|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 60687010511
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cofinity Advantage |
$4.69
|
| Rate for Payer: Cofinity Commercial |
$5.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.03
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: Priority Health SBD |
$4.22
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$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 Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| 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: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
MEDROXYPROGESTERONE 10 MG TABLET
|
Facility
|
IP
|
$200.88
|
|
|
Service Code
|
NDC 60687010521
|
| Hospital Charge Code |
4854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.55 |
| Max. Negotiated Rate |
$180.79 |
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.57
|
| Rate for Payer: Cash Price |
$160.70
|
| Rate for Payer: Cofinity Advantage |
$140.62
|
| Rate for Payer: Cofinity Commercial |
$172.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.66
|
| Rate for Payer: PHP Commercial |
$170.75
|
| Rate for Payer: Priority Health SBD |
$126.55
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$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 |
$47.93
|
| Rate for Payer: Aetna Commercial |
$94.53
|
| Rate for Payer: Aetna Commercial |
$161.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.29
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Cofinity Advantage |
$167.34
|
| Rate for Payer: Cofinity Advantage |
$77.85
|
| Rate for Payer: Cofinity Advantage |
$39.47
|
| Rate for Payer: Cofinity Advantage |
$133.15
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$163.58
|
| Rate for Payer: Cofinity Commercial |
$95.64
|
| 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: Encore Health Key Benefits Commercial |
$191.25
|
| Rate for Payer: Healthscope Commercial |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$50.75
|
| Rate for Payer: Healthscope Commercial |
$100.09
|
| Rate for Payer: Healthscope Commercial |
$171.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.68
|
| 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 |
$94.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.66
|
| Rate for Payer: PHP Commercial |
$203.20
|
| Rate for Payer: PHP Commercial |
$161.68
|
| Rate for Payer: PHP Commercial |
$94.53
|
| Rate for Payer: PHP Commercial |
$47.93
|
| Rate for Payer: Priority Health SBD |
$119.83
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: Priority Health SBD |
$150.61
|
| Rate for Payer: Priority Health SBD |
$70.06
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$190.21
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
112224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$171.19 |
| Rate for Payer: Aetna Commercial |
$161.68
|
| Rate for Payer: Aetna Commercial |
$47.93
|
| Rate for Payer: Aetna Commercial |
$203.20
|
| Rate for Payer: Aetna Commercial |
$94.53
|
| Rate for Payer: Aetna Medicare |
$95.11
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna Medicare |
$119.53
|
| Rate for Payer: Aetna Medicare |
$55.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.64
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: BCBS Complete |
$76.08
|
| Rate for Payer: BCBS Complete |
$44.48
|
| Rate for Payer: BCBS Complete |
$95.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: Cofinity Advantage |
$39.47
|
| Rate for Payer: Cofinity Advantage |
$77.85
|
| Rate for Payer: Cofinity Advantage |
$167.34
|
| Rate for Payer: Cofinity Advantage |
$133.15
|
| Rate for Payer: Cofinity Commercial |
$95.64
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$163.58
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| 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 |
$191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.17
|
| Rate for Payer: Healthscope Commercial |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$100.09
|
| Rate for Payer: Healthscope Commercial |
$50.75
|
| Rate for Payer: Healthscope Commercial |
$171.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.11
|
| 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 |
$94.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.29
|
| Rate for Payer: PHP Commercial |
$203.20
|
| Rate for Payer: PHP Commercial |
$161.68
|
| Rate for Payer: PHP Commercial |
$47.93
|
| Rate for Payer: PHP Commercial |
$94.53
|
| Rate for Payer: Priority Health SBD |
$70.06
|
| Rate for Payer: Priority Health SBD |
$150.61
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: Priority Health SBD |
$119.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Advantage |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.37 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Advantage |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.47
|
| Rate for Payer: UHC Core |
$154.27
|
| Rate for Payer: UHC Exchange |
$116.37
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$40.66
|
|
|
Service Code
|
NDC 00121094510
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$40.66
|
|
|
Service Code
|
NDC 00121094510
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna Medicare |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: BCBS Complete |
$16.26
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$21.18
|
| Rate for Payer: UHC Exchange |
$15.98
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00121477640
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Advantage |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.49
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.02
|
| Rate for Payer: UHC Core |
$23.26
|
| Rate for Payer: UHC Exchange |
$17.55
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$25.25
|
|
|
Service Code
|
NDC 69339016001
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.46
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.41
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.20
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.94
|
| Rate for Payer: PHP Commercial |
$21.46
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.41
|
| Rate for Payer: UHC Core |
$13.16
|
| Rate for Payer: UHC Exchange |
$9.92
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$40.66
|
|
|
Service Code
|
NDC 69339016017
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna Medicare |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: BCBS Complete |
$16.26
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$21.18
|
| Rate for Payer: UHC Exchange |
$15.98
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00121477640
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Advantage |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.49
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health SBD |
$28.13
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$31.73
|
|
|
Service Code
|
NDC 00121477610
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Aetna Commercial |
$26.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.62
|
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Cofinity Advantage |
$22.21
|
| Rate for Payer: Cofinity Commercial |
$27.29
|
| 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: Opus (Opus Packaging Group) HMA |
$23.80
|
| Rate for Payer: PHP Commercial |
$26.97
|
| Rate for Payer: Priority Health SBD |
$19.99
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$40.66
|
|
|
Service Code
|
NDC 69339016017
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$40.66
|
|
|
Service Code
|
NDC 00121094500
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$40.66
|
|
|
Service Code
|
NDC 00121094500
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$36.59 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna Medicare |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.43
|
| Rate for Payer: BCBS Complete |
$16.26
|
| Rate for Payer: Cash Price |
$32.53
|
| Rate for Payer: Cofinity Advantage |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$34.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$36.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.50
|
| Rate for Payer: PHP Commercial |
$34.56
|
| Rate for Payer: Priority Health SBD |
$25.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$21.18
|
| Rate for Payer: UHC Exchange |
$15.98
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$25.25
|
|
|
Service Code
|
NDC 69339016001
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.41
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.20
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.94
|
| Rate for Payer: PHP Commercial |
$21.46
|
| Rate for Payer: Priority Health SBD |
$15.91
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$31.73
|
|
|
Service Code
|
NDC 00121477610
|
| Hospital Charge Code |
162543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| 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 Advantage |
$22.21
|
| Rate for Payer: Cofinity Commercial |
$27.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.38
|
| Rate for Payer: Healthscope Commercial |
$28.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.80
|
| Rate for Payer: PHP Commercial |
$26.97
|
| Rate for Payer: Priority Health SBD |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.62
|
| Rate for Payer: UHC Core |
$16.53
|
| Rate for Payer: UHC Exchange |
$12.47
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.99 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC Core |
$115.32
|
| Rate for Payer: UHC Exchange |
$86.99
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904723661
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.14 |
| 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 Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.85
|
| Rate for Payer: UHC Core |
$108.89
|
| Rate for Payer: UHC Exchange |
$82.14
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 00904723661
|
| Hospital Charge Code |
4871
|
|
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 Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| 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: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$1,201.75
|
|
|
Service Code
|
NDC 64380015903
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$472.29 |
| Max. Negotiated Rate |
$1,081.58 |
| Rate for Payer: Aetna Commercial |
$1,021.49
|
| Rate for Payer: Aetna Medicare |
$600.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.14
|
| Rate for Payer: BCBS Complete |
$480.70
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: Cofinity Advantage |
$841.23
|
| Rate for Payer: Cofinity Commercial |
$1,033.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.40
|
| Rate for Payer: Healthscope Commercial |
$1,081.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$961.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.31
|
| Rate for Payer: PHP Commercial |
$1,021.49
|
| Rate for Payer: Priority Health SBD |
$757.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$781.14
|
| Rate for Payer: UHC Core |
$626.11
|
| Rate for Payer: UHC Exchange |
$472.29
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$1,201.75
|
|
|
Service Code
|
NDC 64380015903
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$757.10 |
| Max. Negotiated Rate |
$1,081.58 |
| Rate for Payer: Aetna Commercial |
$1,021.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.14
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: Cofinity Advantage |
$841.23
|
| Rate for Payer: Cofinity Commercial |
$1,033.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.40
|
| Rate for Payer: Healthscope Commercial |
$1,081.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.31
|
| Rate for Payer: PHP Commercial |
$1,021.49
|
| Rate for Payer: Priority Health SBD |
$757.10
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.45 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
|
