|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 50268-522-11
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079-423-01
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.98
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.12
|
| Rate for Payer: UHC Core |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079-423-20
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.07 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: BCBS Trust/PPO |
$361.21
|
| Rate for Payer: BCN Commercial |
$361.21
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.29
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.31
|
| Rate for Payer: UHC Core |
$390.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 0904-6517-61
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.34 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: BCBS Trust/PPO |
$294.40
|
| Rate for Payer: BCN Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.24
|
| Rate for Payer: UHC Core |
$318.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 50268-523-11
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.88
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.01
|
| Rate for Payer: UHC Core |
$3.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.42
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 0904-7376-61
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.34 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: BCBS Trust/PPO |
$294.40
|
| Rate for Payer: BCN Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.24
|
| Rate for Payer: UHC Core |
$318.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 59746-121-06
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$323.26
|
| Rate for Payer: BCN Commercial |
$323.26
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 65162-442-10
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$323.26
|
| Rate for Payer: BCN Commercial |
$323.26
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 50268-523-15
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.06 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$176.20
|
| Rate for Payer: BCN Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$284.05
|
|
|
Service Code
|
NDC 42806-014-01
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.24 |
| Max. Negotiated Rate |
$255.64 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: BCBS Trust/PPO |
$219.51
|
| Rate for Payer: BCN Commercial |
$219.51
|
| Rate for Payer: Cash Price |
$227.24
|
| Rate for Payer: Cofinity Commercial |
$244.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.24
|
| Rate for Payer: Healthscope Commercial |
$255.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.44
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Core |
$237.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.04
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
IP
|
$200.25
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.13 |
| Max. Negotiated Rate |
$180.22 |
| Rate for Payer: Aetna Commercial |
$170.21
|
| Rate for Payer: Aetna Commercial |
$170.18
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: BCBS Trust/PPO |
$154.72
|
| Rate for Payer: BCBS Trust/PPO |
$78.04
|
| Rate for Payer: BCBS Trust/PPO |
$154.75
|
| Rate for Payer: BCN Commercial |
$154.75
|
| Rate for Payer: BCN Commercial |
$154.72
|
| Rate for Payer: BCN Commercial |
$78.04
|
| Rate for Payer: Cash Price |
$160.17
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cofinity Commercial |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$172.22
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.20
|
| Rate for Payer: Healthscope Commercial |
$180.22
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Healthscope Commercial |
$180.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.21
|
| Rate for Payer: PHP Commercial |
$170.18
|
| Rate for Payer: PHP Commercial |
$170.21
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.86
|
| Rate for Payer: UHC Core |
$84.32
|
| Rate for Payer: UHC Core |
$167.18
|
| Rate for Payer: UHC Core |
$167.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.74
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 59762-0058-1
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.22 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$361.40
|
| Rate for Payer: BCN Commercial |
$361.40
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.50
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 0555-0873-02
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$219.75
|
| Rate for Payer: BCN Commercial |
$219.75
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
MEGESTROL 20 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 0555-0606-02
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Trust/PPO |
$214.30
|
| Rate for Payer: BCN Commercial |
$214.30
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.70
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$12.93
|
|
|
Service Code
|
NDC 9900-0003-43
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCN Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.99
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.38
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 9900-0003-41
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna Commercial |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.00
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$1.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.14
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.98
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$659.88
|
|
|
Service Code
|
NDC 60432-126-08
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$402.46 |
| Max. Negotiated Rate |
$593.89 |
| Rate for Payer: Aetna Commercial |
$560.90
|
| Rate for Payer: BCBS Trust/PPO |
$509.96
|
| Rate for Payer: BCN Commercial |
$509.96
|
| Rate for Payer: Cash Price |
$527.90
|
| Rate for Payer: Cofinity Commercial |
$567.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.90
|
| Rate for Payer: Healthscope Commercial |
$593.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$560.90
|
| Rate for Payer: PHP Commercial |
$560.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$574.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.69
|
| Rate for Payer: UHC Core |
$551.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.91
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 9900-0003-42
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 0904-3571-61
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.85 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: BCBS Trust/PPO |
$330.53
|
| Rate for Payer: BCN Commercial |
$330.53
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.38
|
| Rate for Payer: UHC Core |
$357.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$1,086.88
|
|
|
Service Code
|
NDC 64380-159-02
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$662.89 |
| Max. Negotiated Rate |
$978.19 |
| Rate for Payer: Aetna Commercial |
$923.85
|
| Rate for Payer: BCBS Trust/PPO |
$839.94
|
| Rate for Payer: BCN Commercial |
$839.94
|
| Rate for Payer: Cash Price |
$869.50
|
| Rate for Payer: Cofinity Commercial |
$934.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.50
|
| Rate for Payer: Healthscope Commercial |
$978.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$923.85
|
| Rate for Payer: PHP Commercial |
$923.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$945.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$662.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$956.45
|
| Rate for Payer: UHC Core |
$907.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.16
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$413.60
|
|
|
Service Code
|
NDC 0555-0607-02
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$372.24 |
| Rate for Payer: Aetna Commercial |
$351.56
|
| Rate for Payer: BCBS Trust/PPO |
$319.63
|
| Rate for Payer: BCN Commercial |
$319.63
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cofinity Commercial |
$355.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.88
|
| Rate for Payer: Healthscope Commercial |
$372.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.56
|
| Rate for Payer: PHP Commercial |
$351.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.97
|
| Rate for Payer: UHC Core |
$345.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.20
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 6809411061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.36 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$151.24
|
| Rate for Payer: BCN Commercial |
$151.24
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 7733351625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.94
|
| Rate for Payer: BCN Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.24
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 5026852415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.71 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: BCBS Trust/PPO |
$164.36
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.78
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.16
|
| Rate for Payer: UHC Core |
$177.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 7733351610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.19 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: BCBS Trust/PPO |
$294.20
|
| Rate for Payer: BCN Commercial |
$294.20
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
