|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 60687073011
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health HMO/PPO |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.79
|
| Rate for Payer: UHC Core |
$3.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.72
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: BCBS MAPPO |
$104.58
|
| Rate for Payer: BCBS Trust/PPO |
$343.88
|
| Rate for Payer: BCN Commercial |
$325.23
|
| Rate for Payer: BCN Medicare Advantage |
$104.58
|
| 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: Health Alliance Plan Medicare Advantage |
$104.58
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: PACE Senior Care Partners |
$99.35
|
| Rate for Payer: PACE SWMI |
$104.58
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: PHP Medicare Advantage |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Medicare |
$105.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.58
|
| Rate for Payer: UHC Exchange |
$104.58
|
| Rate for Payer: UHC Medicare Advantage |
$104.58
|
| Rate for Payer: VA VA |
$104.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 65162044210
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$341.46
|
| 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 Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.26
|
| 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
|
$127.92
|
|
|
Service Code
|
NDC 60687073065
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$115.13 |
| Rate for Payer: Aetna Commercial |
$108.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.42
|
| Rate for Payer: BCN Commercial |
$98.86
|
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Cofinity Commercial |
$110.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.34
|
| Rate for Payer: Healthscope Commercial |
$115.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.73
|
| Rate for Payer: Nomi Health Commercial |
$104.89
|
| Rate for Payer: PHP Commercial |
$108.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.15
|
| Rate for Payer: Priority Health HMO/PPO |
$111.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.57
|
| Rate for Payer: UHC Core |
$106.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.94
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$140.64
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: Aetna Medicare |
$36.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.95
|
| Rate for Payer: BCBS Complete |
$56.26
|
| Rate for Payer: BCBS MAPPO |
$35.16
|
| Rate for Payer: BCBS Trust/PPO |
$115.62
|
| Rate for Payer: BCN Commercial |
$109.35
|
| Rate for Payer: BCN Medicare Advantage |
$35.16
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$120.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.16
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: PACE Senior Care Partners |
$33.40
|
| Rate for Payer: PACE SWMI |
$35.16
|
| Rate for Payer: PHP Commercial |
$119.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO |
$122.36
|
| Rate for Payer: Priority Health Medicare |
$35.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.23
|
| Rate for Payer: Railroad Medicare Medicare |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.76
|
| Rate for Payer: UHC Core |
$117.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.16
|
| Rate for Payer: UHC Exchange |
$35.16
|
| Rate for Payer: UHC Medicare Advantage |
$35.16
|
| Rate for Payer: VA VA |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.48
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna Medicare |
$99.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.05
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: BCBS MAPPO |
$95.24
|
| Rate for Payer: BCBS Trust/PPO |
$313.18
|
| Rate for Payer: BCN Commercial |
$296.19
|
| Rate for Payer: BCN Medicare Advantage |
$95.24
|
| 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: Health Alliance Plan Medicare Advantage |
$95.24
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: PACE Senior Care Partners |
$90.48
|
| Rate for Payer: PACE SWMI |
$95.24
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: PHP Medicare Advantage |
$95.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health HMO/PPO |
$331.43
|
| Rate for Payer: Priority Health Medicare |
$96.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.24
|
| Rate for Payer: Railroad Medicare Medicare |
$95.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.24
|
| Rate for Payer: UHC Core |
$318.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.24
|
| Rate for Payer: UHC Exchange |
$95.24
|
| Rate for Payer: UHC Medicare Advantage |
$95.24
|
| Rate for Payer: VA VA |
$95.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$140.64
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.42 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: BCBS Trust/PPO |
$114.80
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$120.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: PHP Commercial |
$119.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO |
$122.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.76
|
| Rate for Payer: UHC Core |
$117.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.48
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2.45
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.89
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.62 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: BCBS Trust/PPO |
$310.97
|
| 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 Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health HMO/PPO |
$331.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.24
|
| 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 59746012106
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$341.46
|
| 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 Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.26
|
| 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
|
$284.05
|
|
|
Service Code
|
NDC 42806001401
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$255.64 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: BCBS Trust/PPO |
$231.87
|
| 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 Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: Priority Health HMO/PPO |
$247.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.31
|
| 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
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 65162044210
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.72
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: BCBS MAPPO |
$104.58
|
| Rate for Payer: BCBS Trust/PPO |
$343.88
|
| Rate for Payer: BCN Commercial |
$325.23
|
| Rate for Payer: BCN Medicare Advantage |
$104.58
|
| 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: Health Alliance Plan Medicare Advantage |
$104.58
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: PACE Senior Care Partners |
$99.35
|
| Rate for Payer: PACE SWMI |
$104.58
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: PHP Medicare Advantage |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health HMO/PPO |
$363.92
|
| Rate for Payer: Priority Health Medicare |
$105.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.58
|
| Rate for Payer: UHC Exchange |
$104.58
|
| Rate for Payer: UHC Medicare Advantage |
$104.58
|
| Rate for Payer: VA VA |
$104.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$284.05
|
|
|
Service Code
|
NDC 42806001401
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$255.64 |
| Rate for Payer: Aetna Commercial |
$241.44
|
| Rate for Payer: Aetna Medicare |
$73.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.77
|
| Rate for Payer: BCBS Complete |
$113.62
|
| Rate for Payer: BCBS MAPPO |
$71.01
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$220.85
|
| Rate for Payer: BCN Medicare Advantage |
$71.01
|
| 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: Health Alliance Plan Medicare Advantage |
$71.01
|
| Rate for Payer: Healthscope Commercial |
$255.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.44
|
| Rate for Payer: Nomi Health Commercial |
$232.92
|
| Rate for Payer: PACE Senior Care Partners |
$67.46
|
| Rate for Payer: PACE SWMI |
$71.01
|
| Rate for Payer: PHP Commercial |
$241.44
|
| Rate for Payer: PHP Medicare Advantage |
$71.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.63
|
| Rate for Payer: Priority Health HMO/PPO |
$247.12
|
| Rate for Payer: Priority Health Medicare |
$71.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.31
|
| Rate for Payer: Railroad Medicare Medicare |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Core |
$237.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.01
|
| Rate for Payer: UHC Exchange |
$71.01
|
| Rate for Payer: UHC Medicare Advantage |
$71.01
|
| Rate for Payer: VA VA |
$71.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.04
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$127.92
|
|
|
Service Code
|
NDC 60687073065
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$115.13 |
| Rate for Payer: Aetna Commercial |
$108.73
|
| Rate for Payer: Aetna Medicare |
$33.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.98
|
| Rate for Payer: BCBS Complete |
$51.17
|
| Rate for Payer: BCBS MAPPO |
$31.98
|
| Rate for Payer: BCBS Trust/PPO |
$105.16
|
| Rate for Payer: BCN Commercial |
$99.46
|
| Rate for Payer: BCN Medicare Advantage |
$31.98
|
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Cofinity Commercial |
$110.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.98
|
| Rate for Payer: Healthscope Commercial |
$115.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.73
|
| Rate for Payer: Nomi Health Commercial |
$104.89
|
| Rate for Payer: PACE Senior Care Partners |
$30.38
|
| Rate for Payer: PACE SWMI |
$31.98
|
| Rate for Payer: PHP Commercial |
$108.73
|
| Rate for Payer: PHP Medicare Advantage |
$31.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.15
|
| Rate for Payer: Priority Health HMO/PPO |
$111.29
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$31.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.57
|
| Rate for Payer: UHC Core |
$106.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.98
|
| Rate for Payer: UHC Exchange |
$31.98
|
| Rate for Payer: UHC Medicare Advantage |
$31.98
|
| Rate for Payer: VA VA |
$31.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.94
|
|
|
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 |
$23.98 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Commercial |
$93.03
|
| Rate for Payer: Aetna Medicare |
$28.46
|
| 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 |
$34.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$40.39
|
| Rate for Payer: BCBS Complete |
$43.78
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: BCBS MAPPO |
$25.24
|
| Rate for Payer: BCBS MAPPO |
$27.36
|
| Rate for Payer: BCBS MAPPO |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$27.38
|
| Rate for Payer: BCBS Trust/PPO |
$83.02
|
| Rate for Payer: BCBS Trust/PPO |
$29.74
|
| Rate for Payer: BCBS Trust/PPO |
$89.98
|
| Rate for Payer: BCBS Trust/PPO |
$90.04
|
| Rate for Payer: BCN Commercial |
$78.51
|
| Rate for Payer: BCN Commercial |
$85.15
|
| Rate for Payer: BCN Commercial |
$85.10
|
| Rate for Payer: BCN Commercial |
$28.12
|
| Rate for Payer: BCN Medicare Advantage |
$27.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.24
|
| Rate for Payer: BCN Medicare Advantage |
$27.38
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cash Price |
$87.56
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Cofinity Commercial |
$94.13
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.36
|
| 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 |
$98.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.73
|
| 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 |
$28.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Nomi Health Commercial |
$29.66
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$89.75
|
| Rate for Payer: PACE Senior Care Partners |
$23.98
|
| 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 |
$25.99
|
| Rate for Payer: PACE SWMI |
$27.36
|
| Rate for Payer: PACE SWMI |
$25.24
|
| Rate for Payer: PACE SWMI |
$27.38
|
| Rate for Payer: PACE SWMI |
$9.04
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: PHP Commercial |
$93.03
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: PHP Medicare Advantage |
$27.36
|
| Rate for Payer: PHP Medicare Advantage |
$25.24
|
| Rate for Payer: PHP Medicare Advantage |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.64
|
| Rate for Payer: Priority Health HMO/PPO |
$95.22
|
| Rate for Payer: Priority Health HMO/PPO |
$31.47
|
| Rate for Payer: Priority Health HMO/PPO |
$95.28
|
| Rate for Payer: Priority Health HMO/PPO |
$87.85
|
| Rate for Payer: Priority Health Medicare |
$27.65
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Medicare |
$27.64
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.66
|
| Rate for Payer: Railroad Medicare Medicare |
$27.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.32
|
| Rate for Payer: UHC Core |
$84.32
|
| Rate for Payer: UHC Core |
$30.20
|
| Rate for Payer: UHC Core |
$91.39
|
| Rate for Payer: UHC Core |
$91.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.36
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UHC Exchange |
$27.36
|
| Rate for Payer: UHC Exchange |
$25.24
|
| Rate for Payer: UHC Exchange |
$27.38
|
| Rate for Payer: UHC Medicare Advantage |
$9.04
|
| Rate for Payer: UHC Medicare Advantage |
$25.24
|
| Rate for Payer: UHC Medicare Advantage |
$27.38
|
| Rate for Payer: UHC Medicare Advantage |
$27.36
|
| Rate for Payer: VA VA |
$27.36
|
| Rate for Payer: VA VA |
$9.04
|
| Rate for Payer: VA VA |
$27.38
|
| Rate for Payer: VA VA |
$25.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
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 |
$71.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Commercial |
$93.03
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: BCBS Trust/PPO |
$89.40
|
| Rate for Payer: BCBS Trust/PPO |
$29.53
|
| Rate for Payer: BCBS Trust/PPO |
$89.34
|
| Rate for Payer: BCBS Trust/PPO |
$82.43
|
| Rate for Payer: BCN Commercial |
$84.64
|
| Rate for Payer: BCN Commercial |
$78.04
|
| Rate for Payer: BCN Commercial |
$27.95
|
| Rate for Payer: BCN Commercial |
$84.58
|
| Rate for Payer: Cash Price |
$87.56
|
| 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 |
$94.13
|
| 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 |
$87.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$98.50
|
| 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 |
$82.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| 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 |
$93.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$89.75
|
| Rate for Payer: Nomi Health Commercial |
$29.66
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: PHP Commercial |
$93.03
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health HMO/PPO |
$95.28
|
| Rate for Payer: Priority Health HMO/PPO |
$31.47
|
| Rate for Payer: Priority Health HMO/PPO |
$87.85
|
| Rate for Payer: Priority Health HMO/PPO |
$95.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.66
|
| 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) |
$96.32
|
| 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 |
$91.39
|
| 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 |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 00555087302
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.02 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.64
|
| Rate for Payer: BCBS Trust/PPO |
$280.07
|
| Rate for Payer: BCN Commercial |
$265.15
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.64
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: PHP Commercial |
$291.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.02
|
| Rate for Payer: Priority Health HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 00555087302
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.49 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.64
|
| Rate for Payer: Aetna Medicare |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.22
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: BCBS MAPPO |
$85.78
|
| Rate for Payer: BCBS Trust/PPO |
$282.06
|
| Rate for Payer: BCN Commercial |
$266.76
|
| Rate for Payer: BCN Medicare Advantage |
$85.78
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.78
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.64
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: PACE Senior Care Partners |
$81.49
|
| Rate for Payer: PACE SWMI |
$85.78
|
| Rate for Payer: PHP Commercial |
$291.64
|
| Rate for Payer: PHP Medicare Advantage |
$85.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.02
|
| Rate for Payer: Priority Health HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Medicare |
$86.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.88
|
| Rate for Payer: Railroad Medicare Medicare |
$85.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.78
|
| Rate for Payer: UHC Exchange |
$85.78
|
| Rate for Payer: UHC Medicare Advantage |
$85.78
|
| Rate for Payer: VA VA |
$85.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 59762005801
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.07 |
| 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 |
$187.06
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$363.60
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| 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 Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.33
|
| 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 Dual Complete DSNP |
$116.91
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicare Advantage |
$116.91
|
| Rate for Payer: VA VA |
$116.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MEDROXYPROGESTERONE 5 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 59762005801
|
| Hospital Charge Code |
4856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.97 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$381.74
|
| 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 Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.33
|
| 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
|
|
|
MEGESTROL 20 MG TABLET
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 00555060602
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.46 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: BCBS Trust/PPO |
$310.77
|
| 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 Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.46
|
| Rate for Payer: Priority Health HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.07
|
| 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
|
|
|
MEGESTROL 20 MG TABLET
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 00555060602
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.42 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$98.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.97
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: BCBS MAPPO |
$95.18
|
| Rate for Payer: BCBS Trust/PPO |
$312.97
|
| Rate for Payer: BCN Commercial |
$295.99
|
| Rate for Payer: BCN Medicare Advantage |
$95.18
|
| 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: Health Alliance Plan Medicare Advantage |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: PACE Senior Care Partners |
$90.42
|
| Rate for Payer: PACE SWMI |
$95.18
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.46
|
| Rate for Payer: Priority Health HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Medicare |
$96.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.07
|
| Rate for Payer: Railroad Medicare Medicare |
$95.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.18
|
| Rate for Payer: UHC Exchange |
$95.18
|
| Rate for Payer: UHC Medicare Advantage |
$95.18
|
| Rate for Payer: VA VA |
$95.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 09900000341
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna Commercial |
$1.10
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.07
|
| Rate for Payer: BCN Commercial |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| 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: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$1.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.10
|
| Rate for Payer: Nomi Health Commercial |
$1.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.31
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PHP Commercial |
$1.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1.13
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.87
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.14
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Medicare Advantage |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.98
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 09900000341
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna Commercial |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| 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 Commercial |
$1.10
|
| Rate for Payer: Nomi Health Commercial |
$1.07
|
| Rate for Payer: PHP Commercial |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.87
|
| 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
|
OP
|
$659.88
|
|
|
Service Code
|
NDC 60432012608
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$593.89 |
| Rate for Payer: Aetna Commercial |
$560.90
|
| Rate for Payer: Aetna Medicare |
$171.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$206.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$206.21
|
| Rate for Payer: BCBS Complete |
$263.95
|
| Rate for Payer: BCBS MAPPO |
$164.97
|
| Rate for Payer: BCBS Trust/PPO |
$542.49
|
| Rate for Payer: BCN Commercial |
$513.06
|
| Rate for Payer: BCN Medicare Advantage |
$164.97
|
| 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: Health Alliance Plan Medicare Advantage |
$164.97
|
| Rate for Payer: Healthscope Commercial |
$593.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.90
|
| Rate for Payer: Nomi Health Commercial |
$541.10
|
| Rate for Payer: PACE Senior Care Partners |
$156.72
|
| Rate for Payer: PACE SWMI |
$164.97
|
| Rate for Payer: PHP Commercial |
$560.90
|
| Rate for Payer: PHP Medicare Advantage |
$164.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.92
|
| Rate for Payer: Priority Health HMO/PPO |
$574.10
|
| Rate for Payer: Priority Health Medicare |
$166.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.12
|
| Rate for Payer: Railroad Medicare Medicare |
$164.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.69
|
| Rate for Payer: UHC Core |
$551.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.97
|
| Rate for Payer: UHC Exchange |
$164.97
|
| Rate for Payer: UHC Medicare Advantage |
$164.97
|
| Rate for Payer: VA VA |
$164.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.91
|
|
