|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC Core |
$115.32
|
| Rate for Payer: UHC Exchange |
$86.99
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
OP
|
$636.50
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna American Axle |
$413.73
|
| Rate for Payer: Aetna Commercial |
$541.02
|
| Rate for Payer: Aetna Medicare |
$318.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.73
|
| Rate for Payer: BCBS Complete |
$254.60
|
| Rate for Payer: Cash Price |
$509.20
|
| Rate for Payer: Cofinity Advantage |
$445.55
|
| Rate for Payer: Cofinity Commercial |
$547.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.20
|
| Rate for Payer: Healthscope Commercial |
$572.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$509.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.38
|
| Rate for Payer: PHP Commercial |
$541.02
|
| Rate for Payer: Priority Health SBD |
$401.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.73
|
| Rate for Payer: UHC Core |
$331.62
|
| Rate for Payer: UHC Exchange |
$250.14
|
| Rate for Payer: UMR Bronson Commercial |
$235.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.38
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$283.10
|
|
|
Service Code
|
NDC 64380015901
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.56 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna American Axle |
$184.01
|
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.01
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Advantage |
$198.17
|
| Rate for Payer: Cofinity Commercial |
$243.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$254.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.32
|
| Rate for Payer: PHP Commercial |
$240.63
|
| Rate for Payer: Priority Health SBD |
$178.35
|
| Rate for Payer: UMR Bronson Commercial |
$124.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.32
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00555060702
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 00904723661
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
MEGESTROL 40 MG TABLET
|
Facility
|
IP
|
$636.50
|
|
|
Service Code
|
NDC 64380015902
|
| Hospital Charge Code |
4871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.06 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna American Axle |
$413.73
|
| Rate for Payer: Aetna Commercial |
$541.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.73
|
| Rate for Payer: Cash Price |
$509.20
|
| Rate for Payer: Cofinity Advantage |
$445.55
|
| Rate for Payer: Cofinity Commercial |
$547.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.20
|
| Rate for Payer: Healthscope Commercial |
$572.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.38
|
| Rate for Payer: PHP Commercial |
$541.02
|
| Rate for Payer: Priority Health SBD |
$401.00
|
| Rate for Payer: UMR Bronson Commercial |
$280.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.38
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$11.76
|
|
|
Service Code
|
NDC 09900001928
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cofinity Advantage |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.82
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health SBD |
$7.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.64
|
| Rate for Payer: UHC Core |
$6.13
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$11.76
|
|
|
Service Code
|
NDC 09900001928
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: Cofinity Advantage |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.82
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health SBD |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$75.76
|
|
|
Service Code
|
NDC 30768016836
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$68.18 |
| Rate for Payer: Aetna American Axle |
$49.24
|
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.24
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Cofinity Advantage |
$53.03
|
| Rate for Payer: Cofinity Commercial |
$65.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.61
|
| Rate for Payer: Healthscope Commercial |
$68.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.82
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: Priority Health SBD |
$47.73
|
| Rate for Payer: UMR Bronson Commercial |
$33.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$75.76
|
|
|
Service Code
|
NDC 30768016836
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$68.18 |
| Rate for Payer: Aetna American Axle |
$49.24
|
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$37.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.24
|
| Rate for Payer: BCBS Complete |
$30.30
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Cofinity Advantage |
$53.03
|
| Rate for Payer: Cofinity Commercial |
$65.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.61
|
| Rate for Payer: Healthscope Commercial |
$68.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.82
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: Priority Health SBD |
$47.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.24
|
| Rate for Payer: UHC Core |
$39.47
|
| Rate for Payer: UHC Exchange |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$28.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.82
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$96.48
|
|
|
Service Code
|
NDC 58438000571
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$86.83 |
| Rate for Payer: Aetna American Axle |
$62.71
|
| Rate for Payer: Aetna Commercial |
$82.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.71
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Cofinity Advantage |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$82.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.18
|
| Rate for Payer: Healthscope Commercial |
$86.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.36
|
| Rate for Payer: PHP Commercial |
$82.01
|
| Rate for Payer: Priority Health SBD |
$60.78
|
| Rate for Payer: UMR Bronson Commercial |
$42.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.36
|
|
|
MELATONIN 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$96.48
|
|
|
Service Code
|
NDC 58438000571
|
| Hospital Charge Code |
163646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$86.83 |
| Rate for Payer: Aetna American Axle |
$62.71
|
| Rate for Payer: Aetna Commercial |
$82.01
|
| Rate for Payer: Aetna Medicare |
$48.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.71
|
| Rate for Payer: BCBS Complete |
$38.59
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Cofinity Advantage |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$82.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.18
|
| Rate for Payer: Healthscope Commercial |
$86.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.36
|
| Rate for Payer: PHP Commercial |
$82.01
|
| Rate for Payer: Priority Health SBD |
$60.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.71
|
| Rate for Payer: UHC Core |
$50.27
|
| Rate for Payer: UHC Exchange |
$37.92
|
| Rate for Payer: UMR Bronson Commercial |
$35.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.36
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$69.09
|
|
|
Service Code
|
NDC 51991001406
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$62.18 |
| Rate for Payer: Aetna American Axle |
$44.91
|
| Rate for Payer: Aetna Commercial |
$58.73
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.91
|
| Rate for Payer: BCBS Complete |
$27.64
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Cofinity Advantage |
$48.36
|
| Rate for Payer: Cofinity Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.27
|
| Rate for Payer: Healthscope Commercial |
$62.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.82
|
| Rate for Payer: PHP Commercial |
$58.73
|
| Rate for Payer: Priority Health SBD |
$43.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.91
|
| Rate for Payer: UHC Core |
$36.00
|
| Rate for Payer: UHC Exchange |
$27.15
|
| Rate for Payer: UMR Bronson Commercial |
$25.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.40
|
| Rate for Payer: UHC Core |
$195.90
|
| Rate for Payer: UHC Exchange |
$147.77
|
| Rate for Payer: UMR Bronson Commercial |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 77333051625
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.59 |
| Max. Negotiated Rate |
$130.08 |
| Rate for Payer: Aetna American Axle |
$93.94
|
| Rate for Payer: Aetna Commercial |
$122.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.94
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Advantage |
$101.17
|
| Rate for Payer: Cofinity Commercial |
$124.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$130.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.40
|
| Rate for Payer: PHP Commercial |
$122.85
|
| Rate for Payer: Priority Health SBD |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$63.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.40
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 68094011059
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$146.64
|
|
|
Service Code
|
NDC 31604002741
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna American Axle |
$95.32
|
| Rate for Payer: Aetna Commercial |
$124.64
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.32
|
| Rate for Payer: BCBS Complete |
$58.66
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cofinity Advantage |
$102.65
|
| Rate for Payer: Cofinity Commercial |
$126.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.31
|
| Rate for Payer: Healthscope Commercial |
$131.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.98
|
| Rate for Payer: PHP Commercial |
$124.64
|
| Rate for Payer: Priority Health SBD |
$92.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.32
|
| Rate for Payer: UHC Core |
$76.40
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UMR Bronson Commercial |
$54.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.98
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$130.08 |
| Rate for Payer: Aetna American Axle |
$93.94
|
| Rate for Payer: Aetna Commercial |
$122.85
|
| Rate for Payer: Aetna Medicare |
$72.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.94
|
| Rate for Payer: BCBS Complete |
$57.81
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Advantage |
$101.17
|
| Rate for Payer: Cofinity Commercial |
$124.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$130.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.40
|
| Rate for Payer: PHP Commercial |
$122.85
|
| Rate for Payer: Priority Health SBD |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.94
|
| Rate for Payer: UHC Core |
$75.30
|
| Rate for Payer: UHC Exchange |
$56.80
|
| Rate for Payer: UMR Bronson Commercial |
$53.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.40
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$146.64
|
|
|
Service Code
|
NDC 31604002741
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna American Axle |
$95.32
|
| Rate for Payer: Aetna Commercial |
$124.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.32
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cofinity Advantage |
$102.65
|
| Rate for Payer: Cofinity Commercial |
$126.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.31
|
| Rate for Payer: Healthscope Commercial |
$131.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.98
|
| Rate for Payer: PHP Commercial |
$124.64
|
| Rate for Payer: Priority Health SBD |
$92.38
|
| Rate for Payer: UMR Bronson Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.98
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 68094011059
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 68094011061
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
