|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.25
|
|
|
Service Code
|
NDC 00409201605
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$12.82
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: ASR ASR |
$13.82
|
| Rate for Payer: ASR Commercial |
$13.82
|
| Rate for Payer: BCBS Complete |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.49
|
| Rate for Payer: Priority Health Narrow Network |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.54
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.25
|
|
|
Service Code
|
NDC 00409177805
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$12.82
|
| Rate for Payer: ASR ASR |
$13.82
|
| Rate for Payer: ASR Commercial |
$13.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.54
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.12
|
|
|
Service Code
|
NDC 47781058720
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: ASR ASR |
$13.70
|
| Rate for Payer: ASR Commercial |
$13.70
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.56
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Whirlpool |
$13.70
|
| Rate for Payer: Mclaren Commercial |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.00
|
| Rate for Payer: Nomi Health Commercial |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.37
|
| Rate for Payer: Priority Health Narrow Network |
$9.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.43
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.25
|
|
|
Service Code
|
NDC 00409177805
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$12.82
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: ASR ASR |
$13.82
|
| Rate for Payer: ASR Commercial |
$13.82
|
| Rate for Payer: BCBS Complete |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.49
|
| Rate for Payer: Priority Health Narrow Network |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.54
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.25
|
|
|
Service Code
|
NDC 00409201605
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$12.82
|
| Rate for Payer: ASR ASR |
$13.82
|
| Rate for Payer: ASR Commercial |
$13.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.54
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.25
|
|
|
Service Code
|
NDC 00409201610
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$12.82
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: ASR ASR |
$13.82
|
| Rate for Payer: ASR Commercial |
$13.82
|
| Rate for Payer: BCBS Complete |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$14.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.49
|
| Rate for Payer: Priority Health Narrow Network |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.54
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.12
|
|
|
Service Code
|
NDC 47781058720
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: ASR ASR |
$13.70
|
| Rate for Payer: ASR Commercial |
$13.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Whirlpool |
$13.70
|
| Rate for Payer: Mclaren Commercial |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.00
|
| Rate for Payer: Nomi Health Commercial |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.43
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$12.80
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Commercial |
$6.48
|
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare |
$3.60
|
| Rate for Payer: Aetna Medicare |
$6.40
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: ASR ASR |
$5.82
|
| Rate for Payer: ASR ASR |
$12.42
|
| Rate for Payer: ASR ASR |
$6.98
|
| Rate for Payer: ASR Commercial |
$5.82
|
| Rate for Payer: ASR Commercial |
$12.42
|
| Rate for Payer: ASR Commercial |
$6.98
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.65
|
| Rate for Payer: BCN Commercial |
$5.58
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$12.80
|
| Rate for Payer: Healthscope Whirlpool |
$6.98
|
| Rate for Payer: Healthscope Whirlpool |
$5.82
|
| Rate for Payer: Healthscope Whirlpool |
$12.42
|
| Rate for Payer: Mclaren Commercial |
$5.40
|
| Rate for Payer: Mclaren Commercial |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$11.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$10.50
|
| Rate for Payer: Nomi Health Commercial |
$5.90
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.34
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$12.42
|
| Rate for Payer: ASR ASR |
$5.82
|
| Rate for Payer: ASR ASR |
$6.98
|
| Rate for Payer: ASR Commercial |
$5.82
|
| Rate for Payer: ASR Commercial |
$12.42
|
| Rate for Payer: ASR Commercial |
$6.98
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.89
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Commercial |
$5.58
|
| Rate for Payer: BCN Commercial |
$4.65
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Healthscope Whirlpool |
$5.82
|
| Rate for Payer: Healthscope Whirlpool |
$12.42
|
| Rate for Payer: Healthscope Whirlpool |
$6.98
|
| Rate for Payer: Mclaren Commercial |
$5.40
|
| Rate for Payer: Mclaren Commercial |
$11.52
|
| Rate for Payer: Mclaren Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.88
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: Nomi Health Commercial |
$10.50
|
| Rate for Payer: Nomi Health Commercial |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.26
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna Commercial |
$404.42
|
| Rate for Payer: ASR ASR |
$435.87
|
| Rate for Payer: ASR Commercial |
$435.87
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$348.38
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$422.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$449.35
|
| Rate for Payer: Healthscope Whirlpool |
$435.87
|
| Rate for Payer: Mclaren Commercial |
$404.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.43
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$214.22
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$214.22 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: Aetna Medicare |
$107.11
|
| Rate for Payer: ASR ASR |
$207.79
|
| Rate for Payer: ASR Commercial |
$207.79
|
| Rate for Payer: BCBS Complete |
$85.69
|
| Rate for Payer: BCBS Trust/PPO |
$175.42
|
| Rate for Payer: BCN Commercial |
$166.08
|
| Rate for Payer: Cash Price |
$171.38
|
| Rate for Payer: Cofinity Commercial |
$201.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.38
|
| Rate for Payer: Healthscope Commercial |
$214.22
|
| Rate for Payer: Healthscope Whirlpool |
$207.79
|
| Rate for Payer: Mclaren Commercial |
$192.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.09
|
| Rate for Payer: Nomi Health Commercial |
$175.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.70
|
| Rate for Payer: Priority Health Narrow Network |
$150.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.51
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: ASR ASR |
$4.15
|
| Rate for Payer: ASR Commercial |
$4.15
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Whirlpool |
$4.15
|
| Rate for Payer: Mclaren Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: Nomi Health Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.75
|
| Rate for Payer: Priority Health Narrow Network |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.77
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.74 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna Commercial |
$404.42
|
| Rate for Payer: Aetna Medicare |
$224.68
|
| Rate for Payer: ASR ASR |
$435.87
|
| Rate for Payer: ASR Commercial |
$435.87
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: BCBS Trust/PPO |
$367.97
|
| Rate for Payer: BCN Commercial |
$348.38
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$422.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$449.35
|
| Rate for Payer: Healthscope Whirlpool |
$435.87
|
| Rate for Payer: Mclaren Commercial |
$404.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.72
|
| Rate for Payer: Priority Health Narrow Network |
$314.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.43
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$214.22
|
|
|
Service Code
|
NDC 50268053515
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$214.22 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: ASR ASR |
$207.79
|
| Rate for Payer: ASR Commercial |
$207.79
|
| Rate for Payer: BCBS Trust/PPO |
$174.57
|
| Rate for Payer: BCN Commercial |
$166.08
|
| Rate for Payer: Cash Price |
$171.38
|
| Rate for Payer: Cofinity Commercial |
$201.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.38
|
| Rate for Payer: Healthscope Commercial |
$214.22
|
| Rate for Payer: Healthscope Whirlpool |
$207.79
|
| Rate for Payer: Mclaren Commercial |
$192.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.09
|
| Rate for Payer: Nomi Health Commercial |
$175.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.51
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 50268053511
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: ASR ASR |
$4.15
|
| Rate for Payer: ASR Commercial |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Whirlpool |
$4.15
|
| Rate for Payer: Mclaren Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: Nomi Health Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.77
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: ASR Commercial |
$8.92
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$7.53
|
| Rate for Payer: BCN Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Healthscope Whirlpool |
$8.92
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.06
|
| Rate for Payer: Priority Health Narrow Network |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.10
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$11.03
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: ASR ASR |
$10.70
|
| Rate for Payer: ASR Commercial |
$10.70
|
| Rate for Payer: BCBS Complete |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.70
|
| Rate for Payer: Mclaren Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.66
|
| Rate for Payer: Priority Health Narrow Network |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.71
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: ASR Commercial |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$7.50
|
| Rate for Payer: BCN Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Healthscope Whirlpool |
$8.92
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.10
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$11.03
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: ASR ASR |
$10.70
|
| Rate for Payer: ASR Commercial |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$8.99
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.70
|
| Rate for Payer: Mclaren Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.71
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.66
|
| Rate for Payer: BCN Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: ASR Commercial |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.48
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$23.19
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: ASR Commercial |
$23.19
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: BCBS Trust/PPO |
$19.58
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$23.19
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.18
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: ASR ASR |
$21.51
|
| Rate for Payer: ASR Commercial |
$21.51
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$20.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Whirlpool |
$21.51
|
| Rate for Payer: Mclaren Commercial |
$19.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.43
|
| Rate for Payer: Priority Health Narrow Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.18
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: ASR ASR |
$21.51
|
| Rate for Payer: ASR Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$20.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Whirlpool |
$21.51
|
| Rate for Payer: Mclaren Commercial |
$19.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
