|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.24 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: BCBS Trust/PPO |
$203.75
|
| 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 Commercial |
$212.16
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health HMO/PPO |
$217.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.23
|
| 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
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.82
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.28
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: VA VA |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.97
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna Medicare |
$64.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.00
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS MAPPO |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$205.20
|
| Rate for Payer: BCN Commercial |
$194.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.40
|
| 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: Health Alliance Plan Medicare Advantage |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE Senior Care Partners |
$59.28
|
| Rate for Payer: PACE SWMI |
$62.40
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: PHP Medicare Advantage |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health HMO/PPO |
$217.15
|
| Rate for Payer: Priority Health Medicare |
$63.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.40
|
| Rate for Payer: UHC Exchange |
$62.40
|
| Rate for Payer: UHC Medicare Advantage |
$62.40
|
| Rate for Payer: VA VA |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 68084067611
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| 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 Commercial |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| 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
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 68084067611
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.78
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| 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: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO |
$2.17
|
| Rate for Payer: Priority Health Medicare |
$0.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$2.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$261.60
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.04 |
| Max. Negotiated Rate |
$235.44 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: BCBS Trust/PPO |
$213.54
|
| Rate for Payer: BCN Commercial |
$202.16
|
| Rate for Payer: Cash Price |
$209.28
|
| Rate for Payer: Cofinity Commercial |
$224.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.28
|
| Rate for Payer: Healthscope Commercial |
$235.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.36
|
| Rate for Payer: Nomi Health Commercial |
$214.51
|
| Rate for Payer: PHP Commercial |
$222.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.04
|
| Rate for Payer: Priority Health HMO/PPO |
$227.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.21
|
| Rate for Payer: UHC Core |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: BCBS Trust/PPO |
$266.44
|
| 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 Commercial |
$277.44
|
| Rate for Payer: Nomi Health Commercial |
$267.65
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.16
|
| Rate for Payer: Priority Health HMO/PPO |
$283.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.69
|
| 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 10 MG TABLET
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
NDC 51079088820
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: Aetna Medicare |
$84.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.00
|
| Rate for Payer: BCBS Complete |
$130.56
|
| Rate for Payer: BCBS MAPPO |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$268.33
|
| Rate for Payer: BCN Commercial |
$253.78
|
| Rate for Payer: BCN Medicare Advantage |
$81.60
|
| 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: Health Alliance Plan Medicare Advantage |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.44
|
| Rate for Payer: Nomi Health Commercial |
$267.65
|
| Rate for Payer: PACE Senior Care Partners |
$77.52
|
| Rate for Payer: PACE SWMI |
$81.60
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: PHP Medicare Advantage |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.16
|
| Rate for Payer: Priority Health HMO/PPO |
$283.97
|
| Rate for Payer: Priority Health Medicare |
$82.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.69
|
| Rate for Payer: Railroad Medicare Medicare |
$81.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.60
|
| Rate for Payer: UHC Exchange |
$81.60
|
| Rate for Payer: UHC Medicare Advantage |
$81.60
|
| Rate for Payer: VA VA |
$81.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$261.60
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$235.44 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: Aetna Medicare |
$68.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.75
|
| Rate for Payer: BCBS Complete |
$104.64
|
| Rate for Payer: BCBS MAPPO |
$65.40
|
| Rate for Payer: BCBS Trust/PPO |
$215.06
|
| Rate for Payer: BCN Commercial |
$203.39
|
| Rate for Payer: BCN Medicare Advantage |
$65.40
|
| Rate for Payer: Cash Price |
$209.28
|
| Rate for Payer: Cofinity Commercial |
$224.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.40
|
| Rate for Payer: Healthscope Commercial |
$235.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.36
|
| Rate for Payer: Nomi Health Commercial |
$214.51
|
| Rate for Payer: PACE Senior Care Partners |
$62.13
|
| Rate for Payer: PACE SWMI |
$65.40
|
| Rate for Payer: PHP Commercial |
$222.36
|
| Rate for Payer: PHP Medicare Advantage |
$65.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.04
|
| Rate for Payer: Priority Health HMO/PPO |
$227.59
|
| Rate for Payer: Priority Health Medicare |
$66.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.27
|
| Rate for Payer: Railroad Medicare Medicare |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.21
|
| Rate for Payer: UHC Core |
$218.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.40
|
| Rate for Payer: UHC Exchange |
$65.40
|
| Rate for Payer: UHC Medicare Advantage |
$65.40
|
| Rate for Payer: VA VA |
$65.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.97
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.02
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| 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: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.88
|
| Rate for Payer: UHC Core |
$2.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.82
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.45
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 51079088801
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna Commercial |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| 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 Commercial |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$2.68
|
| Rate for Payer: PHP Commercial |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| 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 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.74
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.88 |
| 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 |
$13.66
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.37
|
| Rate for Payer: BCBS Trust/PPO |
$8.81
|
| Rate for Payer: BCN Commercial |
$12.94
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$13.00
|
| Rate for Payer: BCN Commercial |
$11.71
|
| 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: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.88
|
| Rate for Payer: Priority Health HMO/PPO |
$14.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health HMO/PPO |
$9.39
|
| Rate for Payer: Priority Health HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.23
|
| 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/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.79
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| 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 |
$5.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.37
|
| 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 |
$4.32
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$6.70
|
| 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 |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.45
|
| Rate for Payer: BCBS Trust/PPO |
$13.76
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: BCN Commercial |
$13.02
|
| Rate for Payer: BCN Commercial |
$11.78
|
| Rate for Payer: BCN Commercial |
$13.08
|
| 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: BCN Medicare Advantage |
$4.18
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| 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 |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| 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 |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.83
|
| 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 |
$4.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| 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 |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Nomi Health Commercial |
$13.73
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$8.85
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: PACE Senior Care Partners |
$2.56
|
| 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 |
$3.60
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PACE SWMI |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health HMO/PPO |
$14.56
|
| Rate for Payer: Priority Health HMO/PPO |
$9.39
|
| Rate for Payer: Priority Health Medicare |
$4.23
|
| Rate for Payer: Priority Health Medicare |
$2.72
|
| Rate for Payer: Priority Health Medicare |
$3.83
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| 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: UHC All Payor (Choice/PPO) |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Core |
$9.01
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.79
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UHC Exchange |
$3.79
|
| Rate for Payer: UHC Exchange |
$2.70
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Medicare Advantage |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.70
|
| Rate for Payer: UHC Medicare Advantage |
$4.18
|
| Rate for Payer: UHC Medicare Advantage |
$3.79
|
| Rate for Payer: VA VA |
$3.79
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: VA VA |
$4.18
|
| Rate for Payer: VA VA |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| 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 |
$12.55
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.03
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS MAPPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$54.81
|
| Rate for Payer: BCN Medicare Advantage |
$17.62
|
| 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: Health Alliance Plan Medicare Advantage |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: PACE Senior Care Partners |
$16.74
|
| Rate for Payer: PACE SWMI |
$17.62
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Medicare |
$17.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.23
|
| Rate for Payer: Railroad Medicare Medicare |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.62
|
| Rate for Payer: UHC Exchange |
$17.62
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
| Rate for Payer: VA VA |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$66.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.40
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: BCBS MAPPO |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$211.51
|
| Rate for Payer: BCN Commercial |
$200.04
|
| Rate for Payer: BCN Medicare Advantage |
$64.32
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.32
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: PACE Senior Care Partners |
$61.10
|
| Rate for Payer: PACE SWMI |
$64.32
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Medicare Advantage |
$64.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Medicare |
$64.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.38
|
| Rate for Payer: Railroad Medicare Medicare |
$64.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.32
|
| Rate for Payer: UHC Exchange |
$64.32
|
| Rate for Payer: UHC Medicare Advantage |
$64.32
|
| Rate for Payer: VA VA |
$64.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: BCBS Trust/PPO |
$210.02
|
| Rate for Payer: BCN Commercial |
$198.83
|
| Rate for Payer: Cash Price |
$205.82
|
| 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: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| 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: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$1.99
|
| 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: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.73
|
| 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
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| 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 Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.23
|
| 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
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$710.92 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: BCBS Trust/PPO |
$892.80
|
| Rate for Payer: BCN Commercial |
$845.23
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: Nomi Health Commercial |
$896.85
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health HMO/PPO |
$951.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$962.47
|
| Rate for Payer: UHC Core |
$913.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.76 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: Aetna Medicare |
$284.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.79
|
| Rate for Payer: BCBS Complete |
$437.49
|
| Rate for Payer: BCBS MAPPO |
$273.43
|
| Rate for Payer: BCBS Trust/PPO |
$899.15
|
| Rate for Payer: BCN Commercial |
$850.37
|
| Rate for Payer: BCN Medicare Advantage |
$273.43
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.43
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: Nomi Health Commercial |
$896.85
|
| Rate for Payer: PACE Senior Care Partners |
$259.76
|
| Rate for Payer: PACE SWMI |
$273.43
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: PHP Medicare Advantage |
$273.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health HMO/PPO |
$951.54
|
| Rate for Payer: Priority Health Medicare |
$276.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.79
|
| Rate for Payer: Railroad Medicare Medicare |
$273.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$962.47
|
| Rate for Payer: UHC Core |
$913.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.43
|
| Rate for Payer: UHC Exchange |
$273.43
|
| Rate for Payer: UHC Medicare Advantage |
$273.43
|
| Rate for Payer: VA VA |
$273.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$240.48
|
|
|
Service Code
|
NDC 09900000013
|
| Hospital Charge Code |
150704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.11 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: Aetna Medicare |
$62.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.15
|
| Rate for Payer: BCBS Complete |
$96.19
|
| Rate for Payer: BCBS MAPPO |
$60.12
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$186.97
|
| Rate for Payer: BCN Medicare Advantage |
$60.12
|
| 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: Health Alliance Plan Medicare Advantage |
$60.12
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| Rate for Payer: PACE Senior Care Partners |
$57.11
|
| Rate for Payer: PACE SWMI |
$60.12
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: PHP Medicare Advantage |
$60.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.31
|
| Rate for Payer: Priority Health HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Medicare |
$60.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| Rate for Payer: Railroad Medicare Medicare |
$60.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.62
|
| Rate for Payer: UHC Core |
$200.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.12
|
| Rate for Payer: UHC Exchange |
$60.12
|
| Rate for Payer: UHC Medicare Advantage |
$60.12
|
| Rate for Payer: VA VA |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.36
|
|
|
METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$240.48
|
|
|
Service Code
|
NDC 09900000013
|
| Hospital Charge Code |
150704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.31 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: BCBS Trust/PPO |
$196.30
|
| 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 Commercial |
$204.41
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.31
|
| Rate for Payer: Priority Health HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| 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
|
OP
|
$371.45
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$334.31 |
| Rate for Payer: Aetna Commercial |
$315.73
|
| Rate for Payer: Aetna Medicare |
$96.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.08
|
| Rate for Payer: BCBS Complete |
$148.58
|
| Rate for Payer: BCBS MAPPO |
$92.86
|
| Rate for Payer: BCBS Trust/PPO |
$305.37
|
| Rate for Payer: BCN Commercial |
$288.80
|
| Rate for Payer: BCN Medicare Advantage |
$92.86
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$319.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.86
|
| Rate for Payer: Healthscope Commercial |
$334.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: PACE Senior Care Partners |
$88.22
|
| Rate for Payer: PACE SWMI |
$92.86
|
| Rate for Payer: PHP Commercial |
$315.73
|
| Rate for Payer: PHP Medicare Advantage |
$92.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$323.16
|
| Rate for Payer: Priority Health Medicare |
$93.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.87
|
| Rate for Payer: Railroad Medicare Medicare |
$92.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.88
|
| Rate for Payer: UHC Core |
$310.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.86
|
| Rate for Payer: UHC Exchange |
$92.86
|
| Rate for Payer: UHC Medicare Advantage |
$92.86
|
| Rate for Payer: VA VA |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.59
|
|
