial	$94.53
Rate for Payer: Aetna New Business (MI Preferred)	$123.64
Rate for Payer: Aetna New Business (MI Preferred)	$72.29
Rate for Payer: Aetna New Business (MI Preferred)	$155.39
Rate for Payer: Aetna New Business (MI Preferred)	$36.65
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$152.17
Rate for Payer: Cash Price	$88.97
Rate for Payer: Cash Price	$45.11
Rate for Payer: Cofinity Commercial	$77.85
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Commercial	$133.15
Rate for Payer: Cofinity Commercial	$163.58
Rate for Payer: Cofinity Commercial	$205.59
Rate for Payer: Cofinity Commercial	$167.34
Rate for Payer: Cofinity Commercial	$95.64
Rate for Payer: Cofinity Medicare Advantage	$77.85
Rate for Payer: Cofinity Medicare Advantage	$133.15
Rate for Payer: Cofinity Medicare Advantage	$167.34
Rate for Payer: Cofinity Medicare Advantage	$39.47
Rate for Payer: Encore Health Key Benefits Commercial	$191.25
Rate for Payer: Encore Health Key Benefits Commercial	$88.97
Rate for Payer: Encore Health Key Benefits Commercial	$152.17
Rate for Payer: Encore Health Key Benefits Commercial	$45.11
Rate for Payer: Healthscope Commercial	$171.19
Rate for Payer: Healthscope Commercial	$100.09
Rate for Payer: Healthscope Commercial	$50.75
Rate for Payer: Healthscope Commercial	$215.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.53
Rate for Payer: PHP Commercial	$94.53
Rate for Payer: PHP Commercial	$203.20
Rate for Payer: PHP Commercial	$161.68
Rate for Payer: PHP Commercial	$47.93
Rate for Payer: Priority Health Cigna Priority Health	$123.64
Rate for Payer: Priority Health Cigna Priority Health	$155.39
Rate for Payer: Priority Health Cigna Priority Health	$72.29
Rate for Payer: Priority Health Cigna Priority Health	$36.65
Rate for Payer: Priority Health SBD	$70.06
Rate for Payer: Priority Health SBD	$150.61
Rate for Payer: Priority Health SBD	$119.83
Rate for Payer: Priority Health SBD	$35.53

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE

Facility

$239.06

Service Code	HCPCS J1050
Hospital Charge Code	112224
Hospital Revenue Code	636
Min. Negotiated Rate	$95.62
Max. Negotiated Rate	$215.15
Rate for Payer: Aetna Commercial	$203.20
Rate for Payer: Aetna Commercial	$161.68
Rate for Payer: Aetna Commercial	$47.93
Rate for Payer: Aetna Commercial	$94.53
Rate for Payer: Aetna Medicare	$28.20
Rate for Payer: Aetna Medicare	$119.53
Rate for Payer: Aetna Medicare	$95.11
Rate for Payer: Aetna Medicare	$55.60
Rate for Payer: Aetna New Business (MI Preferred)	$155.39
Rate for Payer: Aetna New Business (MI Preferred)	$72.29
Rate for Payer: Aetna New Business (MI Preferred)	$123.64
Rate for Payer: Aetna New Business (MI Preferred)	$36.65
Rate for Payer: BCBS Complete	$44.48
Rate for Payer: BCBS Complete	$22.56
Rate for Payer: BCBS Complete	$76.08
Rate for Payer: BCBS Complete	$95.62
Rate for Payer: Cash Price	$45.11
Rate for Payer: Cash Price	$152.17
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$88.97
Rate for Payer: Cofinity Commercial	$163.58
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Cofinity Commercial	$167.34
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Commercial	$205.59
Rate for Payer: Cofinity Commercial	$77.85
Rate for Payer: Cofinity Commercial	$95.64
Rate for Payer: Cofinity Commercial	$133.15
Rate for Payer: Cofinity Medicare Advantage	$167.34
Rate for Payer: Cofinity Medicare Advantage	$77.85
Rate for Payer: Cofinity Medicare Advantage	$133.15
Rate for Payer: Cofinity Medicare Advantage	$39.47
Rate for Payer: Encore Health Key Benefits Commercial	$191.25
Rate for Payer: Encore Health Key Benefits Commercial	$45.11
Rate for Payer: Encore Health Key Benefits Commercial	$88.97
Rate for Payer: Encore Health Key Benefits Commercial	$152.17
Rate for Payer: Healthscope Commercial	$100.09
Rate for Payer: Healthscope Commercial	$50.75
Rate for Payer: Healthscope Commercial	$171.19
Rate for Payer: Healthscope Commercial	$215.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.53
Rate for Payer: PHP Commercial	$161.68
Rate for Payer: PHP Commercial	$47.93
Rate for Payer: PHP Commercial	$203.20
Rate for Payer: PHP Commercial	$94.53
Rate for Payer: Priority Health Cigna Priority Health	$123.64
Rate for Payer: Priority Health Cigna Priority Health	$155.39
Rate for Payer: Priority Health Cigna Priority Health	$72.29
Rate for Payer: Priority Health Cigna Priority Health	$36.65
Rate for Payer: Priority Health SBD	$70.06
Rate for Payer: Priority Health SBD	$150.61
Rate for Payer: Priority Health SBD	$119.83
Rate for Payer: Priority Health SBD	$35.53

MEDROXYPROGESTERONE 2.5 MG TABLET

Facility

$282.00

Service Code	NDC 00555087202
Hospital Charge Code	4855
Hospital Revenue Code	637
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna Commercial	$239.70
Rate for Payer: Aetna Medicare	$141.00
Rate for Payer: Aetna New Business (MI Preferred)	$183.30
Rate for Payer: BCBS Complete	$112.80
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cofinity Commercial	$197.40
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Medicare Advantage	$197.40
Rate for Payer: Encore Health Key Benefits Commercial	$225.60
Rate for Payer: Healthscope Commercial	$253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.70
Rate for Payer: PHP Commercial	$239.70
Rate for Payer: Priority Health Cigna Priority Health	$183.30
Rate for Payer: Priority Health SBD	$177.66

MEDROXYPROGESTERONE 2.5 MG TABLET

Facility

$282.00

Service Code	NDC 00555087202
Hospital Charge Code	4855
Hospital Revenue Code	637
Min. Negotiated Rate	$177.66
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna Commercial	$239.70
Rate for Payer: Aetna New Business (MI Preferred)	$183.30
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cofinity Commercial	$197.40
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Medicare Advantage	$197.40
Rate for Payer: Encore Health Key Benefits Commercial	$225.60
Rate for Payer: Healthscope Commercial	$253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.70
Rate for Payer: PHP Commercial	$239.70
Rate for Payer: Priority Health Cigna Priority Health	$183.30
Rate for Payer: Priority Health SBD	$177.66

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$31.73

Service Code	NDC 00121477610
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna Medicare	$15.87
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: BCBS Complete	$12.69
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Commercial	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Cofinity Medicare Advantage	$22.21
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.97
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health Cigna Priority Health	$20.62
Rate for Payer: Priority Health SBD	$19.99

Know your out-of-pocket cost for care.

All Charges