|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$391.40
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$352.26
|
| Rate for Payer: Aetna Medicare |
$195.70
|
| Rate for Payer: ASR ASR |
$379.66
|
| Rate for Payer: ASR Commercial |
$379.66
|
| Rate for Payer: BCBS Complete |
$156.56
|
| Rate for Payer: BCBS Trust/PPO |
$320.52
|
| Rate for Payer: BCN Commercial |
$303.45
|
| Rate for Payer: Cash Price |
$313.12
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.12
|
| Rate for Payer: Healthscope Commercial |
$391.40
|
| Rate for Payer: Healthscope Whirlpool |
$379.66
|
| Rate for Payer: Mclaren Commercial |
$352.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.69
|
| Rate for Payer: Nomi Health Commercial |
$320.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.94
|
| Rate for Payer: Priority Health Narrow Network |
$274.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.43
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$391.40
|
|
|
Service Code
|
NDC 00904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.41 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$352.26
|
| Rate for Payer: ASR ASR |
$379.66
|
| Rate for Payer: ASR Commercial |
$379.66
|
| Rate for Payer: BCBS Trust/PPO |
$318.95
|
| Rate for Payer: BCN Commercial |
$303.45
|
| Rate for Payer: Cash Price |
$313.12
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.12
|
| Rate for Payer: Healthscope Commercial |
$391.40
|
| Rate for Payer: Healthscope Whirlpool |
$379.66
|
| Rate for Payer: Mclaren Commercial |
$352.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.69
|
| Rate for Payer: Nomi Health Commercial |
$320.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.43
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: ASR Commercial |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: ASR Commercial |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Whirlpool |
$2.73
|
| Rate for Payer: Mclaren Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$140.64
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$140.64 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$70.32
|
| Rate for Payer: ASR ASR |
$136.42
|
| Rate for Payer: ASR Commercial |
$136.42
|
| Rate for Payer: BCBS Complete |
$56.26
|
| Rate for Payer: BCBS Trust/PPO |
$115.17
|
| Rate for Payer: BCN Commercial |
$109.04
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$132.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Healthscope Commercial |
$140.64
|
| Rate for Payer: Healthscope Whirlpool |
$136.42
|
| Rate for Payer: Mclaren Commercial |
$126.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.23
|
| Rate for Payer: Priority Health Narrow Network |
$98.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.76
|
|
|
MEDICAL MAGGOTS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: ASR Commercial |
$848.75
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$716.54
|
| Rate for Payer: BCN Commercial |
$678.39
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Healthscope Whirlpool |
$848.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.75
|
| Rate for Payer: Nomi Health Commercial |
$717.50
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$766.67
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$613.38
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: ASR Commercial |
$848.75
|
| Rate for Payer: BCBS Trust/PPO |
$713.04
|
| Rate for Payer: BCN Commercial |
$678.39
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Healthscope Whirlpool |
$848.75
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.75
|
| Rate for Payer: Nomi Health Commercial |
$717.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Commercial |
$98.57
|
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: ASR ASR |
$176.70
|
| Rate for Payer: ASR ASR |
$176.69
|
| Rate for Payer: ASR ASR |
$106.23
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR ASR |
$97.94
|
| Rate for Payer: ASR Commercial |
$106.23
|
| Rate for Payer: ASR Commercial |
$176.70
|
| Rate for Payer: ASR Commercial |
$176.69
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: ASR Commercial |
$97.94
|
| Rate for Payer: BCBS Trust/PPO |
$148.44
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCBS Trust/PPO |
$89.18
|
| Rate for Payer: BCBS Trust/PPO |
$148.43
|
| Rate for Payer: BCBS Trust/PPO |
$89.25
|
| Rate for Payer: BCN Commercial |
$84.85
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Commercial |
$78.28
|
| Rate for Payer: BCN Commercial |
$84.91
|
| Rate for Payer: BCN Commercial |
$141.22
|
| Rate for Payer: Cash Price |
$87.56
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cash Price |
$145.72
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Cofinity Commercial |
$171.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$109.52
|
| Rate for Payer: Healthscope Commercial |
$182.15
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$100.97
|
| Rate for Payer: Healthscope Commercial |
$182.16
|
| Rate for Payer: Healthscope Whirlpool |
$176.70
|
| Rate for Payer: Healthscope Whirlpool |
$97.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.23
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| Rate for Payer: Healthscope Whirlpool |
$176.69
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Mclaren Commercial |
$98.57
|
| Rate for Payer: Mclaren Commercial |
$90.87
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Nomi Health Commercial |
$149.37
|
| Rate for Payer: Nomi Health Commercial |
$149.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.29
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
OP
|
$100.97
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$100.97 |
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: Aetna Commercial |
$98.57
|
| Rate for Payer: Aetna Medicare |
$54.72
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna Medicare |
$50.48
|
| Rate for Payer: Aetna Medicare |
$91.08
|
| Rate for Payer: Aetna Medicare |
$91.08
|
| Rate for Payer: ASR ASR |
$176.70
|
| Rate for Payer: ASR ASR |
$106.23
|
| Rate for Payer: ASR ASR |
$97.94
|
| Rate for Payer: ASR ASR |
$176.69
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: ASR Commercial |
$176.70
|
| Rate for Payer: ASR Commercial |
$106.16
|
| Rate for Payer: ASR Commercial |
$106.23
|
| Rate for Payer: ASR Commercial |
$176.69
|
| Rate for Payer: ASR Commercial |
$97.94
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS Complete |
$43.78
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS Complete |
$40.39
|
| Rate for Payer: BCBS Trust/PPO |
$149.16
|
| Rate for Payer: BCBS Trust/PPO |
$82.68
|
| Rate for Payer: BCBS Trust/PPO |
$89.62
|
| Rate for Payer: BCBS Trust/PPO |
$89.69
|
| Rate for Payer: BCBS Trust/PPO |
$149.17
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Commercial |
$141.22
|
| Rate for Payer: BCN Commercial |
$84.85
|
| Rate for Payer: BCN Commercial |
$78.28
|
| Rate for Payer: BCN Commercial |
$84.91
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cash Price |
$87.56
|
| Rate for Payer: Cash Price |
$145.72
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$171.23
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.72
|
| Rate for Payer: Healthscope Commercial |
$109.52
|
| Rate for Payer: Healthscope Commercial |
$182.15
|
| Rate for Payer: Healthscope Commercial |
$182.16
|
| Rate for Payer: Healthscope Commercial |
$100.97
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$176.69
|
| Rate for Payer: Healthscope Whirlpool |
$106.23
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| Rate for Payer: Healthscope Whirlpool |
$97.94
|
| Rate for Payer: Healthscope Whirlpool |
$176.70
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Mclaren Commercial |
$98.57
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Mclaren Commercial |
$90.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.84
|
| Rate for Payer: Nomi Health Commercial |
$149.36
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$89.74
|
| Rate for Payer: Nomi Health Commercial |
$149.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.61
|
| Rate for Payer: Priority Health Narrow Network |
$127.69
|
| Rate for Payer: Priority Health Narrow Network |
$127.69
|
| Rate for Payer: Priority Health Narrow Network |
$76.72
|
| Rate for Payer: Priority Health Narrow Network |
$70.78
|
| Rate for Payer: Priority Health Narrow Network |
$76.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.38
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: ASR Commercial |
$273.54
|
| Rate for Payer: BCBS Trust/PPO |
$229.80
|
| Rate for Payer: BCN Commercial |
$218.63
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$282.00
|
| Rate for Payer: Healthscope Whirlpool |
$273.54
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: ASR Commercial |
$273.54
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$230.93
|
| Rate for Payer: BCN Commercial |
$218.63
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$282.00
|
| Rate for Payer: Healthscope Whirlpool |
$273.54
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.09
|
| Rate for Payer: Priority Health Narrow Network |
$197.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.13 |
| 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 |
$174.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
|
|
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 |
$174.13
|
| 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
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: BCBS Complete |
$0.97
|
| 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 |
$2.27
|
| 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: Priority Health HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
|
|
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
|
$109.28
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: ASR Commercial |
$106.00
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: BCBS Trust/PPO |
$89.49
|
| 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: Priority Health HMO/PPO/Tiered Network |
$95.75
|
| Rate for Payer: Priority Health Narrow Network |
$76.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.17
|
|
|
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
|
OP
|
$121.03
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.41 |
| Max. Negotiated Rate |
$121.03 |
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: ASR ASR |
$117.40
|
| Rate for Payer: ASR Commercial |
$117.40
|
| Rate for Payer: BCBS Complete |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| 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: Priority Health HMO/PPO/Tiered Network |
$106.05
|
| Rate for Payer: Priority Health Narrow Network |
$84.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.51
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
NDC 00456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: ASR Commercial |
$24.73
|
| 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 |
$24.73
|
| 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 |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
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
|
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 |
$241.97
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| 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 |
$241.97
|
| 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
|
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
|
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
|
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
|
|
