|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: ASR Commercial |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.05
|
| Rate for Payer: BCN Commercial |
$84.72
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$109.28
|
| Rate for Payer: Healthscope Whirlpool |
$106.00
|
| Rate for Payer: Mclaren Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.17
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Mclaren Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: ASR ASR |
$259.86
|
| Rate for Payer: ASR Commercial |
$259.86
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS Trust/PPO |
$219.38
|
| Rate for Payer: BCN Commercial |
$207.70
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$251.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$267.90
|
| Rate for Payer: Healthscope Whirlpool |
$259.86
|
| Rate for Payer: Mclaren Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.73
|
| Rate for Payer: Priority Health Narrow Network |
$187.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
|
|
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 |
$121.03 |
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: ASR ASR |
$117.40
|
| Rate for Payer: ASR Commercial |
$117.40
|
| Rate for Payer: BCBS Trust/PPO |
$98.63
|
| Rate for Payer: BCN Commercial |
$93.83
|
| Rate for Payer: Cash Price |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$113.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.82
|
| Rate for Payer: Healthscope Commercial |
$121.03
|
| Rate for Payer: Healthscope Whirlpool |
$117.40
|
| Rate for Payer: Mclaren Commercial |
$108.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Nomi Health Commercial |
$99.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.51
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: ASR ASR |
$259.86
|
| Rate for Payer: ASR Commercial |
$259.86
|
| Rate for Payer: BCBS Trust/PPO |
$218.31
|
| Rate for Payer: BCN Commercial |
$207.70
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$251.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$267.90
|
| Rate for Payer: Healthscope Whirlpool |
$259.86
|
| Rate for Payer: Mclaren Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.96
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Trust/PPO |
$219.09
|
| Rate for Payer: BCN Commercial |
$208.44
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$252.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$268.85
|
| Rate for Payer: Healthscope Whirlpool |
$260.78
|
| Rate for Payer: Mclaren Commercial |
$241.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: ASR ASR |
$2.87
|
| Rate for Payer: ASR Commercial |
$2.87
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.59
|
| Rate for Payer: Priority Health Narrow Network |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.60
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$295.45
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna Commercial |
$265.90
|
| Rate for Payer: Aetna Medicare |
$147.72
|
| Rate for Payer: ASR ASR |
$286.59
|
| Rate for Payer: ASR Commercial |
$286.59
|
| Rate for Payer: BCBS Complete |
$118.18
|
| Rate for Payer: BCBS Trust/PPO |
$241.94
|
| Rate for Payer: BCN Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$236.36
|
| Rate for Payer: Cofinity Commercial |
$277.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.36
|
| Rate for Payer: Healthscope Commercial |
$295.45
|
| Rate for Payer: Healthscope Whirlpool |
$286.59
|
| Rate for Payer: Mclaren Commercial |
$265.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.13
|
| Rate for Payer: Nomi Health Commercial |
$242.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.87
|
| Rate for Payer: Priority Health Narrow Network |
$207.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.00
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: ASR Commercial |
$24.74
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$295.45
|
|
|
Service Code
|
NDC 00591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.04 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna Commercial |
$265.90
|
| Rate for Payer: ASR ASR |
$286.59
|
| Rate for Payer: ASR Commercial |
$286.59
|
| Rate for Payer: BCBS Trust/PPO |
$240.76
|
| Rate for Payer: BCN Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$236.36
|
| Rate for Payer: Cofinity Commercial |
$277.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.36
|
| Rate for Payer: Healthscope Commercial |
$295.45
|
| Rate for Payer: Healthscope Whirlpool |
$286.59
|
| Rate for Payer: Mclaren Commercial |
$265.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.13
|
| Rate for Payer: Nomi Health Commercial |
$242.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.00
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$1,530.47
|
|
|
Service Code
|
NDC 00456321060
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$994.81 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: ASR ASR |
$1,484.56
|
| Rate for Payer: ASR Commercial |
$1,484.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.18
|
| Rate for Payer: BCN Commercial |
$1,186.57
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.38
|
| Rate for Payer: Healthscope Commercial |
$1,530.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.56
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.90
|
| Rate for Payer: Nomi Health Commercial |
$1,254.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 00591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: ASR ASR |
$2.87
|
| Rate for Payer: ASR Commercial |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.60
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$1,530.47
|
|
|
Service Code
|
NDC 00456321060
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$612.19 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: Aetna Medicare |
$765.24
|
| Rate for Payer: ASR ASR |
$1,484.56
|
| Rate for Payer: ASR Commercial |
$1,484.56
|
| Rate for Payer: BCBS Complete |
$612.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.30
|
| Rate for Payer: BCN Commercial |
$1,186.57
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.38
|
| Rate for Payer: Healthscope Commercial |
$1,530.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.56
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.90
|
| Rate for Payer: Nomi Health Commercial |
$1,254.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.96
|
| Rate for Payer: Aetna Medicare |
$134.42
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS Trust/PPO |
$220.16
|
| Rate for Payer: BCN Commercial |
$208.44
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$252.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$268.85
|
| Rate for Payer: Healthscope Whirlpool |
$260.78
|
| Rate for Payer: Mclaren Commercial |
$241.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.57
|
| Rate for Payer: Priority Health Narrow Network |
$188.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: ASR Commercial |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$389.44
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.78 |
| Max. Negotiated Rate |
$389.44 |
| Rate for Payer: Aetna Commercial |
$350.50
|
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: Aetna Medicare |
$190.18
|
| Rate for Payer: Aetna Medicare |
$194.72
|
| Rate for Payer: ASR ASR |
$377.76
|
| Rate for Payer: ASR ASR |
$368.95
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: ASR Commercial |
$377.76
|
| Rate for Payer: BCBS Complete |
$155.78
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS Trust/PPO |
$318.91
|
| Rate for Payer: BCBS Trust/PPO |
$311.48
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: BCN Commercial |
$301.93
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Cofinity Commercial |
$366.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Healthscope Commercial |
$389.44
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Whirlpool |
$377.76
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Mclaren Commercial |
$350.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Nomi Health Commercial |
$319.34
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.90
|
| Rate for Payer: Priority Health Narrow Network |
$156.72
|
| Rate for Payer: Priority Health Narrow Network |
$156.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.71
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$389.44
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$253.14 |
| Max. Negotiated Rate |
$389.44 |
| Rate for Payer: Aetna Commercial |
$350.50
|
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: ASR ASR |
$377.76
|
| Rate for Payer: ASR ASR |
$368.95
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: ASR Commercial |
$377.76
|
| Rate for Payer: BCBS Trust/PPO |
$309.96
|
| Rate for Payer: BCBS Trust/PPO |
$317.35
|
| Rate for Payer: BCN Commercial |
$301.93
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: Cash Price |
$311.55
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Cofinity Commercial |
$366.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.55
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Commercial |
$389.44
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Healthscope Whirlpool |
$377.76
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Mclaren Commercial |
$350.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.02
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| Rate for Payer: Nomi Health Commercial |
$319.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.71
|
|
|
MENTHOL 5 % TOPICAL GEL
|
Facility
|
OP
|
$30.96
|
|
|
Service Code
|
NDC 58980061840
|
| Hospital Charge Code |
152031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.13
|
| Rate for Payer: Priority Health Narrow Network |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
MENTHOL 5 % TOPICAL GEL
|
Facility
|
IP
|
$30.96
|
|
|
Service Code
|
NDC 58980061840
|
| Hospital Charge Code |
152031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$25.23
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$9,878.67
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$9,878.67 |
| Rate for Payer: Aetna Commercial |
$8,890.80
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.36
|
| Rate for Payer: ASR ASR |
$9,582.31
|
| Rate for Payer: ASR Commercial |
$9,582.31
|
| Rate for Payer: BCBS Complete |
$17.27
|
| Rate for Payer: BCBS MAPPO |
$30.69
|
| Rate for Payer: BCBS Trust/PPO |
$8,089.64
|
| Rate for Payer: BCN Commercial |
$7,658.93
|
| Rate for Payer: BCN Medicare Advantage |
$30.69
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cofinity Commercial |
$9,285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,902.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.69
|
| Rate for Payer: Healthscope Commercial |
$9,878.67
|
| Rate for Payer: Healthscope Whirlpool |
$9,582.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.69
|
| Rate for Payer: Mclaren Commercial |
$8,890.80
|
| Rate for Payer: Mclaren Medicaid |
$16.45
|
| Rate for Payer: Mclaren Medicare |
$30.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.22
|
| Rate for Payer: Meridian Medicaid |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,396.87
|
| Rate for Payer: Nomi Health Commercial |
$8,100.51
|
| Rate for Payer: PACE Medicare |
$29.16
|
| Rate for Payer: PACE SWMI |
$30.69
|
| Rate for Payer: PHP Commercial |
$33.76
|
| Rate for Payer: PHP Medicaid |
$16.45
|
| Rate for Payer: PHP Medicare Advantage |
$30.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health Medicare |
$30.69
|
| Rate for Payer: Priority Health Narrow Network |
$25.35
|
| Rate for Payer: Railroad Medicare Medicare |
$30.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,693.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.69
|
| Rate for Payer: UHC Exchange |
$47.57
|
| Rate for Payer: UHC Medicare Advantage |
$30.69
|
| Rate for Payer: UHCCP DNSP |
$30.69
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
| Rate for Payer: VA VA |
$30.69
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$9,878.67
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,421.14 |
| Max. Negotiated Rate |
$9,878.67 |
| Rate for Payer: Aetna Commercial |
$8,890.80
|
| Rate for Payer: ASR ASR |
$9,582.31
|
| Rate for Payer: ASR Commercial |
$9,582.31
|
| Rate for Payer: BCBS Trust/PPO |
$8,050.13
|
| Rate for Payer: BCN Commercial |
$7,658.93
|
| Rate for Payer: Cash Price |
$7,902.94
|
| Rate for Payer: Cofinity Commercial |
$9,285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,902.94
|
| Rate for Payer: Healthscope Commercial |
$9,878.67
|
| Rate for Payer: Healthscope Whirlpool |
$9,582.31
|
| Rate for Payer: Mclaren Commercial |
$8,890.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,396.87
|
| Rate for Payer: Nomi Health Commercial |
$8,100.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,421.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,693.23
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,943.88
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$7,943.88 |
| Rate for Payer: Aetna Commercial |
$7,149.49
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.36
|
| Rate for Payer: ASR ASR |
$7,705.56
|
| Rate for Payer: ASR Commercial |
$7,705.56
|
| Rate for Payer: BCBS Complete |
$17.27
|
| Rate for Payer: BCBS MAPPO |
$30.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,505.24
|
| Rate for Payer: BCN Commercial |
$6,158.89
|
| Rate for Payer: BCN Medicare Advantage |
$30.69
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$7,467.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.69
|
| Rate for Payer: Healthscope Commercial |
$7,943.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.69
|
| Rate for Payer: Mclaren Commercial |
$7,149.49
|
| Rate for Payer: Mclaren Medicaid |
$16.45
|
| Rate for Payer: Mclaren Medicare |
$30.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.22
|
| Rate for Payer: Meridian Medicaid |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.30
|
| Rate for Payer: Nomi Health Commercial |
$6,513.98
|
| Rate for Payer: PACE Medicare |
$29.16
|
| Rate for Payer: PACE SWMI |
$30.69
|
| Rate for Payer: PHP Commercial |
$33.76
|
| Rate for Payer: PHP Medicaid |
$16.45
|
| Rate for Payer: PHP Medicare Advantage |
$30.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health Medicare |
$30.69
|
| Rate for Payer: Priority Health Narrow Network |
$25.35
|
| Rate for Payer: Railroad Medicare Medicare |
$30.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.69
|
| Rate for Payer: UHC Exchange |
$47.57
|
| Rate for Payer: UHC Medicare Advantage |
$30.69
|
| Rate for Payer: UHCCP DNSP |
$30.69
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
| Rate for Payer: VA VA |
$30.69
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,943.88
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,163.52 |
| Max. Negotiated Rate |
$7,943.88 |
| Rate for Payer: Aetna Commercial |
$7,149.49
|
| Rate for Payer: ASR ASR |
$7,705.56
|
| Rate for Payer: ASR Commercial |
$7,705.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,473.47
|
| Rate for Payer: BCN Commercial |
$6,158.89
|
| Rate for Payer: Cash Price |
$6,355.11
|
| Rate for Payer: Cofinity Commercial |
$7,467.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,355.10
|
| Rate for Payer: Healthscope Commercial |
$7,943.88
|
| Rate for Payer: Healthscope Whirlpool |
$7,705.56
|
| Rate for Payer: Mclaren Commercial |
$7,149.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,752.30
|
| Rate for Payer: Nomi Health Commercial |
$6,513.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,990.61
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$23.75
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
