|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| 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: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| 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: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$11.48
|
|
|
Service Code
|
NDC 0536-1349-57
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$10.33 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$8.87
|
| Rate for Payer: BCN Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.18
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.76
|
| Rate for Payer: PHP Commercial |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.10
|
| Rate for Payer: UHC Core |
$9.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.61
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| 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: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 68084-676-11
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$1.93
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 63739-293-10
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$145.29
|
| Rate for Payer: BCN Commercial |
$145.29
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 51079-888-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.78
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 60687-631-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: BCBS Trust/PPO |
$198.08
|
| Rate for Payer: BCN Commercial |
$198.08
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.87
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.56
|
| Rate for Payer: UHC Core |
$214.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68084-676-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.23 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: BCBS Trust/PPO |
$192.89
|
| Rate for Payer: BCN Commercial |
$192.89
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 60687-631-11
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
NDC 51079-888-20
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.07 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: BCBS Trust/PPO |
$252.24
|
| Rate for Payer: BCN Commercial |
$252.24
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 9900-0003-44
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.21
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 9900-0003-45
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna Commercial |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.36
|
| Rate for Payer: BCN Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$0.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.41
|
| Rate for Payer: UHC Core |
$0.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$655.82
|
|
|
Service Code
|
NDC 0121-0576-16
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.98 |
| Max. Negotiated Rate |
$590.24 |
| Rate for Payer: Aetna Commercial |
$557.45
|
| Rate for Payer: BCBS Trust/PPO |
$506.82
|
| Rate for Payer: BCN Commercial |
$506.82
|
| Rate for Payer: Cash Price |
$524.66
|
| Rate for Payer: Cofinity Commercial |
$564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.66
|
| Rate for Payer: Healthscope Commercial |
$590.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$557.45
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.12
|
| Rate for Payer: UHC Core |
$547.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.86
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$289.01
|
|
|
Service Code
|
NDC 62559-190-16
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.27 |
| Max. Negotiated Rate |
$260.11 |
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: BCBS Trust/PPO |
$223.35
|
| Rate for Payer: BCN Commercial |
$223.35
|
| Rate for Payer: Cash Price |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$248.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$260.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.66
|
| Rate for Payer: PHP Commercial |
$245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.33
|
| Rate for Payer: UHC Core |
$241.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.76
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$11.05
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| 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 |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.50
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Core |
$9.01
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 0093-2204-01
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.48
|
| Rate for Payer: BCN Commercial |
$54.48
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 60687-620-11
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 60687-620-01
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.04 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: BCBS Trust/PPO |
$197.71
|
| Rate for Payer: BCN Commercial |
$197.71
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.46
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.14
|
| Rate for Payer: UHC Core |
$213.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,070.41
|
|
|
Service Code
|
NDC 51079-024-20
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$652.84 |
| Max. Negotiated Rate |
$963.37 |
| Rate for Payer: Aetna Commercial |
$909.85
|
| Rate for Payer: BCBS Trust/PPO |
$827.21
|
| Rate for Payer: BCN Commercial |
$827.21
|
| Rate for Payer: Cash Price |
$856.33
|
| Rate for Payer: Cofinity Commercial |
$920.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.33
|
| Rate for Payer: Healthscope Commercial |
$963.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$802.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$909.85
|
| Rate for Payer: PHP Commercial |
$909.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.96
|
| Rate for Payer: UHC Core |
$893.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$802.81
|
|
|
METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$240.48
|
|
|
Service Code
|
NDC 9900-0000-13
|
| Hospital Charge Code |
150704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: BCBS Trust/PPO |
$185.84
|
| Rate for Payer: BCN Commercial |
$185.84
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.41
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.62
|
| Rate for Payer: UHC Core |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$367.65
|
|
|
Service Code
|
NDC 0904-6322-61
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.23 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna Commercial |
$312.50
|
| Rate for Payer: BCBS Trust/PPO |
$284.12
|
| Rate for Payer: BCN Commercial |
$284.12
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$316.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.50
|
| Rate for Payer: PHP Commercial |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.53
|
| Rate for Payer: UHC Core |
$306.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.74
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 45963-709-11
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$171.06
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.15
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 0904-6323-61
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.17 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: BCBS Trust/PPO |
$278.98
|
| Rate for Payer: BCN Commercial |
$278.98
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
METOPROLOL TARTRATE 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 9900-0000-38
|
| Hospital Charge Code |
500250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.33 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: BCBS Trust/PPO |
$127.13
|
| Rate for Payer: BCN Commercial |
$127.13
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.76
|
| Rate for Payer: UHC Core |
$137.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
