|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.25
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$23.62
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: ASR ASR |
$25.45
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR Commercial |
$24.97
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: ASR Commercial |
$25.45
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.75
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$24.67
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Mclaren Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.09
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$23.62
|
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$25.45
|
| Rate for Payer: ASR ASR |
$28.37
|
| Rate for Payer: ASR Commercial |
$28.13
|
| Rate for Payer: ASR Commercial |
$28.37
|
| Rate for Payer: ASR Commercial |
$25.45
|
| Rate for Payer: ASR Commercial |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$24.67
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$23.62
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: Nomi Health Commercial |
$23.98
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
|
|
MEROPENEM 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
301712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: ASR ASR |
$19.36
|
| Rate for Payer: ASR Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$19.96
|
| Rate for Payer: Healthscope Whirlpool |
$19.36
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$16.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.45
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: ASR Commercial |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$201.08
|
| Rate for Payer: BCN Commercial |
$191.31
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: ASR Commercial |
$2.40
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.16
|
| Rate for Payer: Priority Health Narrow Network |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: BCBS Trust/PPO |
$202.06
|
| Rate for Payer: BCN Commercial |
$191.31
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.20
|
| Rate for Payer: Priority Health Narrow Network |
$172.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION
|
Facility
|
IP
|
$170.19
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.62 |
| Max. Negotiated Rate |
$170.19 |
| Rate for Payer: Aetna Commercial |
$153.17
|
| Rate for Payer: ASR ASR |
$165.08
|
| Rate for Payer: ASR Commercial |
$165.08
|
| Rate for Payer: BCBS Trust/PPO |
$138.69
|
| Rate for Payer: BCN Commercial |
$131.95
|
| Rate for Payer: Cash Price |
$136.15
|
| Rate for Payer: Cofinity Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.15
|
| Rate for Payer: Healthscope Commercial |
$170.19
|
| Rate for Payer: Healthscope Whirlpool |
$165.08
|
| Rate for Payer: Mclaren Commercial |
$153.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.66
|
| Rate for Payer: Nomi Health Commercial |
$139.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.77
|
|
|
METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$170.19
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$170.19 |
| Rate for Payer: Aetna Commercial |
$153.17
|
| Rate for Payer: Aetna Medicare |
$85.10
|
| Rate for Payer: ASR ASR |
$165.08
|
| Rate for Payer: ASR Commercial |
$165.08
|
| Rate for Payer: BCBS Complete |
$68.08
|
| Rate for Payer: BCBS Trust/PPO |
$139.37
|
| Rate for Payer: BCN Commercial |
$131.95
|
| Rate for Payer: Cash Price |
$136.15
|
| Rate for Payer: Cash Price |
$136.15
|
| Rate for Payer: Cofinity Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.15
|
| Rate for Payer: Healthscope Commercial |
$170.19
|
| Rate for Payer: Healthscope Whirlpool |
$165.08
|
| Rate for Payer: Mclaren Commercial |
$153.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.66
|
| Rate for Payer: Nomi Health Commercial |
$139.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.77
|
|
|
METHACHOLINE 0.25 MG/ML (VIAL D) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
|
|
METHACHOLINE 16 MG/ML (VIAL A) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
|
|
METHACHOLINE 1 MG/ML (VIAL C) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
|
|
METHACHOLINE 4 MG/ML (VIAL B) SOLUTION FOR INHALATION
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$285.60
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Medicare |
$142.80
|
| Rate for Payer: ASR ASR |
$277.03
|
| Rate for Payer: ASR Commercial |
$277.03
|
| Rate for Payer: BCBS Complete |
$114.24
|
| Rate for Payer: BCBS Trust/PPO |
$233.88
|
| Rate for Payer: BCN Commercial |
$221.43
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Healthscope Commercial |
$285.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.03
|
| Rate for Payer: Mclaren Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.76
|
| Rate for Payer: Nomi Health Commercial |
$234.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.33
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: ASR ASR |
$277.03
|
| Rate for Payer: ASR Commercial |
$277.03
|
| Rate for Payer: BCBS Trust/PPO |
$232.74
|
| Rate for Payer: BCN Commercial |
$221.43
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Healthscope Commercial |
$285.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.03
|
| Rate for Payer: Mclaren Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.76
|
| Rate for Payer: Nomi Health Commercial |
$234.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.33
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 00406412303
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: ASR Commercial |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$107.64
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 00054355344
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: ASR Commercial |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$107.64
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$132.09
|
|
|
Service Code
|
NDC 00054355344
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Aetna Medicare |
$66.04
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: ASR Commercial |
$128.13
|
| Rate for Payer: BCBS Complete |
$52.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.17
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.74
|
| Rate for Payer: Priority Health Narrow Network |
$92.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$132.09
|
|
|
Service Code
|
NDC 00406412303
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Aetna Medicare |
$66.04
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: ASR Commercial |
$128.13
|
| Rate for Payer: BCBS Complete |
$52.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.17
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.74
|
| Rate for Payer: Priority Health Narrow Network |
$92.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Aetna Medicare |
$168.00
|
| Rate for Payer: ASR ASR |
$325.92
|
| Rate for Payer: ASR Commercial |
$325.92
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS Trust/PPO |
$275.15
|
| Rate for Payer: BCN Commercial |
$260.50
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Healthscope Commercial |
$336.00
|
| Rate for Payer: Healthscope Whirlpool |
$325.92
|
| Rate for Payer: Mclaren Commercial |
$302.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.60
|
| Rate for Payer: Nomi Health Commercial |
$275.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.40
|
| Rate for Payer: Priority Health Narrow Network |
$235.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.68
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: ASR ASR |
$325.92
|
| Rate for Payer: ASR Commercial |
$325.92
|
| Rate for Payer: BCBS Trust/PPO |
$273.81
|
| Rate for Payer: BCN Commercial |
$260.50
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Healthscope Commercial |
$336.00
|
| Rate for Payer: Healthscope Whirlpool |
$325.92
|
| Rate for Payer: Mclaren Commercial |
$302.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.60
|
| Rate for Payer: Nomi Health Commercial |
$275.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.68
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$500.50
|
|
|
Service Code
|
NDC 00054070920
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Aetna Medicare |
$250.25
|
| Rate for Payer: ASR ASR |
$485.48
|
| Rate for Payer: ASR Commercial |
$485.48
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS Trust/PPO |
$409.86
|
| Rate for Payer: BCN Commercial |
$388.04
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cofinity Commercial |
$470.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.40
|
| Rate for Payer: Healthscope Commercial |
$500.50
|
| Rate for Payer: Healthscope Whirlpool |
$485.48
|
| Rate for Payer: Mclaren Commercial |
$450.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.42
|
| Rate for Payer: Nomi Health Commercial |
$410.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.54
|
| Rate for Payer: Priority Health Narrow Network |
$350.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.44
|
|
