|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$60.39
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.05 |
| Max. Negotiated Rate |
$54.35 |
| Rate for Payer: Aetna Commercial |
$51.33
|
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.32
|
| Rate for Payer: Cash Price |
$54.54
|
| Rate for Payer: Cash Price |
$48.31
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cofinity Advantage |
$42.27
|
| Rate for Payer: Cofinity Advantage |
$73.58
|
| Rate for Payer: Cofinity Advantage |
$47.73
|
| Rate for Payer: Cofinity Commercial |
$58.63
|
| Rate for Payer: Cofinity Commercial |
$90.39
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.54
|
| Rate for Payer: Healthscope Commercial |
$94.60
|
| Rate for Payer: Healthscope Commercial |
$54.35
|
| Rate for Payer: Healthscope Commercial |
$61.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.29
|
| Rate for Payer: PHP Commercial |
$89.34
|
| Rate for Payer: PHP Commercial |
$57.95
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: Priority Health SBD |
$42.95
|
| Rate for Payer: Priority Health SBD |
$66.22
|
| Rate for Payer: Priority Health SBD |
$38.05
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Aetna Commercial |
$51.33
|
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: Aetna Medicare |
$30.20
|
| Rate for Payer: Aetna Medicare |
$34.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.32
|
| Rate for Payer: BCBS Complete |
$27.27
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Complete |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$54.54
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cash Price |
$48.31
|
| Rate for Payer: Cash Price |
$54.54
|
| Rate for Payer: Cash Price |
$48.31
|
| Rate for Payer: Cofinity Advantage |
$42.27
|
| Rate for Payer: Cofinity Advantage |
$73.58
|
| Rate for Payer: Cofinity Advantage |
$47.73
|
| Rate for Payer: Cofinity Commercial |
$90.39
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$58.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.09
|
| Rate for Payer: Healthscope Commercial |
$61.36
|
| Rate for Payer: Healthscope Commercial |
$54.35
|
| Rate for Payer: Healthscope Commercial |
$94.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.13
|
| Rate for Payer: PHP Commercial |
$89.34
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Commercial |
$57.95
|
| Rate for Payer: Priority Health SBD |
$66.22
|
| Rate for Payer: Priority Health SBD |
$42.95
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)
|
Facility
|
OP
|
$34.95
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
163731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna Medicare |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.96
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.21
|
| Rate for Payer: PHP Commercial |
$29.71
|
| Rate for Payer: Priority Health SBD |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)
|
Facility
|
IP
|
$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 Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.06
|
| 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: Opus (Opus Packaging Group) HMA |
$26.21
|
| Rate for Payer: PHP Commercial |
$29.71
|
| Rate for Payer: Priority Health SBD |
$22.02
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.37
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna Commercial |
$14.76
|
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cofinity Advantage |
$12.16
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$14.94
|
| Rate for Payer: Cofinity Commercial |
$30.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.90
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: Healthscope Commercial |
$15.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.21
|
| Rate for Payer: PHP Commercial |
$14.76
|
| Rate for Payer: PHP Commercial |
$29.71
|
| Rate for Payer: Priority Health SBD |
$10.94
|
| Rate for Payer: Priority Health SBD |
$22.02
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$34.95
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna Commercial |
$14.76
|
| Rate for Payer: Aetna Medicare |
$17.48
|
| Rate for Payer: Aetna Medicare |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS Complete |
$6.95
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cofinity Advantage |
$12.16
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.06
|
| Rate for Payer: Cofinity Commercial |
$14.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.90
|
| Rate for Payer: Healthscope Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.21
|
| Rate for Payer: PHP Commercial |
$29.71
|
| Rate for Payer: PHP Commercial |
$14.76
|
| Rate for Payer: Priority Health SBD |
$10.94
|
| Rate for Payer: Priority Health SBD |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$21.97
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.28
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS Complete |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cofinity Advantage |
$11.69
|
| Rate for Payer: Cofinity Advantage |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$19.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.48
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: Priority Health SBD |
$13.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$16.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.28
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cofinity Advantage |
$11.69
|
| Rate for Payer: Cofinity Advantage |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$19.77
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.48
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: Priority Health SBD |
$13.84
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| 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: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 45802017453
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| 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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.81
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| 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: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| 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: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$11.86
|
|
|
Service Code
|
NDC 00536134957
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$5.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.71
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Advantage |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: Priority Health SBD |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.71
|
| Rate for Payer: UHC Core |
$6.18
|
| Rate for Payer: UHC Exchange |
$4.66
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 41167006003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| 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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.81
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 41167006006
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| 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 Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.81
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$11.86
|
|
|
Service Code
|
NDC 00536134957
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.71
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Advantage |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: Priority Health SBD |
$7.47
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$306.24
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.93 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: Cash Price |
$244.99
|
| Rate for Payer: Cofinity Advantage |
$214.37
|
| Rate for Payer: Cofinity Commercial |
$263.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.99
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.68
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: Priority Health SBD |
$192.93
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 00093220301
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$306.24
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.35 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare |
$153.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: BCBS Complete |
$122.50
|
| Rate for Payer: Cash Price |
$244.99
|
| Rate for Payer: Cofinity Advantage |
$214.37
|
| Rate for Payer: Cofinity Commercial |
$263.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.99
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.68
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: Priority Health SBD |
$192.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.06
|
| Rate for Payer: UHC Core |
$159.55
|
| Rate for Payer: UHC Exchange |
$120.35
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.74
|
| Rate for Payer: UHC Core |
$1.40
|
| Rate for Payer: UHC Exchange |
$1.05
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.00
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.21
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 00093220301
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
|
