|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| 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: MI Amish Medical Board Commercial |
$214.27
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00121157610
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00121157610
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.32
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Exchange |
$12.29
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.15
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Advantage |
$11.77
|
| Rate for Payer: Cofinity Advantage |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.21
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$6.80
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.94
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Advantage |
$11.77
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
NDC 51079088601
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health SBD |
$1.63
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.23
|
| Rate for Payer: UHC Core |
$134.04
|
| Rate for Payer: UHC Exchange |
$101.11
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$320.64
|
|
|
Service Code
|
NDC 51079088620
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.01 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Aetna Commercial |
$272.54
|
| Rate for Payer: Aetna Medicare |
$160.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: BCBS Complete |
$128.26
|
| Rate for Payer: Cash Price |
$256.51
|
| Rate for Payer: Cofinity Advantage |
$224.45
|
| Rate for Payer: Cofinity Commercial |
$275.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.51
|
| Rate for Payer: Healthscope Commercial |
$288.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.48
|
| Rate for Payer: PHP Commercial |
$272.54
|
| Rate for Payer: Priority Health SBD |
$202.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.42
|
| Rate for Payer: UHC Core |
$167.05
|
| Rate for Payer: UHC Exchange |
$126.01
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$320.64
|
|
|
Service Code
|
NDC 51079088620
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Aetna Commercial |
$272.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: Cash Price |
$256.51
|
| Rate for Payer: Cofinity Advantage |
$224.45
|
| Rate for Payer: Cofinity Commercial |
$275.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.51
|
| Rate for Payer: Healthscope Commercial |
$288.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.48
|
| Rate for Payer: PHP Commercial |
$272.54
|
| Rate for Payer: Priority Health SBD |
$202.00
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.09 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health SBD |
$162.09
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
NDC 51079088601
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.09
|
| Rate for Payer: UHC Core |
$1.67
|
| Rate for Payer: UHC Exchange |
$1.26
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health SBD |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.01
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.06 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$11.32
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.49
|
| Rate for Payer: PHP Commercial |
$9.62
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.36
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: UHC Exchange |
$4.45
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$805.44
|
|
|
Service Code
|
NDC 00378617201
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.43 |
| Max. Negotiated Rate |
$724.90 |
| Rate for Payer: Aetna Commercial |
$684.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.54
|
| Rate for Payer: Cash Price |
$644.35
|
| Rate for Payer: Cofinity Advantage |
$563.81
|
| Rate for Payer: Cofinity Commercial |
$692.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.35
|
| Rate for Payer: Healthscope Commercial |
$724.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.08
|
| Rate for Payer: PHP Commercial |
$684.62
|
| Rate for Payer: Priority Health SBD |
$507.43
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$108.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.41
|
| Rate for Payer: UHC Core |
$113.34
|
| Rate for Payer: UHC Exchange |
$85.50
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$805.44
|
|
|
Service Code
|
NDC 00378617201
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$724.90 |
| Rate for Payer: Aetna Commercial |
$684.62
|
| Rate for Payer: Aetna Medicare |
$402.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.54
|
| Rate for Payer: BCBS Complete |
$322.18
|
| Rate for Payer: Cash Price |
$644.35
|
| Rate for Payer: Cofinity Advantage |
$563.81
|
| Rate for Payer: Cofinity Commercial |
$692.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.35
|
| Rate for Payer: Healthscope Commercial |
$724.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.08
|
| Rate for Payer: PHP Commercial |
$684.62
|
| Rate for Payer: Priority Health SBD |
$507.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.54
|
| Rate for Payer: UHC Core |
$419.63
|
| Rate for Payer: UHC Exchange |
$316.54
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$1,131.46
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$712.82 |
| Max. Negotiated Rate |
$1,018.31 |
| Rate for Payer: Aetna Commercial |
$961.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: Cash Price |
$905.17
|
| Rate for Payer: Cofinity Advantage |
$792.02
|
| Rate for Payer: Cofinity Commercial |
$973.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.17
|
| Rate for Payer: Healthscope Commercial |
$1,018.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$848.60
|
| Rate for Payer: PHP Commercial |
$961.74
|
| Rate for Payer: Priority Health SBD |
$712.82
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$1,131.46
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.66 |
| Max. Negotiated Rate |
$1,018.31 |
| Rate for Payer: Aetna Commercial |
$961.74
|
| Rate for Payer: Aetna Medicare |
$565.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: BCBS Complete |
$452.58
|
| Rate for Payer: Cash Price |
$905.17
|
| Rate for Payer: Cofinity Advantage |
$792.02
|
| Rate for Payer: Cofinity Commercial |
$973.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.17
|
| Rate for Payer: Healthscope Commercial |
$1,018.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$905.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$848.60
|
| Rate for Payer: PHP Commercial |
$961.74
|
| Rate for Payer: Priority Health SBD |
$712.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.45
|
| Rate for Payer: UHC Core |
$589.49
|
| Rate for Payer: UHC Exchange |
$444.66
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$11.32
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.49
|
| Rate for Payer: PHP Commercial |
$9.62
|
| Rate for Payer: Priority Health SBD |
$7.13
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,200.28
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$471.71 |
| Max. Negotiated Rate |
$1,080.25 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna Medicare |
$600.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.18
|
| Rate for Payer: BCBS Complete |
$480.11
|
| Rate for Payer: Cash Price |
$960.22
|
| Rate for Payer: Cofinity Advantage |
$840.20
|
| Rate for Payer: Cofinity Commercial |
$1,032.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.22
|
| Rate for Payer: Healthscope Commercial |
$1,080.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$960.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.21
|
| Rate for Payer: PHP Commercial |
$1,020.24
|
| Rate for Payer: Priority Health SBD |
$756.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.18
|
| Rate for Payer: UHC Core |
$625.35
|
| Rate for Payer: UHC Exchange |
$471.71
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cofinity Advantage |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$10.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.01
|
| Rate for Payer: PHP Commercial |
$10.21
|
| Rate for Payer: Priority Health SBD |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$6.26
|
| Rate for Payer: UHC Exchange |
$4.72
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,200.28
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$756.18 |
| Max. Negotiated Rate |
$1,080.25 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.18
|
| Rate for Payer: Cash Price |
$960.22
|
| Rate for Payer: Cofinity Advantage |
$840.20
|
| Rate for Payer: Cofinity Commercial |
$1,032.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.22
|
| Rate for Payer: Healthscope Commercial |
$1,080.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.21
|
| Rate for Payer: PHP Commercial |
$1,020.24
|
| Rate for Payer: Priority Health SBD |
$756.18
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$991.97
|
|
|
Service Code
|
NDC 00904732961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$389.84 |
| Max. Negotiated Rate |
$892.77 |
| Rate for Payer: Aetna Commercial |
$843.17
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.78
|
| Rate for Payer: BCBS Complete |
$396.79
|
| Rate for Payer: Cash Price |
$793.58
|
| Rate for Payer: Cofinity Advantage |
$694.38
|
| Rate for Payer: Cofinity Commercial |
$853.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.58
|
| Rate for Payer: Healthscope Commercial |
$892.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$793.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.98
|
| Rate for Payer: PHP Commercial |
$843.17
|
| Rate for Payer: Priority Health SBD |
$624.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.78
|
| Rate for Payer: UHC Core |
$516.82
|
| Rate for Payer: UHC Exchange |
$389.84
|
|
