|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00121157610
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.32
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,533.94
|
|
|
Service Code
|
NDC 62559019016
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$674.93 |
| Max. Negotiated Rate |
$1,380.55 |
| Rate for Payer: Aetna American Axle |
$997.06
|
| Rate for Payer: Aetna Commercial |
$1,303.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.06
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cofinity Advantage |
$1,073.76
|
| Rate for Payer: Cofinity Commercial |
$1,319.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.15
|
| Rate for Payer: Healthscope Commercial |
$1,380.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,303.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,150.45
|
| Rate for Payer: PHP Commercial |
$1,303.85
|
| Rate for Payer: Priority Health SBD |
$966.38
|
| Rate for Payer: UMR Bronson Commercial |
$674.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.45
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.82
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Aetna American Axle |
$10.93
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$7.01
|
| 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 |
$16.02
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| 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) |
$12.25
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Advantage |
$13.20
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$11.77
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.77
|
| 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: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| 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 |
$16.02
|
| 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 |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$16.02
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
| 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/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.79
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna American Axle |
$7.01
|
| Rate for Payer: Aetna American Axle |
$10.93
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$16.02
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| 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) |
$12.25
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Advantage |
$11.77
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Advantage |
$13.20
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| 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 |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| 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 |
$8.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| 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: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| 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: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$16.02
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$3.99
|
| Rate for Payer: UMR Bronson Commercial |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$6.97
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
METOCLOPRAMIDE (BULK) POWDER
|
Facility
|
OP
|
$86.58
|
|
|
Service Code
|
NDC 38779040301
|
| Hospital Charge Code |
14955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$77.92 |
| Rate for Payer: Aetna American Axle |
$56.28
|
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Aetna Medicare |
$43.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.28
|
| Rate for Payer: BCBS Complete |
$34.63
|
| Rate for Payer: Cash Price |
$69.26
|
| Rate for Payer: Cofinity Advantage |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$74.46
|
| 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: MI Amish Medical Board Commercial |
$69.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.94
|
| Rate for Payer: PHP Commercial |
$73.59
|
| Rate for Payer: Priority Health SBD |
$54.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.28
|
| Rate for Payer: UHC Core |
$45.11
|
| Rate for Payer: UHC Exchange |
$34.03
|
| Rate for Payer: UMR Bronson Commercial |
$32.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.94
|
|
|
METOCLOPRAMIDE (BULK) POWDER
|
Facility
|
IP
|
$86.58
|
|
|
Service Code
|
NDC 38779040301
|
| 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 Advantage |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$74.46
|
| 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 Commercial |
$73.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.94
|
| Rate for Payer: PHP Commercial |
$73.59
|
| 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
|
OP
|
$845.08
|
|
|
Service Code
|
NDC 00378617401
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.68 |
| Max. Negotiated Rate |
$760.57 |
| Rate for Payer: Aetna American Axle |
$549.30
|
| Rate for Payer: Aetna Commercial |
$718.32
|
| Rate for Payer: Aetna Medicare |
$422.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.30
|
| Rate for Payer: BCBS Complete |
$338.03
|
| Rate for Payer: Cash Price |
$676.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$676.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.81
|
| Rate for Payer: PHP Commercial |
$718.32
|
| Rate for Payer: Priority Health SBD |
$532.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.30
|
| Rate for Payer: UHC Core |
$440.29
|
| Rate for Payer: UHC Exchange |
$332.12
|
| Rate for Payer: UMR Bronson Commercial |
$312.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.81
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
OP
|
$413.76
|
|
|
Service Code
|
NDC 00185560001
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.09 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna Medicare |
$206.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Advantage |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.32
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.94
|
| Rate for Payer: UHC Core |
$215.57
|
| Rate for Payer: UHC Exchange |
$162.61
|
| Rate for Payer: UMR Bronson Commercial |
$153.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
IP
|
$845.08
|
|
|
Service Code
|
NDC 00378617401
|
| 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 Advantage |
$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 Commercial |
$718.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.81
|
| Rate for Payer: PHP Commercial |
$718.32
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$413.76
|
|
|
Service Code
|
NDC 00185560001
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.05 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Advantage |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.32
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UMR Bronson Commercial |
$182.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$11.32
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna American Axle |
$7.36
|
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.49
|
| Rate for Payer: PHP Commercial |
$9.62
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.36
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: UHC Exchange |
$4.45
|
| Rate for Payer: UMR Bronson Commercial |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.49
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$108.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.41
|
| Rate for Payer: UHC Core |
$113.34
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$11.32
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna American Axle |
$7.36
|
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.49
|
| Rate for Payer: PHP Commercial |
$9.62
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: UMR Bronson Commercial |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.49
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$1,131.46
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$1,018.31 |
| Rate for Payer: Aetna American Axle |
$735.45
|
| Rate for Payer: Aetna Commercial |
$961.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: Cash Price |
$905.17
|
| Rate for Payer: Cofinity Advantage |
$792.02
|
| Rate for Payer: Cofinity Commercial |
$973.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.17
|
| Rate for Payer: Healthscope Commercial |
$1,018.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$792.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$848.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$848.60
|
| Rate for Payer: PHP Commercial |
$961.74
|
| Rate for Payer: Priority Health SBD |
$712.82
|
| Rate for Payer: UMR Bronson Commercial |
$497.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$848.60
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$1,131.46
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.64 |
| Max. Negotiated Rate |
$1,018.31 |
| Rate for Payer: Aetna American Axle |
$735.45
|
| Rate for Payer: Aetna Commercial |
$961.74
|
| Rate for Payer: Aetna Medicare |
$565.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: BCBS Complete |
$452.58
|
| Rate for Payer: Cash Price |
$905.17
|
| Rate for Payer: Cofinity Advantage |
$792.02
|
| Rate for Payer: Cofinity Commercial |
$973.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.17
|
| Rate for Payer: Healthscope Commercial |
$1,018.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$792.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$848.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$905.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$848.60
|
| Rate for Payer: PHP Commercial |
$961.74
|
| Rate for Payer: Priority Health SBD |
$712.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.45
|
| Rate for Payer: UHC Core |
$589.49
|
| Rate for Payer: UHC Exchange |
$444.66
|
| Rate for Payer: UMR Bronson Commercial |
$418.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$848.60
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$991.97
|
|
|
Service Code
|
NDC 00904732961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.47 |
| Max. Negotiated Rate |
$892.77 |
| Rate for Payer: Aetna American Axle |
$644.78
|
| Rate for Payer: Aetna Commercial |
$843.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.78
|
| Rate for Payer: Cash Price |
$793.58
|
| Rate for Payer: Cofinity Advantage |
$694.38
|
| Rate for Payer: Cofinity Commercial |
$853.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.58
|
| Rate for Payer: Healthscope Commercial |
$892.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.98
|
| Rate for Payer: PHP Commercial |
$843.17
|
| Rate for Payer: Priority Health SBD |
$624.94
|
| Rate for Payer: UMR Bronson Commercial |
$436.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.98
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$895.40
|
|
|
Service Code
|
NDC 00904713961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.30 |
| Max. Negotiated Rate |
$805.86 |
| Rate for Payer: Aetna American Axle |
$582.01
|
| Rate for Payer: Aetna Commercial |
$761.09
|
| Rate for Payer: Aetna Medicare |
$447.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.01
|
| Rate for Payer: BCBS Complete |
$358.16
|
| Rate for Payer: Cash Price |
$716.32
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$716.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.55
|
| Rate for Payer: PHP Commercial |
$761.09
|
| Rate for Payer: Priority Health SBD |
$564.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.01
|
| Rate for Payer: UHC Core |
$466.50
|
| Rate for Payer: UHC Exchange |
$351.89
|
| Rate for Payer: UMR Bronson Commercial |
$331.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.55
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna American Axle |
$7.81
|
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cofinity Advantage |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$10.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.01
|
| Rate for Payer: PHP Commercial |
$10.21
|
| Rate for Payer: Priority Health SBD |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$6.26
|
| Rate for Payer: UHC Exchange |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.01
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,200.28
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.10 |
| Max. Negotiated Rate |
$1,080.25 |
| Rate for Payer: Aetna American Axle |
$780.18
|
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna Medicare |
$600.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.18
|
| Rate for Payer: BCBS Complete |
$480.11
|
| Rate for Payer: Cash Price |
$960.22
|
| Rate for Payer: Cofinity Advantage |
$840.20
|
| Rate for Payer: Cofinity Commercial |
$1,032.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.22
|
| Rate for Payer: Healthscope Commercial |
$1,080.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$960.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.21
|
| Rate for Payer: PHP Commercial |
$1,020.24
|
| Rate for Payer: Priority Health SBD |
$756.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.18
|
| Rate for Payer: UHC Core |
$625.35
|
| Rate for Payer: UHC Exchange |
$471.71
|
| Rate for Payer: UMR Bronson Commercial |
$444.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.21
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna American Axle |
$7.81
|
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cofinity Advantage |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$10.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.01
|
| Rate for Payer: PHP Commercial |
$10.21
|
| Rate for Payer: Priority Health SBD |
$7.57
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.01
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$991.97
|
|
|
Service Code
|
NDC 00904732961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.03 |
| Max. Negotiated Rate |
$892.77 |
| Rate for Payer: Aetna American Axle |
$644.78
|
| Rate for Payer: Aetna Commercial |
$843.17
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.78
|
| Rate for Payer: BCBS Complete |
$396.79
|
| Rate for Payer: Cash Price |
$793.58
|
| Rate for Payer: Cofinity Advantage |
$694.38
|
| Rate for Payer: Cofinity Commercial |
$853.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.58
|
| Rate for Payer: Healthscope Commercial |
$892.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$793.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.98
|
| Rate for Payer: PHP Commercial |
$843.17
|
| Rate for Payer: Priority Health SBD |
$624.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.78
|
| Rate for Payer: UHC Core |
$516.82
|
| Rate for Payer: UHC Exchange |
$389.84
|
| Rate for Payer: UMR Bronson Commercial |
$367.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.98
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$250.08
|
|
|
Service Code
|
NDC 00185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna Medicare |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: BCBS Complete |
$100.03
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Advantage |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.56
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.55
|
| Rate for Payer: UHC Core |
$130.29
|
| Rate for Payer: UHC Exchange |
$98.28
|
| Rate for Payer: UMR Bronson Commercial |
$92.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
