|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: ASR ASR |
$21.52
|
| Rate for Payer: ASR ASR |
$16.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Whirlpool |
$22.19
|
| Rate for Payer: Healthscope Whirlpool |
$17.20
|
| Rate for Payer: Mclaren Commercial |
$19.97
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.53
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: ASR ASR |
$21.52
|
| Rate for Payer: ASR ASR |
$16.69
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.19
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Whirlpool |
$22.19
|
| Rate for Payer: Healthscope Whirlpool |
$17.20
|
| Rate for Payer: Mclaren Commercial |
$19.97
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.53
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: Aetna Medicare |
$99.10
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: BCBS Trust/PPO |
$220.83
|
| Rate for Payer: BCN Commercial |
$220.83
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$259.80
|
| Rate for Payer: Healthscope Whirlpool |
$267.84
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$234.68
|
| Rate for Payer: Priority Health Narrow Network |
$187.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.35
|
| Rate for Payer: Priority Health Narrow Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: BCBS Trust/PPO |
$219.95
|
| Rate for Payer: BCN Commercial |
$219.95
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$259.80
|
| Rate for Payer: Healthscope Whirlpool |
$267.84
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.82
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Aetna Medicare |
$6.19
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: ASR ASR |
$16.23
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: ASR ASR |
$10.61
|
| Rate for Payer: ASR ASR |
$16.32
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.80
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$10.61
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Whirlpool |
$10.93
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Healthscope Whirlpool |
$16.82
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$9.84
|
| Rate for Payer: Mclaren Commercial |
$15.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Nomi Health Commercial |
$13.72
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: Priority Health Narrow Network |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: ASR ASR |
$16.32
|
| Rate for Payer: ASR ASR |
$16.23
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: ASR ASR |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.81
|
| Rate for Payer: BCN Commercial |
$8.98
|
| Rate for Payer: BCN Commercial |
$13.81
|
| Rate for Payer: BCN Commercial |
$12.43
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$10.61
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Healthscope Whirlpool |
$16.82
|
| Rate for Payer: Healthscope Whirlpool |
$10.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$9.84
|
| Rate for Payer: Mclaren Commercial |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.29
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.72
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.80
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 72888005301
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$238.54
|
| Rate for Payer: Aetna Medicare |
$98.07
|
| Rate for Payer: ASR ASR |
$257.10
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: BCBS Trust/PPO |
$218.53
|
| Rate for Payer: BCN Commercial |
$218.53
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$257.10
|
| Rate for Payer: Healthscope Whirlpool |
$265.05
|
| Rate for Payer: Mclaren Commercial |
$238.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Nomi Health Commercial |
$217.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.24
|
| Rate for Payer: Priority Health Narrow Network |
$185.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.24
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCN Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Healthscope Whirlpool |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$250.08
|
|
|
Service Code
|
NDC 185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$225.07
|
| Rate for Payer: Aetna Medicare |
$92.53
|
| Rate for Payer: ASR ASR |
$242.58
|
| Rate for Payer: BCBS Complete |
$100.03
|
| Rate for Payer: BCBS Trust/PPO |
$206.19
|
| Rate for Payer: BCN Commercial |
$206.19
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$235.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$242.58
|
| Rate for Payer: Healthscope Whirlpool |
$250.08
|
| Rate for Payer: Mclaren Commercial |
$225.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$219.12
|
| Rate for Payer: Priority Health Narrow Network |
$175.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.07
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 72888005301
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.79 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$238.54
|
| Rate for Payer: ASR ASR |
$257.10
|
| Rate for Payer: BCBS Trust/PPO |
$217.66
|
| Rate for Payer: BCN Commercial |
$217.66
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$257.10
|
| Rate for Payer: Healthscope Whirlpool |
$265.05
|
| Rate for Payer: Mclaren Commercial |
$238.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Nomi Health Commercial |
$217.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.24
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCN Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Healthscope Whirlpool |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.52
|
| Rate for Payer: Priority Health Narrow Network |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.56 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$225.07
|
| Rate for Payer: ASR ASR |
$242.58
|
| Rate for Payer: BCBS Trust/PPO |
$205.37
|
| Rate for Payer: BCN Commercial |
$205.37
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$235.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$242.58
|
| Rate for Payer: Healthscope Whirlpool |
$250.08
|
| Rate for Payer: Mclaren Commercial |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.07
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
NDC 50742061510
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,797.75 |
| 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 |
$1,968.42
|
| Rate for Payer: BCN Commercial |
$1,968.42
|
| 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 |
$2,325.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,397.00
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$276.48
|
|
|
Service Code
|
NDC 904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$248.83
|
| Rate for Payer: Aetna Medicare |
$102.30
|
| Rate for Payer: ASR ASR |
$268.19
|
| Rate for Payer: BCBS Complete |
$110.59
|
| Rate for Payer: BCBS Trust/PPO |
$227.96
|
| Rate for Payer: BCN Commercial |
$227.96
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cofinity Commercial |
$259.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.18
|
| Rate for Payer: Healthscope Commercial |
$268.19
|
| Rate for Payer: Healthscope Whirlpool |
$276.48
|
| Rate for Payer: Mclaren Commercial |
$248.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.01
|
| Rate for Payer: Nomi Health Commercial |
$226.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.25
|
| Rate for Payer: Priority Health Narrow Network |
$193.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.30
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$276.48
|
|
|
Service Code
|
NDC 904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$248.83
|
| Rate for Payer: ASR ASR |
$268.19
|
| Rate for Payer: BCBS Trust/PPO |
$227.05
|
| Rate for Payer: BCN Commercial |
$227.05
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cofinity Commercial |
$259.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.18
|
| Rate for Payer: Healthscope Commercial |
$268.19
|
| Rate for Payer: Healthscope Whirlpool |
$276.48
|
| Rate for Payer: Mclaren Commercial |
$248.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.01
|
| Rate for Payer: Nomi Health Commercial |
$226.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.30
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
NDC 50742061510
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$886.89 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Aetna Medicare |
$886.89
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: BCBS Complete |
$958.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,976.33
|
| Rate for Payer: BCN Commercial |
$1,976.33
|
| 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 |
$2,325.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,397.00
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,917.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,100.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,680.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: Aetna Medicare |
$56.52
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.94
|
| Rate for Payer: BCN Commercial |
$125.94
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$148.17
|
| Rate for Payer: Healthscope Whirlpool |
$152.75
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.56 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.47
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: BCBS Trust/PPO |
$125.44
|
| Rate for Payer: BCN Commercial |
$125.44
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$148.17
|
| Rate for Payer: Healthscope Whirlpool |
$152.75
|
| Rate for Payer: Mclaren Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 51079017020
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.15 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$406.98
|
| Rate for Payer: ASR ASR |
$438.63
|
| Rate for Payer: BCBS Trust/PPO |
$371.35
|
| Rate for Payer: BCN Commercial |
$371.35
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$425.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$438.63
|
| Rate for Payer: Healthscope Whirlpool |
$452.20
|
| Rate for Payer: Mclaren Commercial |
$406.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.94
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$259.68
|
|
|
Service Code
|
NDC 904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$259.68 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: ASR ASR |
$251.89
|
| Rate for Payer: BCBS Trust/PPO |
$213.25
|
| Rate for Payer: BCN Commercial |
$213.25
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Commercial |
$244.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Healthscope Commercial |
$251.89
|
| Rate for Payer: Healthscope Whirlpool |
$259.68
|
| Rate for Payer: Mclaren Commercial |
$233.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$212.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.52
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 51079017020
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$406.98
|
| Rate for Payer: Aetna Medicare |
$167.31
|
| Rate for Payer: ASR ASR |
$438.63
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: BCBS Trust/PPO |
$372.84
|
| Rate for Payer: BCN Commercial |
$372.84
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$425.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$438.63
|
| Rate for Payer: Healthscope Whirlpool |
$452.20
|
| Rate for Payer: Mclaren Commercial |
$406.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$396.22
|
| Rate for Payer: Priority Health Narrow Network |
$316.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.94
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 51079017001
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$4.07
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: ASR ASR |
$4.39
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCN Commercial |
$3.73
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.39
|
| Rate for Payer: Healthscope Whirlpool |
$4.52
|
| Rate for Payer: Mclaren Commercial |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.96
|
| Rate for Payer: Priority Health Narrow Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.98
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$259.68
|
|
|
Service Code
|
NDC 904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.08 |
| Max. Negotiated Rate |
$259.68 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$96.08
|
| Rate for Payer: ASR ASR |
$251.89
|
| Rate for Payer: BCBS Complete |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$214.11
|
| Rate for Payer: BCN Commercial |
$214.11
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Commercial |
$244.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Healthscope Commercial |
$251.89
|
| Rate for Payer: Healthscope Whirlpool |
$259.68
|
| Rate for Payer: Mclaren Commercial |
$233.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$212.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.53
|
| Rate for Payer: Priority Health Narrow Network |
$182.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.52
|
|
