|
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 |
$11.62 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$13.79
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$17.58
|
| 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: Lakeland Regional Health Systems Commercial |
$12.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Nomi Health Commercial |
$13.69
|
| Rate for Payer: Nomi Health Commercial |
$18.02
|
| 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 Cigna Priority Health/HMO/PPO |
$19.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.33
|
| Rate for Payer: UHC Core |
$13.94
|
| Rate for Payer: UHC Core |
$18.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.48
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: Aetna Medicare |
$4.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.87
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: BCBS MAPPO |
$4.17
|
| Rate for Payer: BCBS MAPPO |
$5.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$18.06
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$5.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.17
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$17.58
|
| 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: Health Alliance Plan Medicare Advantage |
$5.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.17
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.48
|
| Rate for Payer: Mclaren Medicaid |
$3.87
|
| Rate for Payer: Mclaren Medicaid |
$2.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.38
|
| Rate for Payer: Meridian Medicaid |
$3.09
|
| Rate for Payer: Meridian Medicaid |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.20
|
| Rate for Payer: Nomi Health Commercial |
$18.02
|
| Rate for Payer: Nomi Health Commercial |
$13.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.22
|
| Rate for Payer: PACE Senior Care Partners |
$3.97
|
| Rate for Payer: PACE SWMI |
$5.49
|
| Rate for Payer: PACE SWMI |
$4.17
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: PHP Medicare Advantage |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$5.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.53
|
| Rate for Payer: Priority Health Medicare |
$5.55
|
| Rate for Payer: Priority Health Medicare |
$4.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.17
|
| Rate for Payer: Railroad Medicare Medicare |
$5.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.33
|
| Rate for Payer: UHC Core |
$18.34
|
| Rate for Payer: UHC Core |
$13.94
|
| Rate for Payer: UHC Exchange |
$5.49
|
| Rate for Payer: UHC Exchange |
$4.17
|
| Rate for Payer: UHC Medicaid |
$3.87
|
| Rate for Payer: UHC Medicaid |
$2.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.17
|
| Rate for Payer: UHC Medicare Advantage |
$5.49
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: UHCCP Medicaid |
$3.87
|
| Rate for Payer: VA VA |
$4.17
|
| Rate for Payer: VA VA |
$5.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.53
|
|
|
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 |
$8.52 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$10.11
|
| 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 Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| 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 45802017453
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$10.11
|
| 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 Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| 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
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 41167006003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| 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: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicaid |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
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 |
$2.16 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| 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: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicaid |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: VA VA |
$3.06
|
| 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 41167060003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$10.11
|
| 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 Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| 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
|
$11.86
|
|
|
Service Code
|
NDC 00536134957
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$9.49
|
| 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: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
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 |
$2.09 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Medicare Advantage |
$2.96
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.89
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.89
|
| Rate for Payer: PACE Senior Care Partners |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.96
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: PHP Medicare Advantage |
$2.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.32
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.44
|
| Rate for Payer: UHC Core |
$9.90
|
| Rate for Payer: UHC Exchange |
$2.96
|
| Rate for Payer: UHC Medicaid |
$2.09
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: VA VA |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.89
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 41167060003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| 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: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicaid |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: VA VA |
$3.06
|
| 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 41167006006
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$10.11
|
| 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 Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| 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
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 45802017453
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| 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: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicaid |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$17.22
|
|
|
Service Code
|
NDC 00536110145
|
| Hospital Charge Code |
168488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$15.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.64
|
| Rate for Payer: Nomi Health Commercial |
$14.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE SWMI |
$4.30
|
| Rate for Payer: PHP Commercial |
$14.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.98
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.15
|
| Rate for Payer: UHC Core |
$14.38
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Medicaid |
$3.04
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$17.22
|
|
|
Service Code
|
NDC 00536110145
|
| Hospital Charge Code |
168488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna Commercial |
$14.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$15.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.64
|
| Rate for Payer: Nomi Health Commercial |
$14.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.91
|
| Rate for Payer: PHP Commercial |
$14.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.15
|
| Rate for Payer: UHC Core |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.57
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: Meridian Medicaid |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PACE Senior Care Partners |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.67
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UHC Medicaid |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.77
|
| Rate for Payer: UHCCP Medicaid |
$0.54
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.14
|
| 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: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$0.50
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: Meridian Medicaid |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicaid |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$306.24
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare |
$79.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.70
|
| Rate for Payer: BCBS Complete |
$56.69
|
| Rate for Payer: BCBS MAPPO |
$76.56
|
| Rate for Payer: BCBS Trust/PPO |
$251.76
|
| Rate for Payer: BCN Commercial |
$251.76
|
| Rate for Payer: BCN Medicare Advantage |
$76.56
|
| Rate for Payer: Cash Price |
$244.99
|
| Rate for Payer: Cofinity Commercial |
$263.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.68
|
| Rate for Payer: Mclaren Medicaid |
$53.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.39
|
| Rate for Payer: Meridian Medicaid |
$56.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: Nomi Health Commercial |
$251.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.68
|
| Rate for Payer: PACE Senior Care Partners |
$72.73
|
| Rate for Payer: PACE SWMI |
$76.56
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: PHP Medicare Advantage |
$76.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.43
|
| Rate for Payer: Priority Health Medicare |
$77.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.14
|
| Rate for Payer: Railroad Medicare Medicare |
$76.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.49
|
| Rate for Payer: UHC Core |
$255.71
|
| Rate for Payer: UHC Exchange |
$76.56
|
| Rate for Payer: UHC Medicaid |
$53.99
|
| Rate for Payer: UHC Medicare Advantage |
$76.56
|
| Rate for Payer: UHCCP Medicaid |
$53.99
|
| Rate for Payer: VA VA |
$76.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.68
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$306.24
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.14 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: BCBS Trust/PPO |
$252.92
|
| Rate for Payer: BCN Commercial |
$252.92
|
| Rate for Payer: Cash Price |
$244.99
|
| 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: Lakeland Regional Health Systems Commercial |
$229.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.30
|
| Rate for Payer: Nomi Health Commercial |
$251.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.68
|
| Rate for Payer: PHP Commercial |
$260.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.49
|
| Rate for Payer: UHC Core |
$255.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.68
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.42 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$221.21
|
| Rate for Payer: BCN Commercial |
$221.21
|
| Rate for Payer: Cash Price |
$214.27
|
| 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: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.46
|
| 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: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$69.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.70
|
| Rate for Payer: BCBS Complete |
$49.58
|
| Rate for Payer: BCBS MAPPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$220.19
|
| Rate for Payer: BCN Commercial |
$220.19
|
| Rate for Payer: BCN Medicare Advantage |
$66.96
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.96
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Mclaren Medicaid |
$47.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.31
|
| Rate for Payer: Meridian Medicaid |
$49.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PACE Senior Care Partners |
$63.61
|
| Rate for Payer: PACE SWMI |
$66.96
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: PHP Medicare Advantage |
$66.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Medicare |
$67.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.42
|
| Rate for Payer: Railroad Medicare Medicare |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: UHC Exchange |
$66.96
|
| Rate for Payer: UHC Medicaid |
$47.22
|
| Rate for Payer: UHC Medicare Advantage |
$66.96
|
| Rate for Payer: UHCCP Medicaid |
$47.22
|
| Rate for Payer: VA VA |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.79
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.37
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$2.70
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.45
|
| Rate for Payer: BCN Commercial |
$13.76
|
| Rate for Payer: BCN Commercial |
$13.83
|
| Rate for Payer: BCN Commercial |
$12.45
|
| Rate for Payer: BCN Commercial |
$8.87
|
| Rate for Payer: BCN Medicare Advantage |
$4.18
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: BCN Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.18
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicaid |
$1.90
|
| Rate for Payer: Mclaren Medicaid |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.83
|
| Rate for Payer: Meridian Medicaid |
$2.00
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: Meridian Medicaid |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$13.73
|
| Rate for Payer: Nomi Health Commercial |
$8.85
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: PACE Senior Care Partners |
$3.98
|
| Rate for Payer: PACE Senior Care Partners |
$3.99
|
| Rate for Payer: PACE Senior Care Partners |
$2.56
|
| Rate for Payer: PACE Senior Care Partners |
$3.60
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PACE SWMI |
$4.18
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$4.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.39
|
| Rate for Payer: Priority Health Medicare |
$3.83
|
| Rate for Payer: Priority Health Medicare |
$2.72
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.51
|
| Rate for Payer: Railroad Medicare Medicare |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$2.70
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC Core |
$9.01
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Exchange |
$3.79
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UHC Exchange |
$2.70
|
| Rate for Payer: UHC Medicaid |
$1.90
|
| Rate for Payer: UHC Medicaid |
$2.67
|
| Rate for Payer: UHC Medicaid |
$2.95
|
| Rate for Payer: UHC Medicaid |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Medicare Advantage |
$2.70
|
| Rate for Payer: UHC Medicare Advantage |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.18
|
| Rate for Payer: UHCCP Medicaid |
$2.95
|
| Rate for Payer: UHCCP Medicaid |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$2.67
|
| Rate for Payer: UHCCP Medicaid |
$1.90
|
| Rate for Payer: VA VA |
$2.70
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: VA VA |
$4.18
|
| Rate for Payer: VA VA |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.74
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCBS Trust/PPO |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$8.91
|
| Rate for Payer: BCN Commercial |
$13.83
|
| Rate for Payer: BCN Commercial |
$8.91
|
| Rate for Payer: BCN Commercial |
$13.89
|
| Rate for Payer: BCN Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| 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 |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$8.85
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.73
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$9.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.06
|
| 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: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
