|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$10,664.67
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$9,642.14 |
| Max. Negotiated Rate |
$10,664.67 |
| Rate for Payer: BCBS Complete |
$10,664.67
|
| Rate for Payer: Mclaren Medicaid |
$10,156.83
|
| Rate for Payer: Meridian Medicaid |
$10,664.67
|
| Rate for Payer: PHP Medicaid |
$9,642.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,156.83
|
| Rate for Payer: UHC Medicaid |
$10,156.83
|
| Rate for Payer: UHCCP Medicaid |
$10,156.83
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$14,228.64
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$12,864.40 |
| Max. Negotiated Rate |
$14,228.64 |
| Rate for Payer: BCBS Complete |
$14,228.64
|
| Rate for Payer: Mclaren Medicaid |
$13,551.09
|
| Rate for Payer: Meridian Medicaid |
$14,228.64
|
| Rate for Payer: PHP Medicaid |
$12,864.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,551.09
|
| Rate for Payer: UHC Medicaid |
$13,551.09
|
| Rate for Payer: UHCCP Medicaid |
$13,551.09
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$15,334.35
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$13,864.09 |
| Max. Negotiated Rate |
$15,334.35 |
| Rate for Payer: BCBS Complete |
$15,334.35
|
| Rate for Payer: Mclaren Medicaid |
$14,604.14
|
| Rate for Payer: Meridian Medicaid |
$15,334.35
|
| Rate for Payer: PHP Medicaid |
$13,864.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,604.14
|
| Rate for Payer: UHC Medicaid |
$14,604.14
|
| Rate for Payer: UHCCP Medicaid |
$14,604.14
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$342.86
|
| Rate for Payer: Aetna Medicare |
$140.95
|
| Rate for Payer: ASR ASR |
$369.52
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: BCBS Trust/PPO |
$314.09
|
| Rate for Payer: BCN Commercial |
$314.09
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$358.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$369.52
|
| Rate for Payer: Healthscope Whirlpool |
$380.95
|
| Rate for Payer: Mclaren Commercial |
$342.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$333.79
|
| Rate for Payer: Priority Health Narrow Network |
$267.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.24
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
NDC 904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Medicare |
$147.63
|
| Rate for Payer: ASR ASR |
$387.03
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: BCBS Trust/PPO |
$328.98
|
| Rate for Payer: BCN Commercial |
$328.98
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$375.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$387.03
|
| Rate for Payer: Healthscope Whirlpool |
$399.00
|
| Rate for Payer: Mclaren Commercial |
$359.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Nomi Health Commercial |
$327.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$349.60
|
| Rate for Payer: Priority Health Narrow Network |
$279.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.12
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: ASR ASR |
$3.27
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Healthscope Whirlpool |
$3.37
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.95
|
| Rate for Payer: Priority Health Narrow Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.71 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$342.86
|
| Rate for Payer: ASR ASR |
$369.52
|
| Rate for Payer: BCBS Trust/PPO |
$312.84
|
| Rate for Payer: BCN Commercial |
$312.84
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$358.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$369.52
|
| Rate for Payer: Healthscope Whirlpool |
$380.95
|
| Rate for Payer: Mclaren Commercial |
$342.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.24
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 904737661
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: ASR ASR |
$387.03
|
| Rate for Payer: BCBS Trust/PPO |
$327.66
|
| Rate for Payer: BCN Commercial |
$327.66
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$375.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$387.03
|
| Rate for Payer: Healthscope Whirlpool |
$399.00
|
| Rate for Payer: Mclaren Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Nomi Health Commercial |
$327.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.12
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: ASR ASR |
$163.43
|
| Rate for Payer: BCBS Trust/PPO |
$138.36
|
| Rate for Payer: BCN Commercial |
$138.36
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Commercial |
$158.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$163.43
|
| Rate for Payer: Healthscope Whirlpool |
$168.48
|
| Rate for Payer: Mclaren Commercial |
$151.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Nomi Health Commercial |
$138.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.26
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: ASR ASR |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Healthscope Whirlpool |
$3.37
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$168.48
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Medicare |
$62.34
|
| Rate for Payer: ASR ASR |
$163.43
|
| Rate for Payer: BCBS Complete |
$67.39
|
| Rate for Payer: BCBS Trust/PPO |
$138.91
|
| Rate for Payer: BCN Commercial |
$138.91
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cofinity Commercial |
$158.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$163.43
|
| Rate for Payer: Healthscope Whirlpool |
$168.48
|
| Rate for Payer: Mclaren Commercial |
$151.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.21
|
| Rate for Payer: Nomi Health Commercial |
$138.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.62
|
| Rate for Payer: Priority Health Narrow Network |
$118.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.26
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$23,027.60
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$13,133.24 |
| Max. Negotiated Rate |
$23,027.60 |
| Rate for Payer: Aetna Medicare |
$13,824.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,280.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,280.58
|
| Rate for Payer: BCBS MAPPO |
$13,824.46
|
| Rate for Payer: BCN Medicare Advantage |
$13,824.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,824.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,824.46
|
| Rate for Payer: Mclaren Medicare |
$13,824.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,515.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,898.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,206.91
|
| Rate for Payer: PACE Medicare |
$13,133.24
|
| Rate for Payer: PACE SWMI |
$13,824.46
|
| Rate for Payer: PHP Commercial |
$15,206.91
|
| Rate for Payer: PHP Medicare Advantage |
$13,824.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,027.60
|
| Rate for Payer: Priority Health Medicare |
$13,824.46
|
| Rate for Payer: Priority Health Narrow Network |
$18,422.08
|
| Rate for Payer: Railroad Medicare Medicare |
$13,824.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,824.46
|
| Rate for Payer: UHC Exchange |
$21,427.91
|
| Rate for Payer: UHCCP DNSP |
$13,824.46
|
| Rate for Payer: VA VA |
$13,824.46
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$13,449.37
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$8,243.16 |
| Max. Negotiated Rate |
$13,449.37 |
| Rate for Payer: Aetna Medicare |
$8,677.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,846.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,846.26
|
| Rate for Payer: BCBS MAPPO |
$8,677.01
|
| Rate for Payer: BCN Medicare Advantage |
$8,677.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,677.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,677.01
|
| Rate for Payer: Mclaren Medicare |
$8,677.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,110.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,978.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,544.71
|
| Rate for Payer: PACE Medicare |
$8,243.16
|
| Rate for Payer: PACE SWMI |
$8,677.01
|
| Rate for Payer: PHP Commercial |
$9,544.71
|
| Rate for Payer: PHP Medicare Advantage |
$8,677.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,207.11
|
| Rate for Payer: Priority Health Medicare |
$8,677.01
|
| Rate for Payer: Priority Health Narrow Network |
$10,565.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8,677.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,677.01
|
| Rate for Payer: UHC Exchange |
$13,449.37
|
| Rate for Payer: UHCCP DNSP |
$8,677.01
|
| Rate for Payer: VA VA |
$8,677.01
|
|
|
MEDICAL MAGGOTS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$721.44
|
| Rate for Payer: BCN Commercial |
$721.44
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| 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 |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$848.75
|
| Rate for Payer: Healthscope Whirlpool |
$875.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.75
|
| Rate for Payer: Nomi Health Commercial |
$717.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$656.25
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: BCBS Trust/PPO |
$718.55
|
| Rate for Payer: BCN Commercial |
$718.55
|
| 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 |
$848.75
|
| Rate for Payer: Healthscope Whirlpool |
$875.00
|
| 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: Opus (Opus Packaging Group) HMA |
$656.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
IP
|
$182.17
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.62 |
| Max. Negotiated Rate |
$182.16 |
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: ASR ASR |
$106.23
|
| Rate for Payer: ASR ASR |
$97.94
|
| Rate for Payer: ASR ASR |
$176.70
|
| Rate for Payer: ASR ASR |
$100.36
|
| Rate for Payer: ASR ASR |
$176.69
|
| Rate for Payer: BCBS Trust/PPO |
$149.59
|
| Rate for Payer: BCBS Trust/PPO |
$84.96
|
| Rate for Payer: BCBS Trust/PPO |
$82.92
|
| Rate for Payer: BCBS Trust/PPO |
$149.58
|
| Rate for Payer: BCBS Trust/PPO |
$89.93
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: BCN Commercial |
$84.96
|
| Rate for Payer: BCN Commercial |
$149.58
|
| Rate for Payer: BCN Commercial |
$149.59
|
| Rate for Payer: BCN Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cash Price |
$145.72
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cofinity Commercial |
$97.26
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$171.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.73
|
| Rate for Payer: Healthscope Commercial |
$106.23
|
| Rate for Payer: Healthscope Commercial |
$100.36
|
| Rate for Payer: Healthscope Commercial |
$176.69
|
| Rate for Payer: Healthscope Commercial |
$97.94
|
| Rate for Payer: Healthscope Commercial |
$176.70
|
| Rate for Payer: Healthscope Whirlpool |
$182.15
|
| Rate for Payer: Healthscope Whirlpool |
$182.16
|
| Rate for Payer: Healthscope Whirlpool |
$100.97
|
| Rate for Payer: Healthscope Whirlpool |
$103.46
|
| Rate for Payer: Healthscope Whirlpool |
$109.52
|
| Rate for Payer: Mclaren Commercial |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Mclaren Commercial |
$90.87
|
| Rate for Payer: Mclaren Commercial |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$98.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$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 |
$89.80
|
| Rate for Payer: Nomi Health Commercial |
$84.84
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$149.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.85
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Aetna Commercial |
$163.94
|
| Rate for Payer: Aetna Medicare |
$67.40
|
| Rate for Payer: Aetna Medicare |
$37.36
|
| Rate for Payer: Aetna Medicare |
$67.40
|
| Rate for Payer: Aetna Medicare |
$40.52
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: ASR ASR |
$106.23
|
| Rate for Payer: ASR ASR |
$176.70
|
| Rate for Payer: ASR ASR |
$176.69
|
| Rate for Payer: ASR ASR |
$100.36
|
| Rate for Payer: ASR ASR |
$97.94
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS Complete |
$40.39
|
| Rate for Payer: BCBS Complete |
$72.87
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCBS Trust/PPO |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$150.18
|
| Rate for Payer: BCBS Trust/PPO |
$150.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.30
|
| Rate for Payer: BCN Commercial |
$150.18
|
| Rate for Payer: BCN Commercial |
$85.31
|
| Rate for Payer: BCN Commercial |
$83.25
|
| Rate for Payer: BCN Commercial |
$150.20
|
| Rate for Payer: BCN Commercial |
$90.30
|
| Rate for Payer: Cash Price |
$145.72
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cash Price |
$80.78
|
| 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 |
$145.73
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$171.24
|
| Rate for Payer: Cofinity Commercial |
$97.26
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| 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 |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$97.94
|
| Rate for Payer: Healthscope Commercial |
$100.36
|
| Rate for Payer: Healthscope Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$106.23
|
| Rate for Payer: Healthscope Commercial |
$176.69
|
| Rate for Payer: Healthscope Whirlpool |
$109.52
|
| Rate for Payer: Healthscope Whirlpool |
$100.97
|
| Rate for Payer: Healthscope Whirlpool |
$103.46
|
| Rate for Payer: Healthscope Whirlpool |
$182.16
|
| Rate for Payer: Healthscope Whirlpool |
$182.15
|
| Rate for Payer: Mclaren Commercial |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$90.87
|
| Rate for Payer: Mclaren Commercial |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$163.94
|
| Rate for Payer: Mclaren Commercial |
$98.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: Nomi Health Commercial |
$84.84
|
| Rate for Payer: Nomi Health Commercial |
$82.80
|
| Rate for Payer: Nomi Health Commercial |
$149.38
|
| Rate for Payer: Nomi Health Commercial |
$149.36
|
| Rate for Payer: Nomi Health Commercial |
$89.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.37
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
NDC 555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: Aetna Medicare |
$109.56
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$244.13
|
| Rate for Payer: BCN Commercial |
$244.13
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$287.22
|
| Rate for Payer: Healthscope Whirlpool |
$296.10
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$259.44
|
| Rate for Payer: Priority Health Narrow Network |
$207.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 555087202
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.07 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: ASR ASR |
$287.22
|
| Rate for Payer: BCBS Trust/PPO |
$243.16
|
| Rate for Payer: BCN Commercial |
$243.16
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$278.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$287.22
|
| Rate for Payer: Healthscope Whirlpool |
$296.10
|
| Rate for Payer: Mclaren Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.57
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Aetna Commercial |
$130.07
|
| Rate for Payer: Aetna Medicare |
$53.47
|
| Rate for Payer: ASR ASR |
$140.19
|
| Rate for Payer: BCBS Complete |
$57.81
|
| Rate for Payer: BCBS Trust/PPO |
$119.16
|
| Rate for Payer: BCN Commercial |
$119.16
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$135.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$140.19
|
| Rate for Payer: Healthscope Whirlpool |
$144.53
|
| Rate for Payer: Mclaren Commercial |
$130.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Nomi Health Commercial |
$118.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$126.63
|
| Rate for Payer: Priority Health Narrow Network |
$101.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.18
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: ASR ASR |
$262.14
|
| Rate for Payer: BCBS Trust/PPO |
$221.93
|
| Rate for Payer: BCN Commercial |
$221.93
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$254.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$262.14
|
| Rate for Payer: Healthscope Whirlpool |
$270.25
|
| Rate for Payer: Mclaren Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.82
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.53
|
| Rate for Payer: Priority Health Narrow Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$144.53
|
|
|
Service Code
|
NDC 50268052415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Aetna Commercial |
$130.07
|
| Rate for Payer: ASR ASR |
$140.19
|
| Rate for Payer: BCBS Trust/PPO |
$118.68
|
| Rate for Payer: BCN Commercial |
$118.68
|
| Rate for Payer: Cash Price |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$135.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$140.19
|
| Rate for Payer: Healthscope Whirlpool |
$144.53
|
| Rate for Payer: Mclaren Commercial |
$130.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Nomi Health Commercial |
$118.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.18
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Aetna Commercial |
$243.22
|
| Rate for Payer: Aetna Medicare |
$99.99
|
| Rate for Payer: ASR ASR |
$262.14
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: BCBS Trust/PPO |
$222.82
|
| Rate for Payer: BCN Commercial |
$222.82
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$254.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$262.14
|
| Rate for Payer: Healthscope Whirlpool |
$270.25
|
| Rate for Payer: Mclaren Commercial |
$243.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.79
|
| Rate for Payer: Priority Health Narrow Network |
$189.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.82
|
|
