|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$151.63 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: BCBS Trust/PPO |
$139.15
|
| Rate for Payer: BCN Commercial |
$139.15
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Commercial |
$144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$151.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Nomi Health Commercial |
$138.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: PHP Commercial |
$143.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.26
|
| Rate for Payer: UHC Core |
$140.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.36
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.70 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: BCBS Trust/PPO |
$329.53
|
| Rate for Payer: BCN Commercial |
$329.53
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Nomi Health Commercial |
$327.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$347.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.12
|
| Rate for Payer: UHC Core |
$333.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.25
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$153.12
|
|
|
Service Code
|
NDC 60687073065
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: BCBS Trust/PPO |
$126.46
|
| Rate for Payer: BCN Commercial |
$126.46
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$131.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.50
|
| Rate for Payer: Healthscope Commercial |
$137.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.15
|
| Rate for Payer: Nomi Health Commercial |
$125.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.84
|
| Rate for Payer: PHP Commercial |
$130.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.75
|
| Rate for Payer: UHC Core |
$127.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.84
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna Medicare |
$28.48
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS Complete |
$18.69
|
| Rate for Payer: BCBS Complete |
$20.27
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS MAPPO |
$25.87
|
| Rate for Payer: BCBS MAPPO |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$27.38
|
| Rate for Payer: BCBS Trust/PPO |
$90.04
|
| Rate for Payer: BCBS Trust/PPO |
$83.02
|
| Rate for Payer: BCBS Trust/PPO |
$29.74
|
| Rate for Payer: BCBS Trust/PPO |
$85.06
|
| Rate for Payer: BCN Commercial |
$90.04
|
| Rate for Payer: BCN Commercial |
$29.74
|
| Rate for Payer: BCN Commercial |
$85.06
|
| Rate for Payer: BCN Commercial |
$83.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.38
|
| Rate for Payer: BCN Medicare Advantage |
$25.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.38
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.73
|
| Rate for Payer: Mclaren Medicaid |
$19.31
|
| Rate for Payer: Mclaren Medicaid |
$18.24
|
| Rate for Payer: Mclaren Medicaid |
$17.80
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Medicaid |
$18.69
|
| Rate for Payer: Meridian Medicaid |
$20.27
|
| Rate for Payer: Meridian Medicaid |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$19.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Nomi Health Commercial |
$29.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: PACE Senior Care Partners |
$26.01
|
| Rate for Payer: PACE Senior Care Partners |
$8.59
|
| Rate for Payer: PACE Senior Care Partners |
$23.98
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PACE SWMI |
$9.04
|
| Rate for Payer: PACE SWMI |
$25.87
|
| Rate for Payer: PACE SWMI |
$27.38
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$25.87
|
| Rate for Payer: PHP Medicare Advantage |
$27.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.85
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Medicare |
$27.65
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.28
|
| Rate for Payer: Railroad Medicare Medicare |
$27.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: Railroad Medicare Medicare |
$9.04
|
| Rate for Payer: Railroad Medicare Medicare |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.83
|
| Rate for Payer: UHC Core |
$84.32
|
| Rate for Payer: UHC Core |
$91.45
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Core |
$30.20
|
| Rate for Payer: UHC Exchange |
$27.38
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UHC Exchange |
$25.25
|
| Rate for Payer: UHC Medicaid |
$17.80
|
| Rate for Payer: UHC Medicaid |
$18.24
|
| Rate for Payer: UHC Medicaid |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$25.25
|
| Rate for Payer: UHC Medicare Advantage |
$9.04
|
| Rate for Payer: UHC Medicare Advantage |
$27.38
|
| Rate for Payer: UHCCP Medicaid |
$19.31
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$18.24
|
| Rate for Payer: UHCCP Medicaid |
$17.80
|
| Rate for Payer: VA VA |
$25.25
|
| Rate for Payer: VA VA |
$9.04
|
| Rate for Payer: VA VA |
$27.38
|
| Rate for Payer: VA VA |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: BCBS Trust/PPO |
$90.45
|
| Rate for Payer: BCBS Trust/PPO |
$29.87
|
| Rate for Payer: BCBS Trust/PPO |
$85.46
|
| Rate for Payer: BCBS Trust/PPO |
$83.40
|
| Rate for Payer: BCN Commercial |
$90.45
|
| Rate for Payer: BCN Commercial |
$83.40
|
| Rate for Payer: BCN Commercial |
$29.87
|
| Rate for Payer: BCN Commercial |
$85.46
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Nomi Health Commercial |
$29.66
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.13
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.38
|
| Rate for Payer: UHC Core |
$91.45
|
| Rate for Payer: UHC Core |
$30.20
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Core |
$84.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 59762005801
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.48 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$386.23
|
| Rate for Payer: BCN Commercial |
$386.23
|
| 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 Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| 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
|
$397.15
|
|
|
Service Code
|
NDC 00555087302
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.42 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: BCBS Trust/PPO |
$328.01
|
| Rate for Payer: BCN Commercial |
$328.01
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$345.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.49
|
| Rate for Payer: UHC Core |
$331.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 00555087302
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna Medicare |
$103.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.11
|
| Rate for Payer: BCBS Complete |
$73.51
|
| Rate for Payer: BCBS MAPPO |
$99.29
|
| Rate for Payer: BCBS Trust/PPO |
$326.50
|
| Rate for Payer: BCN Commercial |
$326.50
|
| Rate for Payer: BCN Medicare Advantage |
$99.29
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.29
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Mclaren Medicaid |
$70.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.25
|
| Rate for Payer: Meridian Medicaid |
$73.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: PACE Senior Care Partners |
$94.32
|
| Rate for Payer: PACE SWMI |
$99.29
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: PHP Medicare Advantage |
$99.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$345.52
|
| Rate for Payer: Priority Health Medicare |
$100.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.42
|
| Rate for Payer: Railroad Medicare Medicare |
$99.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.49
|
| Rate for Payer: UHC Core |
$331.62
|
| Rate for Payer: UHC Exchange |
$99.29
|
| Rate for Payer: UHC Medicaid |
$70.02
|
| Rate for Payer: UHC Medicare Advantage |
$99.29
|
| Rate for Payer: UHCCP Medicaid |
$70.02
|
| Rate for Payer: VA VA |
$99.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 59762005801
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$121.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.14
|
| Rate for Payer: BCBS Complete |
$86.56
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$384.46
|
| Rate for Payer: BCN Medicare Advantage |
$116.91
|
| 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: Health Alliance Plan Medicare Advantage |
$116.91
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Mclaren Medicaid |
$82.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: Meridian Medicaid |
$86.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PACE Senior Care Partners |
$111.07
|
| Rate for Payer: PACE SWMI |
$116.91
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: PHP Medicare Advantage |
$116.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| Rate for Payer: Railroad Medicare Medicare |
$116.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicaid |
$82.45
|
| Rate for Payer: UHC Medicare Advantage |
$116.91
|
| Rate for Payer: UHCCP Medicaid |
$82.45
|
| Rate for Payer: VA VA |
$116.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MEGESTROL 20 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 00555060602
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.94 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.29
|
| Rate for Payer: BCN Commercial |
$199.29
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
MEGESTROL 20 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 00555060602
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$60.33
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$198.37
|
| Rate for Payer: BCN Medicare Advantage |
$60.33
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.33
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Mclaren Medicaid |
$42.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: Meridian Medicaid |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.33
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UHC Medicaid |
$42.54
|
| Rate for Payer: UHC Medicare Advantage |
$60.33
|
| Rate for Payer: UHCCP Medicaid |
$42.54
|
| Rate for Payer: VA VA |
$60.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$636.50
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna Commercial |
$541.02
|
| Rate for Payer: Aetna Medicare |
$165.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.91
|
| Rate for Payer: BCBS Complete |
$117.82
|
| Rate for Payer: BCBS MAPPO |
$159.12
|
| Rate for Payer: BCBS Trust/PPO |
$523.27
|
| Rate for Payer: BCN Commercial |
$523.27
|
| Rate for Payer: BCN Medicare Advantage |
$159.12
|
| Rate for Payer: Cash Price |
$509.20
|
| Rate for Payer: Cofinity Commercial |
$547.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.12
|
| Rate for Payer: Healthscope Commercial |
$572.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.38
|
| Rate for Payer: Mclaren Medicaid |
$112.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.08
|
| Rate for Payer: Meridian Medicaid |
$117.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.02
|
| Rate for Payer: Nomi Health Commercial |
$521.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.38
|
| Rate for Payer: PACE Senior Care Partners |
$151.17
|
| Rate for Payer: PACE SWMI |
$159.12
|
| Rate for Payer: PHP Commercial |
$541.02
|
| Rate for Payer: PHP Medicare Advantage |
$159.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$553.75
|
| Rate for Payer: Priority Health Medicare |
$160.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.00
|
| Rate for Payer: Railroad Medicare Medicare |
$159.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.12
|
| Rate for Payer: UHC Core |
$531.48
|
| Rate for Payer: UHC Exchange |
$159.12
|
| Rate for Payer: UHC Medicaid |
$112.21
|
| Rate for Payer: UHC Medicare Advantage |
$159.12
|
| Rate for Payer: UHCCP Medicaid |
$112.21
|
| Rate for Payer: VA VA |
$159.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.38
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$636.50
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$443.00 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna Commercial |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$525.69
|
| Rate for Payer: BCN Commercial |
$525.69
|
| Rate for Payer: Cash Price |
$509.20
|
| Rate for Payer: Cofinity Commercial |
$547.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.20
|
| Rate for Payer: Healthscope Commercial |
$572.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.02
|
| Rate for Payer: Nomi Health Commercial |
$521.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.38
|
| Rate for Payer: PHP Commercial |
$541.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$553.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.12
|
| Rate for Payer: UHC Core |
$531.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.38
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.17
|
| Rate for Payer: BCBS Complete |
$40.97
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$181.97
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Mclaren Medicaid |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.10
|
| Rate for Payer: Meridian Medicaid |
$40.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PACE Senior Care Partners |
$52.57
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Medicare |
$55.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.06
|
| Rate for Payer: Railroad Medicare Medicare |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicaid |
$39.02
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| Rate for Payer: UHCCP Medicaid |
$39.02
|
| Rate for Payer: VA VA |
$55.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.06 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$182.81
|
| Rate for Payer: BCN Commercial |
$182.81
|
| Rate for Payer: Cash Price |
$177.08
|
| 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: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.79 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$84.82
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$376.73
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Mclaren Medicaid |
$80.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: Meridian Medicaid |
$84.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicaid |
$80.79
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: UHCCP Medicaid |
$80.79
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$69.09
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$62.18 |
| Rate for Payer: Aetna Commercial |
$58.73
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$56.80
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$62.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.82
|
| Rate for Payer: Mclaren Medicaid |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$12.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.73
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.82
|
| Rate for Payer: PACE Senior Care Partners |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$58.73
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.11
|
| Rate for Payer: Priority Health Medicare |
$17.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.09
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.80
|
| Rate for Payer: UHC Core |
$57.69
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicaid |
$12.18
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$12.18
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Mclaren Medicaid |
$0.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PACE Senior Care Partners |
$0.89
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.27
|
| Rate for Payer: Priority Health Medicare |
$0.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.31
|
| Rate for Payer: UHC Core |
$3.14
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicaid |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: UHCCP Medicaid |
$0.66
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.70 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: BCBS Trust/PPO |
$310.54
|
| Rate for Payer: BCN Commercial |
$310.54
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$327.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$223.20
|
| Rate for Payer: BCN Commercial |
$223.20
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$309.11
|
| Rate for Payer: BCN Commercial |
$309.11
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Mclaren Medicaid |
$66.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: Meridian Medicaid |
$69.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PACE Senior Care Partners |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$327.12
|
| Rate for Payer: Priority Health Medicare |
$94.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.70
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.88
|
| Rate for Payer: UHC Core |
$313.96
|
| Rate for Payer: UHC Exchange |
$94.00
|
| Rate for Payer: UHC Medicaid |
$66.29
|
| Rate for Payer: UHC Medicare Advantage |
$94.00
|
| Rate for Payer: UHCCP Medicaid |
$66.29
|
| Rate for Payer: VA VA |
$94.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 68094011059
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.94 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$378.47
|
| Rate for Payer: BCN Commercial |
$378.47
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.59 |
| Max. Negotiated Rate |
$130.08 |
| Rate for Payer: Aetna Commercial |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$119.37
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$124.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$130.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Nomi Health Commercial |
$118.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.40
|
| Rate for Payer: PHP Commercial |
$122.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.19
|
| Rate for Payer: UHC Core |
$120.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.40
|
|
