|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.66 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$61.27
|
| Rate for Payer: ASR ASR |
$66.04
|
| Rate for Payer: BCBS Trust/PPO |
$52.78
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$64.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Healthscope Whirlpool |
$66.04
|
| Rate for Payer: Mclaren Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.91
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$507.90
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$507.90 |
| Rate for Payer: Aetna Commercial |
$457.11
|
| Rate for Payer: ASR ASR |
$492.66
|
| Rate for Payer: BCBS Trust/PPO |
$393.77
|
| Rate for Payer: BCN Commercial |
$393.77
|
| Rate for Payer: Cash Price |
$406.32
|
| Rate for Payer: Cofinity Commercial |
$477.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.32
|
| Rate for Payer: Healthscope Commercial |
$507.90
|
| Rate for Payer: Healthscope Whirlpool |
$492.66
|
| Rate for Payer: Mclaren Commercial |
$457.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.95
|
|
|
METHYLPREDNISOLONE 4 MG TABLET
|
Facility
|
IP
|
$250.80
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Commercial |
$582.77
|
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: Aetna Commercial |
$344.74
|
| Rate for Payer: Aetna Commercial |
$459.22
|
| Rate for Payer: ASR ASR |
$371.55
|
| Rate for Payer: ASR ASR |
$243.28
|
| Rate for Payer: ASR ASR |
$628.09
|
| Rate for Payer: ASR ASR |
$494.93
|
| Rate for Payer: ASR ASR |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$502.02
|
| Rate for Payer: BCBS Trust/PPO |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$194.45
|
| Rate for Payer: BCBS Trust/PPO |
$296.97
|
| Rate for Payer: BCBS Trust/PPO |
$395.59
|
| Rate for Payer: BCN Commercial |
$194.45
|
| Rate for Payer: BCN Commercial |
$502.02
|
| Rate for Payer: BCN Commercial |
$5.02
|
| Rate for Payer: BCN Commercial |
$296.97
|
| Rate for Payer: BCN Commercial |
$395.59
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$518.02
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$306.43
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$608.67
|
| Rate for Payer: Cofinity Commercial |
$479.63
|
| Rate for Payer: Cofinity Commercial |
$360.06
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$235.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.43
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$510.24
|
| Rate for Payer: Healthscope Commercial |
$647.52
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Healthscope Commercial |
$250.80
|
| Rate for Payer: Healthscope Whirlpool |
$494.93
|
| Rate for Payer: Healthscope Whirlpool |
$243.28
|
| Rate for Payer: Healthscope Whirlpool |
$371.55
|
| Rate for Payer: Healthscope Whirlpool |
$6.29
|
| Rate for Payer: Healthscope Whirlpool |
$628.09
|
| Rate for Payer: Mclaren Commercial |
$5.83
|
| Rate for Payer: Mclaren Commercial |
$344.74
|
| Rate for Payer: Mclaren Commercial |
$225.72
|
| Rate for Payer: Mclaren Commercial |
$459.22
|
| Rate for Payer: Mclaren Commercial |
$582.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$550.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$569.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.70
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$35.18 |
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$53.31
|
| Rate for Payer: Aetna Commercial |
$31.68
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: ASR ASR |
$57.44
|
| Rate for Payer: ASR ASR |
$34.14
|
| Rate for Payer: ASR ASR |
$34.12
|
| Rate for Payer: ASR ASR |
$57.45
|
| Rate for Payer: BCBS Trust/PPO |
$45.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.29
|
| Rate for Payer: BCBS Trust/PPO |
$27.28
|
| Rate for Payer: BCBS Trust/PPO |
$45.92
|
| Rate for Payer: BCN Commercial |
$27.28
|
| Rate for Payer: BCN Commercial |
$45.92
|
| Rate for Payer: BCN Commercial |
$45.91
|
| Rate for Payer: BCN Commercial |
$27.29
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.16
|
| Rate for Payer: Cash Price |
$47.38
|
| Rate for Payer: Cash Price |
$47.38
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Commercial |
$33.09
|
| Rate for Payer: Cofinity Commercial |
$33.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.38
|
| Rate for Payer: Healthscope Commercial |
$59.23
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Healthscope Commercial |
$35.18
|
| Rate for Payer: Healthscope Commercial |
$35.20
|
| Rate for Payer: Healthscope Whirlpool |
$57.44
|
| Rate for Payer: Healthscope Whirlpool |
$34.14
|
| Rate for Payer: Healthscope Whirlpool |
$34.12
|
| Rate for Payer: Healthscope Whirlpool |
$57.45
|
| Rate for Payer: Mclaren Commercial |
$31.68
|
| Rate for Payer: Mclaren Commercial |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$53.31
|
| Rate for Payer: Mclaren Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.12
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$141.60
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Aetna Commercial |
$127.44
|
| Rate for Payer: Aetna Commercial |
$50.30
|
| Rate for Payer: Aetna Commercial |
$163.60
|
| Rate for Payer: ASR ASR |
$176.33
|
| Rate for Payer: ASR ASR |
$137.35
|
| Rate for Payer: ASR ASR |
$54.21
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| Rate for Payer: BCBS Trust/PPO |
$43.33
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: BCN Commercial |
$43.33
|
| Rate for Payer: BCN Commercial |
$109.78
|
| Rate for Payer: BCN Commercial |
$140.93
|
| Rate for Payer: Cash Price |
$44.71
|
| Rate for Payer: Cash Price |
$113.28
|
| Rate for Payer: Cash Price |
$145.43
|
| Rate for Payer: Cofinity Commercial |
$170.87
|
| Rate for Payer: Cofinity Commercial |
$133.10
|
| Rate for Payer: Cofinity Commercial |
$52.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.71
|
| Rate for Payer: Healthscope Commercial |
$141.60
|
| Rate for Payer: Healthscope Commercial |
$181.78
|
| Rate for Payer: Healthscope Commercial |
$55.89
|
| Rate for Payer: Healthscope Whirlpool |
$54.21
|
| Rate for Payer: Healthscope Whirlpool |
$137.35
|
| Rate for Payer: Healthscope Whirlpool |
$176.33
|
| Rate for Payer: Mclaren Commercial |
$127.44
|
| Rate for Payer: Mclaren Commercial |
$50.30
|
| Rate for Payer: Mclaren Commercial |
$163.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.18
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$26.69 |
| Rate for Payer: Aetna Commercial |
$24.02
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: ASR ASR |
$25.89
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$46.72
|
| Rate for Payer: BCBS Trust/PPO |
$37.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCN Commercial |
$20.69
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: Cash Price |
$21.35
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$25.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$26.69
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Healthscope Whirlpool |
$25.89
|
| Rate for Payer: Healthscope Whirlpool |
$46.72
|
| Rate for Payer: Mclaren Commercial |
$43.35
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$24.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.39
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$13.34
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$100.26
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$100.26 |
| Rate for Payer: Aetna Commercial |
$90.23
|
| Rate for Payer: ASR ASR |
$97.25
|
| Rate for Payer: BCBS Trust/PPO |
$77.73
|
| Rate for Payer: BCN Commercial |
$77.73
|
| Rate for Payer: Cash Price |
$80.21
|
| Rate for Payer: Cofinity Commercial |
$94.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.21
|
| Rate for Payer: Healthscope Commercial |
$100.26
|
| Rate for Payer: Healthscope Whirlpool |
$97.25
|
| Rate for Payer: Mclaren Commercial |
$90.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.23
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
163731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: ASR ASR |
$31.12
|
| Rate for Payer: BCBS Trust/PPO |
$24.87
|
| Rate for Payer: BCN Commercial |
$24.87
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$30.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Healthscope Commercial |
$32.08
|
| Rate for Payer: Healthscope Whirlpool |
$31.12
|
| Rate for Payer: Mclaren Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.23
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
119451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: ASR ASR |
$31.12
|
| Rate for Payer: BCBS Trust/PPO |
$24.87
|
| Rate for Payer: BCN Commercial |
$24.87
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$30.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.66
|
| Rate for Payer: Healthscope Commercial |
$32.08
|
| Rate for Payer: Healthscope Whirlpool |
$31.12
|
| Rate for Payer: Mclaren Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.23
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$20.16
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$15.63
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 60687-631-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.42 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$230.69
|
| Rate for Payer: ASR ASR |
$248.63
|
| Rate for Payer: BCBS Trust/PPO |
$198.72
|
| Rate for Payer: BCN Commercial |
$198.72
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Commercial |
$240.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$256.32
|
| Rate for Payer: Healthscope Whirlpool |
$248.63
|
| Rate for Payer: Mclaren Commercial |
$230.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.56
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 60687-631-11
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 63739-293-10
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.24 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$147.58
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 68084-676-11
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: ASR ASR |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Healthscope Whirlpool |
$2.42
|
| Rate for Payer: Mclaren Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.20
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68084-676-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: ASR ASR |
$242.11
|
| Rate for Payer: BCBS Trust/PPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$193.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$234.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$242.11
|
| Rate for Payer: Mclaren Commercial |
$224.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.65
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.93
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: ASR ASR |
$13.87
|
| Rate for Payer: ASR ASR |
$10.60
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.09
|
| Rate for Payer: BCN Commercial |
$8.47
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: BCN Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$10.27
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Whirlpool |
$14.69
|
| Rate for Payer: Healthscope Whirlpool |
$10.60
|
| Rate for Payer: Healthscope Whirlpool |
$13.87
|
| Rate for Payer: Mclaren Commercial |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$9.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.62
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
NDC 51079-024-01
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$9.63
|
| Rate for Payer: ASR ASR |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Whirlpool |
$10.38
|
| Rate for Payer: Mclaren Commercial |
$9.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.42
|
|
|
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 |
$211.01 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$271.30
|
| Rate for Payer: ASR ASR |
$292.40
|
| Rate for Payer: BCBS Trust/PPO |
$233.71
|
| Rate for Payer: BCN Commercial |
$233.71
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$301.44
|
| Rate for Payer: Healthscope Whirlpool |
$292.40
|
| Rate for Payer: Mclaren Commercial |
$271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.27
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$367.65
|
|
|
Service Code
|
NDC 0904-6322-61
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.36 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$330.88
|
| Rate for Payer: ASR ASR |
$356.62
|
| Rate for Payer: BCBS Trust/PPO |
$285.04
|
| Rate for Payer: BCN Commercial |
$285.04
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Healthscope Whirlpool |
$356.62
|
| Rate for Payer: Mclaren Commercial |
$330.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.53
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
NDC 50742-615-10
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,677.90 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.39
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,037.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$402.80
|
|
|
Service Code
|
NDC 51079-170-20
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.96 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$362.52
|
| Rate for Payer: ASR ASR |
$390.72
|
| Rate for Payer: BCBS Trust/PPO |
$312.29
|
| Rate for Payer: BCN Commercial |
$312.29
|
| Rate for Payer: Cash Price |
$322.24
|
| Rate for Payer: Cofinity Commercial |
$378.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.24
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Healthscope Whirlpool |
$390.72
|
| Rate for Payer: Mclaren Commercial |
$362.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$342.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.46
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 0904-6323-61
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.70 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: ASR ASR |
$350.17
|
| Rate for Payer: BCBS Trust/PPO |
$279.88
|
| Rate for Payer: BCN Commercial |
$279.88
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$339.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$361.00
|
| Rate for Payer: Healthscope Whirlpool |
$350.17
|
| Rate for Payer: Mclaren Commercial |
$324.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.68
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
NDC 51079-170-01
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: ASR ASR |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Healthscope Whirlpool |
$3.91
|
| Rate for Payer: Mclaren Commercial |
$3.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.55
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 62584-265-01
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$136.65
|
| Rate for Payer: BCN Commercial |
$136.65
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$176.25
|
| Rate for Payer: Healthscope Whirlpool |
$170.96
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
