Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION

Facility

$21.17

Service Code	HCPCS J2919
Hospital Charge Code	10578
Hospital Revenue Code	636
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$19.05
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna New Business (MI Preferred)	$13.76
Rate for Payer: Cash Price	$16.94
Rate for Payer: Cofinity Commercial	$14.82
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Medicare Advantage	$14.82
Rate for Payer: Encore Health Key Benefits Commercial	$16.94
Rate for Payer: Healthscope Commercial	$19.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.99
Rate for Payer: PHP Commercial	$17.99
Rate for Payer: Priority Health Cigna Priority Health	$13.76
Rate for Payer: Priority Health SBD	$13.34

METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION

Facility

$21.17

Service Code	HCPCS J2919
Hospital Charge Code	10578
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$19.05
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare	$0.22
Rate for Payer: Aetna New Business (MI Preferred)	$13.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.26
Rate for Payer: Amish Plain Church Group Commercial	$0.26
Rate for Payer: BCBS Complete	$0.12
Rate for Payer: BCBS MAPPO	$0.21
Rate for Payer: BCN Medicare Advantage	$0.21
Rate for Payer: Cash Price	$16.94
Rate for Payer: Cash Price	$16.94
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$14.82
Rate for Payer: Cofinity Medicare Advantage	$14.82
Rate for Payer: Encore Health Key Benefits Commercial	$16.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.21
Rate for Payer: Healthscope Commercial	$19.05
Rate for Payer: Mclaren Medicaid	$0.11
Rate for Payer: Mclaren Medicare	$0.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.22
Rate for Payer: Meridian Medicaid	$0.12
Rate for Payer: MI Amish Medical Board Commercial	$0.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.99
Rate for Payer: PACE Medicare	$0.20
Rate for Payer: PACE SWMI	$0.21
Rate for Payer: PHP Commercial	$17.99
Rate for Payer: PHP Medicare Advantage	$0.21
Rate for Payer: Priority Health Choice Medicaid	$0.11
Rate for Payer: Priority Health Cigna Priority Health	$13.76
Rate for Payer: Priority Health Medicare	$0.21
Rate for Payer: Priority Health SBD	$13.34
Rate for Payer: Railroad Medicare Medicare	$0.21
Rate for Payer: UHC All Payor (Choice/PPO)	$0.59
Rate for Payer: UHC Dual Complete DSNP	$0.21
Rate for Payer: UHC Medicare Advantage	$0.21
Rate for Payer: UHCCP Medicaid	$0.12
Rate for Payer: VA VA	$0.21

METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION

Facility

$105.11

Service Code	HCPCS J2919
Hospital Charge Code	10581
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$94.60
Rate for Payer: Aetna Commercial	$89.34
Rate for Payer: Aetna Medicare	$0.22
Rate for Payer: Aetna New Business (MI Preferred)	$68.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.26
Rate for Payer: Amish Plain Church Group Commercial	$0.26
Rate for Payer: BCBS Complete	$0.12
Rate for Payer: BCBS MAPPO	$0.21
Rate for Payer: BCN Medicare Advantage	$0.21
Rate for Payer: Cash Price	$84.09
Rate for Payer: Cash Price	$84.09
Rate for Payer: Cofinity Commercial	$90.39
Rate for Payer: Cofinity Commercial	$73.58
Rate for Payer: Cofinity Medicare Advantage	$73.58
Rate for Payer: Encore Health Key Benefits Commercial	$84.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.21
Rate for Payer: Healthscope Commercial	$94.60
Rate for Payer: Mclaren Medicaid	$0.11
Rate for Payer: Mclaren Medicare	$0.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.22
Rate for Payer: Meridian Medicaid	$0.12
Rate for Payer: MI Amish Medical Board Commercial	$0.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.34
Rate for Payer: PACE Medicare	$0.20
Rate for Payer: PACE SWMI	$0.21
Rate for Payer: PHP Commercial	$89.34
Rate for Payer: PHP Medicare Advantage	$0.21
Rate for Payer: Priority Health Choice Medicaid	$0.11
Rate for Payer: Priority Health Cigna Priority Health	$68.32
Rate for Payer: Priority Health Medicare	$0.21
Rate for Payer: Priority Health SBD	$66.22
Rate for Payer: Railroad Medicare Medicare	$0.21
Rate for Payer: UHC All Payor (Choice/PPO)	$0.59
Rate for Payer: UHC Dual Complete DSNP	$0.21
Rate for Payer: UHC Medicare Advantage	$0.21
Rate for Payer: UHCCP Medicaid	$0.12
Rate for Payer: VA VA	$0.21

METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION

Facility

$105.11

Service Code	HCPCS J2919
Hospital Charge Code	10581
Hospital Revenue Code	636
Min. Negotiated Rate	$66.22
Max. Negotiated Rate	$94.60
Rate for Payer: Aetna Commercial	$89.34
Rate for Payer: Aetna New Business (MI Preferred)	$68.32
Rate for Payer: Cash Price	$84.09
Rate for Payer: Cofinity Commercial	$73.58
Rate for Payer: Cofinity Commercial	$90.39
Rate for Payer: Cofinity Medicare Advantage	$73.58
Rate for Payer: Encore Health Key Benefits Commercial	$84.09
Rate for Payer: Healthscope Commercial	$94.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.34
Rate for Payer: PHP Commercial	$89.34
Rate for Payer: Priority Health Cigna Priority Health	$68.32
Rate for Payer: Priority Health SBD	$66.22

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)

Facility

$34.95

Service Code	HCPCS J2919
Hospital Charge Code	163731
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$29.71
Rate for Payer: Aetna Medicare	$0.22
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.26
Rate for Payer: Amish Plain Church Group Commercial	$0.26
Rate for Payer: BCBS Complete	$0.12
Rate for Payer: BCBS MAPPO	$0.21
Rate for Payer: BCN Medicare Advantage	$0.21
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cofinity Commercial	$30.06
Rate for Payer: Cofinity Commercial	$24.46
Rate for Payer: Cofinity Medicare Advantage	$24.46
Rate for Payer: Encore Health Key Benefits Commercial	$27.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.21
Rate for Payer: Healthscope Commercial	$31.45
Rate for Payer: Mclaren Medicaid	$0.11
Rate for Payer: Mclaren Medicare	$0.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.22
Rate for Payer: Meridian Medicaid	$0.12
Rate for Payer: MI Amish Medical Board Commercial	$0.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.71
Rate for Payer: PACE Medicare	$0.20
Rate for Payer: PACE SWMI	$0.21
Rate for Payer: PHP Commercial	$29.71
Rate for Payer: PHP Medicare Advantage	$0.21
Rate for Payer: Priority Health Choice Medicaid	$0.11
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health Medicare	$0.21
Rate for Payer: Priority Health SBD	$22.02
Rate for Payer: Railroad Medicare Medicare	$0.21
Rate for Payer: UHC All Payor (Choice/PPO)	$0.59
Rate for Payer: UHC Dual Complete DSNP	$0.21
Rate for Payer: UHC Medicare Advantage	$0.21
Rate for Payer: UHCCP Medicaid	$0.12
Rate for Payer: VA VA	$0.21

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)

Facility

$34.95

Service Code	HCPCS J2919
Hospital Charge Code	163731
Hospital Revenue Code	636
Min. Negotiated Rate	$22.02
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$29.71
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cofinity Commercial	$24.46
Rate for Payer: Cofinity Commercial	$30.06
Rate for Payer: Cofinity Medicare Advantage	$24.46
Rate for Payer: Encore Health Key Benefits Commercial	$27.96
Rate for Payer: Healthscope Commercial	$31.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.71
Rate for Payer: PHP Commercial	$29.71
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health SBD	$22.02

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION

Facility

$34.95

Service Code	HCPCS J2919
Hospital Charge Code	119451
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$29.71
Rate for Payer: Aetna Medicare	$0.22
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.26
Rate for Payer: Amish Plain Church Group Commercial	$0.26
Rate for Payer: BCBS Complete	$0.12
Rate for Payer: BCBS MAPPO	$0.21
Rate for Payer: BCN Medicare Advantage	$0.21
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cofinity Commercial	$30.06
Rate for Payer: Cofinity Commercial	$24.46
Rate for Payer: Cofinity Medicare Advantage	$24.46
Rate for Payer: Encore Health Key Benefits Commercial	$27.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.21
Rate for Payer: Healthscope Commercial	$31.45
Rate for Payer: Mclaren Medicaid	$0.11
Rate for Payer: Mclaren Medicare	$0.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.22
Rate for Payer: Meridian Medicaid	$0.12
Rate for Payer: MI Amish Medical Board Commercial	$0.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.71
Rate for Payer: PACE Medicare	$0.20
Rate for Payer: PACE SWMI	$0.21
Rate for Payer: PHP Commercial	$29.71
Rate for Payer: PHP Medicare Advantage	$0.21
Rate for Payer: Priority Health Choice Medicaid	$0.11
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health Medicare	$0.21
Rate for Payer: Priority Health SBD	$22.02
Rate for Payer: Railroad Medicare Medicare	$0.21
Rate for Payer: UHC All Payor (Choice/PPO)	$0.59
Rate for Payer: UHC Dual Complete DSNP	$0.21
Rate for Payer: UHC Medicare Advantage	$0.21
Rate for Payer: UHCCP Medicaid	$0.12
Rate for Payer: VA VA	$0.21

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION

Facility

$34.95

Service Code	HCPCS J2919
Hospital Charge Code	119451
Hospital Revenue Code	636
Min. Negotiated Rate	$22.02
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$29.71
Rate for Payer: Aetna New Business (MI Preferred)	$22.72
Rate for Payer: Cash Price	$27.96
Rate for Payer: Cofinity Commercial	$24.46
Rate for Payer: Cofinity Commercial	$30.06
Rate for Payer: Cofinity Medicare Advantage	$24.46
Rate for Payer: Encore Health Key Benefits Commercial	$27.96
Rate for Payer: Healthscope Commercial	$31.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.71
Rate for Payer: PHP Commercial	$29.71
Rate for Payer: Priority Health Cigna Priority Health	$22.72
Rate for Payer: Priority Health SBD	$22.02

METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION

Facility

$21.97

Service Code	HCPCS J2919
Hospital Charge Code	119450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$18.67
Rate for Payer: Aetna Medicare	$0.22
Rate for Payer: Aetna New Business (MI Preferred)	$14.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.26
Rate for Payer: Amish Plain Church Group Commercial	$0.26
Rate for Payer: BCBS Complete	$0.12
Rate for Payer: BCBS MAPPO	$0.21
Rate for Payer: BCN Medicare Advantage	$0.21
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cofinity Commercial	$18.89
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Medicare Advantage	$15.38
Rate for Payer: Encore Health Key Benefits Commercial	$17.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.21
Rate for Payer: Healthscope Commercial	$19.77
Rate for Payer: Mclaren Medicaid	$0.11
Rate for Payer: Mclaren Medicare	$0.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.22
Rate for Payer: Meridian Medicaid	$0.12
Rate for Payer: MI Amish Medical Board Commercial	$0.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.67
Rate for Payer: PACE Medicare	$0.20
Rate for Payer: PACE SWMI	$0.21
Rate for Payer: PHP Commercial	$18.67
Rate for Payer: PHP Medicare Advantage	$0.21
Rate for Payer: Priority Health Choice Medicaid	$0.11
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health Medicare	$0.21
Rate for Payer: Priority Health SBD	$13.84
Rate for Payer: Railroad Medicare Medicare	$0.21
Rate for Payer: UHC All Payor (Choice/PPO)	$0.59
Rate for Payer: UHC Dual Complete DSNP	$0.21
Rate for Payer: UHC Medicare Advantage	$0.21
Rate for Payer: UHCCP Medicaid	$0.12
Rate for Payer: VA VA	$0.21

METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION

Facility

$21.97

Service Code	HCPCS J2919
Hospital Charge Code	119450
Hospital Revenue Code	636
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$18.67
Rate for Payer: Aetna New Business (MI Preferred)	$14.28
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Commercial	$18.89
Rate for Payer: Cofinity Medicare Advantage	$15.38
Rate for Payer: Encore Health Key Benefits Commercial	$17.58
Rate for Payer: Healthscope Commercial	$19.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.67
Rate for Payer: PHP Commercial	$18.67
Rate for Payer: Priority Health Cigna Priority Health	$14.28
Rate for Payer: Priority Health SBD	$13.84

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 41167006003
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 45802017453
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 45802017453
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 41167006006
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 41167006006
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM

Facility

$12.24

Service Code	NDC 41167006003
Hospital Charge Code	76971
Hospital Revenue Code	637
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

METOCLOPRAMIDE 10 MG TABLET

Facility

$326.40

Service Code	NDC 51079088820
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$205.63
Max. Negotiated Rate	$293.76
Rate for Payer: Aetna Commercial	$277.44
Rate for Payer: Aetna New Business (MI Preferred)	$212.16
Rate for Payer: Cash Price	$261.12
Rate for Payer: Cofinity Commercial	$228.48
Rate for Payer: Cofinity Commercial	$280.70
Rate for Payer: Cofinity Medicare Advantage	$228.48
Rate for Payer: Encore Health Key Benefits Commercial	$261.12
Rate for Payer: Healthscope Commercial	$293.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.44
Rate for Payer: PHP Commercial	$277.44
Rate for Payer: Priority Health Cigna Priority Health	$212.16
Rate for Payer: Priority Health SBD	$205.63

METOCLOPRAMIDE 10 MG TABLET

Facility

$3.27

Service Code	NDC 51079088801
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.78
Rate for Payer: Aetna New Business (MI Preferred)	$2.13
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cofinity Commercial	$2.29
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Cofinity Medicare Advantage	$2.29
Rate for Payer: Encore Health Key Benefits Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.78
Rate for Payer: PHP Commercial	$2.78
Rate for Payer: Priority Health Cigna Priority Health	$2.13
Rate for Payer: Priority Health SBD	$2.06

METOCLOPRAMIDE 10 MG TABLET

Facility

$98.70

Service Code	NDC 00093220301
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna Medicare	$49.35
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: BCBS Complete	$39.48
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

METOCLOPRAMIDE 10 MG TABLET

Facility

$261.60

Service Code	NDC 60687063101
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$104.64
Max. Negotiated Rate	$235.44
Rate for Payer: Aetna Commercial	$222.36
Rate for Payer: Aetna Medicare	$130.80
Rate for Payer: Aetna New Business (MI Preferred)	$170.04
Rate for Payer: BCBS Complete	$104.64
Rate for Payer: Cash Price	$209.28
Rate for Payer: Cofinity Commercial	$183.12
Rate for Payer: Cofinity Commercial	$224.98
Rate for Payer: Cofinity Medicare Advantage	$183.12
Rate for Payer: Encore Health Key Benefits Commercial	$209.28
Rate for Payer: Healthscope Commercial	$235.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.36
Rate for Payer: PHP Commercial	$222.36
Rate for Payer: Priority Health Cigna Priority Health	$170.04
Rate for Payer: Priority Health SBD	$164.81

METOCLOPRAMIDE 10 MG TABLET

Facility

$98.70

Service Code	NDC 00093220301
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

METOCLOPRAMIDE 10 MG TABLET

Facility

$261.60

Service Code	NDC 60687063101
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$164.81
Max. Negotiated Rate	$235.44
Rate for Payer: Aetna Commercial	$222.36
Rate for Payer: Aetna New Business (MI Preferred)	$170.04
Rate for Payer: Cash Price	$209.28
Rate for Payer: Cofinity Commercial	$183.12
Rate for Payer: Cofinity Commercial	$224.98
Rate for Payer: Cofinity Medicare Advantage	$183.12
Rate for Payer: Encore Health Key Benefits Commercial	$209.28
Rate for Payer: Healthscope Commercial	$235.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.36
Rate for Payer: PHP Commercial	$222.36
Rate for Payer: Priority Health Cigna Priority Health	$170.04
Rate for Payer: Priority Health SBD	$164.81

METOCLOPRAMIDE 10 MG TABLET

Facility

$2.62

Service Code	NDC 60687063111
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna New Business (MI Preferred)	$1.70
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$1.83
Rate for Payer: Cofinity Commercial	$2.25
Rate for Payer: Cofinity Medicare Advantage	$1.83
Rate for Payer: Encore Health Key Benefits Commercial	$2.10
Rate for Payer: Healthscope Commercial	$2.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.23
Rate for Payer: PHP Commercial	$2.23
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.65

METOCLOPRAMIDE 10 MG TABLET

Facility

$3.27

Service Code	NDC 51079088801
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.78
Rate for Payer: Aetna Medicare	$1.64
Rate for Payer: Aetna New Business (MI Preferred)	$2.13
Rate for Payer: BCBS Complete	$1.31
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cofinity Commercial	$2.29
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Cofinity Medicare Advantage	$2.29
Rate for Payer: Encore Health Key Benefits Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.78
Rate for Payer: PHP Commercial	$2.78
Rate for Payer: Priority Health Cigna Priority Health	$2.13
Rate for Payer: Priority Health SBD	$2.06

METOCLOPRAMIDE 10 MG TABLET

Facility

$2.62

Service Code	NDC 60687063111
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare	$1.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.70
Rate for Payer: BCBS Complete	$1.05
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$1.83
Rate for Payer: Cofinity Commercial	$2.25
Rate for Payer: Cofinity Medicare Advantage	$1.83
Rate for Payer: Encore Health Key Benefits Commercial	$2.10
Rate for Payer: Healthscope Commercial	$2.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.23
Rate for Payer: PHP Commercial	$2.23
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.65

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