|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$12.93
|
|
|
Service Code
|
NDC 09900000343
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: Nomi Health Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.38
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$659.88
|
|
|
Service Code
|
NDC 60432012608
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.92 |
| Max. Negotiated Rate |
$593.89 |
| Rate for Payer: Aetna Commercial |
$560.90
|
| Rate for Payer: BCBS Trust/PPO |
$538.66
|
| Rate for Payer: BCN Commercial |
$509.96
|
| Rate for Payer: Cash Price |
$527.90
|
| Rate for Payer: Cofinity Commercial |
$567.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.90
|
| Rate for Payer: Healthscope Commercial |
$593.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.90
|
| Rate for Payer: Nomi Health Commercial |
$541.10
|
| Rate for Payer: PHP Commercial |
$560.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.92
|
| Rate for Payer: Priority Health HMO/PPO |
$574.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.69
|
| Rate for Payer: UHC Core |
$551.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.91
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 09900000342
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$12.93
|
|
|
Service Code
|
NDC 09900000343
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.04
|
| Rate for Payer: BCBS Complete |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCN Commercial |
$10.05
|
| Rate for Payer: BCN Medicare Advantage |
$3.23
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: Nomi Health Commercial |
$10.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.07
|
| Rate for Payer: PACE SWMI |
$3.23
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: PHP Medicare Advantage |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO |
$11.25
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.38
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.23
|
| Rate for Payer: UHC Exchange |
$3.23
|
| Rate for Payer: UHC Medicare Advantage |
$3.23
|
| Rate for Payer: VA VA |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 09900000342
|
| Hospital Charge Code |
10521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 00904357161
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: BCBS Trust/PPO |
$349.13
|
| Rate for Payer: BCN Commercial |
$330.53
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO |
$372.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.38
|
| Rate for Payer: UHC Core |
$357.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: BCBS Trust/PPO |
$177.59
|
| Rate for Payer: BCN Commercial |
$168.12
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.98
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: BCBS MAPPO |
$54.39
|
| Rate for Payer: BCBS Trust/PPO |
$178.85
|
| Rate for Payer: BCN Commercial |
$169.15
|
| Rate for Payer: BCN Medicare Advantage |
$54.39
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.39
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: PACE Senior Care Partners |
$51.67
|
| Rate for Payer: PACE SWMI |
$54.39
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: PHP Medicare Advantage |
$54.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Medicare |
$54.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.76
|
| Rate for Payer: Railroad Medicare Medicare |
$54.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.39
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
| Rate for Payer: VA VA |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.35 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna Medicare |
$138.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.25
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$133.00
|
| Rate for Payer: BCBS Trust/PPO |
$437.36
|
| Rate for Payer: BCN Commercial |
$413.63
|
| Rate for Payer: BCN Medicare Advantage |
$133.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.00
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.20
|
| Rate for Payer: Nomi Health Commercial |
$436.24
|
| Rate for Payer: PACE Senior Care Partners |
$126.35
|
| Rate for Payer: PACE SWMI |
$133.00
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: PHP Medicare Advantage |
$133.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO |
$462.84
|
| Rate for Payer: Priority Health Medicare |
$134.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.44
|
| Rate for Payer: Railroad Medicare Medicare |
$133.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.16
|
| Rate for Payer: UHC Core |
$444.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.00
|
| Rate for Payer: UHC Exchange |
$133.00
|
| Rate for Payer: UHC Medicare Advantage |
$133.00
|
| Rate for Payer: VA VA |
$133.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.00
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 00904357161
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.58 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna Medicare |
$111.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.66
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: BCBS MAPPO |
$106.92
|
| Rate for Payer: BCBS Trust/PPO |
$351.61
|
| Rate for Payer: BCN Commercial |
$332.54
|
| Rate for Payer: BCN Medicare Advantage |
$106.92
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.92
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: PACE Senior Care Partners |
$101.58
|
| Rate for Payer: PACE SWMI |
$106.92
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: PHP Medicare Advantage |
$106.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO |
$372.10
|
| Rate for Payer: Priority Health Medicare |
$107.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.56
|
| Rate for Payer: Railroad Medicare Medicare |
$106.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.38
|
| Rate for Payer: UHC Core |
$357.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.92
|
| Rate for Payer: UHC Exchange |
$106.92
|
| Rate for Payer: UHC Medicare Advantage |
$106.92
|
| Rate for Payer: VA VA |
$106.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.80 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: BCBS Trust/PPO |
$434.27
|
| Rate for Payer: BCN Commercial |
$411.13
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.60
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.20
|
| Rate for Payer: Nomi Health Commercial |
$436.24
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO |
$462.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.16
|
| Rate for Payer: UHC Core |
$444.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.35
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS MAPPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.44
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE Senior Care Partners |
$17.75
|
| Rate for Payer: PACE SWMI |
$18.68
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: PHP Medicare Advantage |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Medicare |
$18.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.07
|
| Rate for Payer: Railroad Medicare Medicare |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.68
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: BCBS Trust/PPO |
$161.30
|
| Rate for Payer: BCN Commercial |
$152.71
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: Nomi Health Commercial |
$162.03
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health HMO/PPO |
$171.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.89
|
| Rate for Payer: UHC Core |
$165.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$121.03
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.67 |
| Max. Negotiated Rate |
$108.93 |
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: BCBS Trust/PPO |
$98.80
|
| Rate for Payer: BCN Commercial |
$93.53
|
| Rate for Payer: Cash Price |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.82
|
| Rate for Payer: Healthscope Commercial |
$108.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Nomi Health Commercial |
$99.24
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.67
|
| Rate for Payer: Priority Health HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.51
|
| Rate for Payer: UHC Core |
$101.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.77
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.76
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Medicare |
$0.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$74.73
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: BCBS Trust/PPO |
$61.00
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.57
|
| Rate for Payer: Priority Health HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$197.60
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.93 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare |
$51.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.75
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: BCBS MAPPO |
$49.40
|
| Rate for Payer: BCBS Trust/PPO |
$162.45
|
| Rate for Payer: BCN Commercial |
$153.63
|
| Rate for Payer: BCN Medicare Advantage |
$49.40
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.40
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: Nomi Health Commercial |
$162.03
|
| Rate for Payer: PACE Senior Care Partners |
$46.93
|
| Rate for Payer: PACE SWMI |
$49.40
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: PHP Medicare Advantage |
$49.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health HMO/PPO |
$171.91
|
| Rate for Payer: Priority Health Medicare |
$49.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.39
|
| Rate for Payer: Railroad Medicare Medicare |
$49.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.89
|
| Rate for Payer: UHC Core |
$165.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.40
|
| Rate for Payer: UHC Exchange |
$49.40
|
| Rate for Payer: UHC Medicare Advantage |
$49.40
|
| Rate for Payer: VA VA |
$49.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$121.03
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$108.93 |
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Medicare |
$31.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.82
|
| Rate for Payer: BCBS Complete |
$48.41
|
| Rate for Payer: BCBS MAPPO |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$99.50
|
| Rate for Payer: BCN Commercial |
$94.10
|
| Rate for Payer: BCN Medicare Advantage |
$30.26
|
| Rate for Payer: Cash Price |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$108.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Nomi Health Commercial |
$99.24
|
| Rate for Payer: PACE Senior Care Partners |
$28.74
|
| Rate for Payer: PACE SWMI |
$30.26
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Medicare Advantage |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.67
|
| Rate for Payer: Priority Health HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$30.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.09
|
| Rate for Payer: Railroad Medicare Medicare |
$30.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.51
|
| Rate for Payer: UHC Core |
$101.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.26
|
| Rate for Payer: UHC Exchange |
$30.26
|
| Rate for Payer: UHC Medicare Advantage |
$30.26
|
| Rate for Payer: VA VA |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.77
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 68094011059
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.62
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.63
|
| Rate for Payer: BCN Commercial |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.47
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health HMO/PPO |
$1.72
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.74
|
| Rate for Payer: UHC Core |
$1.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.50
|
| Rate for Payer: UHC Exchange |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.50
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.25
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: Nomi Health Commercial |
$3.28
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health HMO/PPO |
$3.48
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.52
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.00
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna Medicare |
$103.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.84
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$328.43
|
| Rate for Payer: BCN Commercial |
$310.61
|
| Rate for Payer: BCN Medicare Advantage |
$99.88
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: PACE Senior Care Partners |
$94.88
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health HMO/PPO |
$347.56
|
| Rate for Payer: Priority Health Medicare |
$100.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.66
|
| Rate for Payer: Railroad Medicare Medicare |
$99.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Exchange |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
| Rate for Payer: VA VA |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.72
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS MAPPO |
$66.98
|
| Rate for Payer: BCBS Trust/PPO |
$220.24
|
| Rate for Payer: BCN Commercial |
$208.29
|
| Rate for Payer: BCN Medicare Advantage |
$66.98
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.98
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: PACE Senior Care Partners |
$63.63
|
| Rate for Payer: PACE SWMI |
$66.98
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: Priority Health HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Medicare |
$67.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.49
|
| Rate for Payer: Railroad Medicare Medicare |
$66.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.98
|
| Rate for Payer: UHC Exchange |
$66.98
|
| Rate for Payer: UHC Medicare Advantage |
$66.98
|
| Rate for Payer: VA VA |
$66.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: Nomi Health Commercial |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health HMO/PPO |
$3.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.52
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: BCBS Trust/PPO |
$326.11
|
| Rate for Payer: BCN Commercial |
$308.73
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health HMO/PPO |
$347.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
