|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 41167006003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 45802017453
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 45802017453
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 41167060003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 41167006006
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 57896011603
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna American Axle |
$9.94
|
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| 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 |
$1.10 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna Medicare |
$124.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.24
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$92.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 68084067611
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 49884068901
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 00093220301
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 49884068901
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 00093220301
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$300.12
|
|
|
Service Code
|
NDC 62559019016
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.05 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Aetna American Axle |
$195.08
|
| Rate for Payer: Aetna Commercial |
$255.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.08
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cofinity Commercial |
$210.08
|
| Rate for Payer: Cofinity Commercial |
$258.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.10
|
| Rate for Payer: Healthscope Commercial |
$270.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.10
|
| Rate for Payer: PHP Commercial |
$255.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.08
|
| Rate for Payer: Priority Health SBD |
$189.08
|
| Rate for Payer: UMR Bronson Commercial |
$132.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$655.82
|
|
|
Service Code
|
NDC 00121057616
|
| 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: Cofinity Medicare Advantage |
$459.07
|
| 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 Commercial |
$557.45
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.28
|
| 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
|
OP
|
$30.50
|
|
|
Service Code
|
NDC 00121157610
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Aetna American Axle |
$19.82
|
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: Aetna Medicare |
$15.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.82
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$21.35
|
| Rate for Payer: Cofinity Commercial |
$26.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.35
|
| 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 Commercial |
$25.92
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.82
|
| Rate for Payer: Priority Health SBD |
$19.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
NDC 00121157610
|
| 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: Cofinity Medicare Advantage |
$21.35
|
| 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 Commercial |
$25.92
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.82
|
| 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/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$655.82
|
|
|
Service Code
|
NDC 00121057616
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$590.24 |
| Rate for Payer: Aetna American Axle |
$426.28
|
| Rate for Payer: Aetna Commercial |
$557.45
|
| Rate for Payer: Aetna Medicare |
$327.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.28
|
| Rate for Payer: BCBS Complete |
$262.33
|
| Rate for Payer: Cash Price |
$524.66
|
| Rate for Payer: Cofinity Commercial |
$459.07
|
| Rate for Payer: Cofinity Commercial |
$564.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.07
|
| 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 Commercial |
$557.45
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.28
|
| Rate for Payer: Priority Health SBD |
$413.17
|
| Rate for Payer: UMR Bronson Commercial |
$242.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.86
|
|
|
METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$300.12
|
|
|
Service Code
|
NDC 62559019016
|
| Hospital Charge Code |
77725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Aetna American Axle |
$195.08
|
| Rate for Payer: Aetna Commercial |
$255.10
|
| Rate for Payer: Aetna Medicare |
$150.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.08
|
| Rate for Payer: BCBS Complete |
$120.05
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cofinity Commercial |
$210.08
|
| Rate for Payer: Cofinity Commercial |
$258.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.10
|
| Rate for Payer: Healthscope Commercial |
$270.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.10
|
| Rate for Payer: PHP Commercial |
$255.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.08
|
| Rate for Payer: Priority Health SBD |
$189.08
|
| Rate for Payer: UMR Bronson Commercial |
$111.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.15
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$10.93
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna American Axle |
$7.01
|
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$16.02
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| 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) |
$10.88
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.63
|
| 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 |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| 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: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| 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 |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| 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 |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$16.02
|
| 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 Commercial |
$14.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| 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 |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.99
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.97
|
| 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 |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
|
|
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 |
$7.01
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$16.02
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| 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) |
$12.25
|
| 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 |
$13.46
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.72
|
| 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 |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.09
|
| 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 |
$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: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$16.02
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health SBD |
$11.88
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.82
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.35
|
| 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 Commercial |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: Priority Health SBD |
$44.42
|
| Rate for Payer: UMR Bronson Commercial |
$26.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00093220401
|
| 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: Cofinity Medicare Advantage |
$49.35
|
| 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 Commercial |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| 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
|
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 Commercial |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$74.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$73.59
|
| Rate for Payer: PHP Commercial |
$73.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.28
|
| Rate for Payer: Priority Health SBD |
$54.55
|
| Rate for Payer: UMR Bronson Commercial |
$32.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.94
|
|
