|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 63739-293-10
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$289.01
|
|
|
Service Code
|
NDC 62559-190-16
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$260.11 |
| Rate for Payer: Aetna American Axle |
$187.86
|
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.86
|
| Rate for Payer: Cash Price |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Cofinity Commercial |
$248.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$260.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.66
|
| Rate for Payer: PHP Commercial |
$245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.31
|
| Rate for Payer: Priority Health SBD |
$182.08
|
| Rate for Payer: UMR Bronson Commercial |
$127.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.76
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$655.82
|
|
|
Service Code
|
NDC 0121-0576-16
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$590.24 |
| Rate for Payer: Aetna American Axle |
$426.28
|
| Rate for Payer: Aetna Commercial |
$557.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.28
|
| Rate for Payer: Cash Price |
$524.66
|
| Rate for Payer: Cofinity Commercial |
$459.07
|
| Rate for Payer: Cofinity Commercial |
$564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.66
|
| Rate for Payer: Healthscope Commercial |
$590.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$557.45
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.07
|
| Rate for Payer: Priority Health SBD |
$413.17
|
| Rate for Payer: UMR Bronson Commercial |
$288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.86
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
NDC 0121-1576-10
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Aetna American Axle |
$19.82
|
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.82
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$21.35
|
| Rate for Payer: Cofinity Commercial |
$26.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.40
|
| Rate for Payer: Healthscope Commercial |
$27.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.92
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.35
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: UMR Bronson Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
|
|
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 |
$3.52 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna American Axle |
$7.01
|
| Rate for Payer: Aetna American Axle |
$9.30
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$3.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.79
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna American Axle |
$7.01
|
| Rate for Payer: Aetna American Axle |
$9.30
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 63739-103-10
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.92
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 0093-2204-01
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.82
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
METOCLOPRAMIDE (BULK) POWDER
|
Facility
|
IP
|
$86.58
|
|
|
Service Code
|
NDC 38779-0403-1
|
| Hospital Charge Code |
14955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$77.92 |
| Rate for Payer: Aetna American Axle |
$56.28
|
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.28
|
| Rate for Payer: Cash Price |
$69.26
|
| Rate for Payer: Cofinity Commercial |
$74.46
|
| Rate for Payer: Cofinity Commercial |
$60.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.26
|
| Rate for Payer: Healthscope Commercial |
$77.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.59
|
| Rate for Payer: PHP Commercial |
$73.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.61
|
| Rate for Payer: Priority Health SBD |
$54.55
|
| Rate for Payer: UMR Bronson Commercial |
$38.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.94
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
NDC 0185-5600-01
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.50
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.23
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
IP
|
$845.08
|
|
|
Service Code
|
NDC 0378-6174-01
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.84 |
| Max. Negotiated Rate |
$760.57 |
| Rate for Payer: Aetna American Axle |
$549.30
|
| Rate for Payer: Aetna Commercial |
$718.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.30
|
| Rate for Payer: Cash Price |
$676.06
|
| Rate for Payer: Cofinity Commercial |
$591.56
|
| Rate for Payer: Cofinity Commercial |
$726.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.06
|
| Rate for Payer: Healthscope Commercial |
$760.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$591.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$633.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.32
|
| Rate for Payer: PHP Commercial |
$718.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.56
|
| Rate for Payer: Priority Health SBD |
$532.40
|
| Rate for Payer: UMR Bronson Commercial |
$371.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.81
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
NDC 51079-023-01
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Commercial |
$8.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.95
|
| Rate for Payer: PHP Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.54
|
| Rate for Payer: Priority Health SBD |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.01
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$934.99
|
|
|
Service Code
|
NDC 51079-023-20
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.40 |
| Max. Negotiated Rate |
$841.49 |
| Rate for Payer: Aetna American Axle |
$607.74
|
| Rate for Payer: Aetna Commercial |
$794.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.74
|
| Rate for Payer: Cash Price |
$747.99
|
| Rate for Payer: Cofinity Commercial |
$654.49
|
| Rate for Payer: Cofinity Commercial |
$804.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.99
|
| Rate for Payer: Healthscope Commercial |
$841.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$701.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.74
|
| Rate for Payer: PHP Commercial |
$794.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.49
|
| Rate for Payer: Priority Health SBD |
$589.04
|
| Rate for Payer: UMR Bronson Commercial |
$411.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$701.24
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 0185-5050-01
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.10
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$895.40
|
|
|
Service Code
|
NDC 0904-7139-61
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.98 |
| Max. Negotiated Rate |
$805.86 |
| Rate for Payer: Aetna American Axle |
$582.01
|
| Rate for Payer: Aetna Commercial |
$761.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.01
|
| Rate for Payer: Cash Price |
$716.32
|
| Rate for Payer: Cofinity Commercial |
$626.78
|
| Rate for Payer: Cofinity Commercial |
$770.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.32
|
| Rate for Payer: Healthscope Commercial |
$805.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.09
|
| Rate for Payer: PHP Commercial |
$761.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.78
|
| Rate for Payer: Priority Health SBD |
$564.10
|
| Rate for Payer: UMR Bronson Commercial |
$393.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.55
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$967.55
|
|
|
Service Code
|
NDC 0904-7329-61
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.72 |
| Max. Negotiated Rate |
$870.80 |
| Rate for Payer: Aetna American Axle |
$628.91
|
| Rate for Payer: Aetna Commercial |
$822.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.91
|
| Rate for Payer: Cash Price |
$774.04
|
| Rate for Payer: Cofinity Commercial |
$677.28
|
| Rate for Payer: Cofinity Commercial |
$832.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$774.04
|
| Rate for Payer: Healthscope Commercial |
$870.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$677.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$822.42
|
| Rate for Payer: PHP Commercial |
$822.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.28
|
| Rate for Payer: Priority Health SBD |
$609.56
|
| Rate for Payer: UMR Bronson Commercial |
$425.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.66
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,070.41
|
|
|
Service Code
|
NDC 51079-024-20
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.98 |
| Max. Negotiated Rate |
$963.37 |
| Rate for Payer: Aetna American Axle |
$695.77
|
| Rate for Payer: Aetna Commercial |
$909.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.77
|
| Rate for Payer: Cash Price |
$856.33
|
| Rate for Payer: Cofinity Commercial |
$920.55
|
| Rate for Payer: Cofinity Commercial |
$749.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.33
|
| Rate for Payer: Healthscope Commercial |
$963.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$802.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$909.85
|
| Rate for Payer: PHP Commercial |
$909.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.29
|
| Rate for Payer: Priority Health SBD |
$674.36
|
| Rate for Payer: UMR Bronson Commercial |
$470.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$802.81
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$301.44
|
|
|
Service Code
|
NDC 0185-0055-01
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna American Axle |
$195.94
|
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.22
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.01
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UMR Bronson Commercial |
$132.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.08
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$818.81
|
|
|
Service Code
|
NDC 0904-6915-61
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.28 |
| Max. Negotiated Rate |
$736.93 |
| Rate for Payer: Aetna American Axle |
$532.23
|
| Rate for Payer: Aetna Commercial |
$695.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.23
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Cofinity Commercial |
$704.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.05
|
| Rate for Payer: Healthscope Commercial |
$736.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$695.99
|
| Rate for Payer: PHP Commercial |
$695.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.17
|
| Rate for Payer: Priority Health SBD |
$515.85
|
| Rate for Payer: UMR Bronson Commercial |
$360.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.11
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$10.71
|
|
|
Service Code
|
NDC 51079-024-01
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$9.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.50
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$328.70
|
|
|
Service Code
|
NDC 0527-2602-37
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$295.83 |
| Rate for Payer: Aetna American Axle |
$213.66
|
| Rate for Payer: Aetna Commercial |
$279.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: Cash Price |
$262.96
|
| Rate for Payer: Cofinity Commercial |
$282.68
|
| Rate for Payer: Cofinity Commercial |
$230.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.96
|
| Rate for Payer: Healthscope Commercial |
$295.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.40
|
| Rate for Payer: PHP Commercial |
$279.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.09
|
| Rate for Payer: Priority Health SBD |
$207.08
|
| Rate for Payer: UMR Bronson Commercial |
$144.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.52
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 55111-468-01
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$311.52
|
|
|
Service Code
|
NDC 0904-6324-61
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.07 |
| Max. Negotiated Rate |
$280.37 |
| Rate for Payer: Aetna American Axle |
$202.49
|
| Rate for Payer: Aetna Commercial |
$264.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.49
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cofinity Commercial |
$218.06
|
| Rate for Payer: Cofinity Commercial |
$267.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.22
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.79
|
| Rate for Payer: PHP Commercial |
$264.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.06
|
| Rate for Payer: Priority Health SBD |
$196.26
|
| Rate for Payer: UMR Bronson Commercial |
$137.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.64
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$333.45
|
|
|
Service Code
|
NDC 45963-677-11
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.72 |
| Max. Negotiated Rate |
$300.10 |
| Rate for Payer: Aetna American Axle |
$216.74
|
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.74
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.43
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.42
|
| Rate for Payer: Priority Health SBD |
$210.07
|
| Rate for Payer: UMR Bronson Commercial |
$146.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.09
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$379.68
|
|
|
Service Code
|
NDC 63739-454-10
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.78
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
