METHYLPREDNISOLONE INJ [125 MG]
|
Facility
IP
|
$40.00
|
|
Service Code
|
CPT J2930
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$28.00 |
Max. Negotiated Rate |
$40.00 |
Rate for Payer: AETNA Commercial |
$38.00
|
Rate for Payer: AETNA Medicare |
$36.00
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
Rate for Payer: BCBS Healthlink |
$36.00
|
Rate for Payer: BCBS HMK CHIP |
$36.00
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
Rate for Payer: BCBS POS |
$38.00
|
Rate for Payer: BCBS Traditional |
$40.00
|
Rate for Payer: CASH_PRICE |
$32.00
|
Rate for Payer: CIGNA Commercial |
$38.00
|
Rate for Payer: CIGNA Medicare |
$36.00
|
Rate for Payer: HUMANA Commercial |
$36.00
|
Rate for Payer: MEDICAID Medicaid |
$36.80
|
Rate for Payer: MEDICARE Medicare |
$28.00
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
METHYLPREDNISOLONE INJ [40 MG/ML]
|
Facility
OP
|
$25.00
|
|
Service Code
|
CPT J2920
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$25.00 |
Rate for Payer: AETNA Commercial |
$23.75
|
Rate for Payer: AETNA Medicare |
$22.50
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
Rate for Payer: BCBS Healthlink |
$22.50
|
Rate for Payer: BCBS HMK CHIP |
$22.50
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
Rate for Payer: BCBS POS |
$23.75
|
Rate for Payer: BCBS Traditional |
$25.00
|
Rate for Payer: CASH_PRICE |
$20.00
|
Rate for Payer: CIGNA Commercial |
$23.75
|
Rate for Payer: CIGNA Medicare |
$22.50
|
Rate for Payer: HUMANA Commercial |
$22.50
|
Rate for Payer: MEDICAID Medicaid |
$23.00
|
Rate for Payer: MEDICARE Medicare |
$17.50
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
METHYLPREDNISOLONE INJ [40 MG/ML]
|
Facility
IP
|
$25.00
|
|
Service Code
|
CPT J2920
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$25.00 |
Rate for Payer: AETNA Commercial |
$23.75
|
Rate for Payer: AETNA Medicare |
$22.50
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
Rate for Payer: BCBS Healthlink |
$22.50
|
Rate for Payer: BCBS HMK CHIP |
$22.50
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
Rate for Payer: BCBS POS |
$23.75
|
Rate for Payer: BCBS Traditional |
$25.00
|
Rate for Payer: CASH_PRICE |
$20.00
|
Rate for Payer: CIGNA Commercial |
$23.75
|
Rate for Payer: CIGNA Medicare |
$22.50
|
Rate for Payer: HUMANA Commercial |
$22.50
|
Rate for Payer: MEDICAID Medicaid |
$23.00
|
Rate for Payer: MEDICARE Medicare |
$17.50
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
METHYLPREDNISOLONE TAB [4 MG]
|
Facility
IP
|
$101.00
|
|
Service Code
|
CPT J7509
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$70.70 |
Max. Negotiated Rate |
$101.00 |
Rate for Payer: AETNA Commercial |
$95.95
|
Rate for Payer: AETNA Medicare |
$90.90
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$95.95
|
Rate for Payer: BCBS Healthlink |
$90.90
|
Rate for Payer: BCBS HMK CHIP |
$90.90
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$90.90
|
Rate for Payer: BCBS POS |
$95.95
|
Rate for Payer: BCBS Traditional |
$101.00
|
Rate for Payer: CASH_PRICE |
$80.80
|
Rate for Payer: CIGNA Commercial |
$95.95
|
Rate for Payer: CIGNA Medicare |
$90.90
|
Rate for Payer: HUMANA Commercial |
$90.90
|
Rate for Payer: MEDICAID Medicaid |
$92.92
|
Rate for Payer: MEDICARE Medicare |
$70.70
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$95.95
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$97.97
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$95.95
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$95.95
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$85.85
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$80.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$80.80
|
|
METHYLPREDNISOLONE TAB [4 MG]
|
Facility
OP
|
$101.00
|
|
Service Code
|
CPT J7509
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$70.70 |
Max. Negotiated Rate |
$101.00 |
Rate for Payer: AETNA Commercial |
$95.95
|
Rate for Payer: AETNA Medicare |
$90.90
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$95.95
|
Rate for Payer: BCBS Healthlink |
$90.90
|
Rate for Payer: BCBS HMK CHIP |
$90.90
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$90.90
|
Rate for Payer: BCBS POS |
$95.95
|
Rate for Payer: BCBS Traditional |
$101.00
|
Rate for Payer: CASH_PRICE |
$80.80
|
Rate for Payer: CIGNA Commercial |
$95.95
|
Rate for Payer: CIGNA Medicare |
$90.90
|
Rate for Payer: HUMANA Commercial |
$90.90
|
Rate for Payer: MEDICAID Medicaid |
$92.92
|
Rate for Payer: MEDICARE Medicare |
$70.70
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$95.95
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$97.97
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$95.95
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$95.95
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$85.85
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$80.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$80.80
|
|
METOCLOPRAMIDE INJ [5 MG/ML]
|
Facility
IP
|
$26.00
|
|
Service Code
|
CPT J2765
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
258
|
Min. Negotiated Rate |
$18.20 |
Max. Negotiated Rate |
$26.00 |
Rate for Payer: AETNA Commercial |
$24.70
|
Rate for Payer: AETNA Medicare |
$23.40
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
Rate for Payer: BCBS Healthlink |
$23.40
|
Rate for Payer: BCBS HMK CHIP |
$23.40
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
Rate for Payer: BCBS POS |
$24.70
|
Rate for Payer: BCBS Traditional |
$26.00
|
Rate for Payer: CASH_PRICE |
$20.80
|
Rate for Payer: CIGNA Commercial |
$24.70
|
Rate for Payer: CIGNA Medicare |
$23.40
|
Rate for Payer: HUMANA Commercial |
$23.40
|
Rate for Payer: MEDICAID Medicaid |
$23.92
|
Rate for Payer: MEDICARE Medicare |
$18.20
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
METOCLOPRAMIDE INJ [5 MG/ML]
|
Facility
OP
|
$26.00
|
|
Service Code
|
CPT J2765
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
258
|
Min. Negotiated Rate |
$18.20 |
Max. Negotiated Rate |
$26.00 |
Rate for Payer: AETNA Commercial |
$24.70
|
Rate for Payer: AETNA Medicare |
$23.40
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
Rate for Payer: BCBS Healthlink |
$23.40
|
Rate for Payer: BCBS HMK CHIP |
$23.40
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
Rate for Payer: BCBS POS |
$24.70
|
Rate for Payer: BCBS Traditional |
$26.00
|
Rate for Payer: CASH_PRICE |
$20.80
|
Rate for Payer: CIGNA Commercial |
$24.70
|
Rate for Payer: CIGNA Medicare |
$23.40
|
Rate for Payer: HUMANA Commercial |
$23.40
|
Rate for Payer: MEDICAID Medicaid |
$23.92
|
Rate for Payer: MEDICARE Medicare |
$18.20
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
METOCLOPRAMIDE TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOCLOPRAMIDE TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOLAZONE 5MG TAB NON FORMULARY
|
Facility
IP
|
$13.50
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20230531
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$9.45 |
Max. Negotiated Rate |
$13.50 |
Rate for Payer: AETNA Commercial |
$12.82
|
Rate for Payer: AETNA Medicare |
$12.15
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.82
|
Rate for Payer: BCBS Healthlink |
$12.15
|
Rate for Payer: BCBS HMK CHIP |
$12.15
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.15
|
Rate for Payer: BCBS POS |
$12.82
|
Rate for Payer: BCBS Traditional |
$13.50
|
Rate for Payer: CASH_PRICE |
$10.80
|
Rate for Payer: CIGNA Commercial |
$12.82
|
Rate for Payer: CIGNA Medicare |
$12.15
|
Rate for Payer: HUMANA Commercial |
$12.15
|
Rate for Payer: MEDICAID Medicaid |
$12.42
|
Rate for Payer: MEDICARE Medicare |
$9.45
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.82
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.09
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.82
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.82
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$11.47
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.80
|
|
METOLAZONE 5MG TAB NON FORMULARY
|
Facility
OP
|
$13.50
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20230531
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$9.45 |
Max. Negotiated Rate |
$13.50 |
Rate for Payer: AETNA Commercial |
$12.82
|
Rate for Payer: AETNA Medicare |
$12.15
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.82
|
Rate for Payer: BCBS Healthlink |
$12.15
|
Rate for Payer: BCBS HMK CHIP |
$12.15
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.15
|
Rate for Payer: BCBS POS |
$12.82
|
Rate for Payer: BCBS Traditional |
$13.50
|
Rate for Payer: CASH_PRICE |
$10.80
|
Rate for Payer: CIGNA Commercial |
$12.82
|
Rate for Payer: CIGNA Medicare |
$12.15
|
Rate for Payer: HUMANA Commercial |
$12.15
|
Rate for Payer: MEDICAID Medicaid |
$12.42
|
Rate for Payer: MEDICARE Medicare |
$9.45
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.82
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.09
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.82
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.82
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$11.47
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.80
|
|
METOPROLOL INJ [5 MG/5 ML]
|
Facility
OP
|
$26.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
258
|
Min. Negotiated Rate |
$18.20 |
Max. Negotiated Rate |
$26.00 |
Rate for Payer: AETNA Commercial |
$24.70
|
Rate for Payer: AETNA Medicare |
$23.40
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
Rate for Payer: BCBS Healthlink |
$23.40
|
Rate for Payer: BCBS HMK CHIP |
$23.40
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
Rate for Payer: BCBS POS |
$24.70
|
Rate for Payer: BCBS Traditional |
$26.00
|
Rate for Payer: CASH_PRICE |
$20.80
|
Rate for Payer: CIGNA Commercial |
$24.70
|
Rate for Payer: CIGNA Medicare |
$23.40
|
Rate for Payer: HUMANA Commercial |
$23.40
|
Rate for Payer: MEDICAID Medicaid |
$23.92
|
Rate for Payer: MEDICARE Medicare |
$18.20
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
METOPROLOL INJ [5 MG/5 ML]
|
Facility
IP
|
$26.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
258
|
Min. Negotiated Rate |
$18.20 |
Max. Negotiated Rate |
$26.00 |
Rate for Payer: AETNA Commercial |
$24.70
|
Rate for Payer: AETNA Medicare |
$23.40
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
Rate for Payer: BCBS Healthlink |
$23.40
|
Rate for Payer: BCBS HMK CHIP |
$23.40
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
Rate for Payer: BCBS POS |
$24.70
|
Rate for Payer: BCBS Traditional |
$26.00
|
Rate for Payer: CASH_PRICE |
$20.80
|
Rate for Payer: CIGNA Commercial |
$24.70
|
Rate for Payer: CIGNA Medicare |
$23.40
|
Rate for Payer: HUMANA Commercial |
$23.40
|
Rate for Payer: MEDICAID Medicaid |
$23.92
|
Rate for Payer: MEDICARE Medicare |
$18.20
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
METOPROLOL SUCC ER TAB [25 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL SUCC ER TAB [25 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL SUCC ER TAB [50 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL SUCC ER TAB [50 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL TAR TAB [25 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL TAR TAB [25 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL TART TAB [50 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METOPROLOL TART TAB [50 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METRONIDAZOLE/ NACL [500MG/100ML] PREMIX
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METRONIDAZOLE/ NACL [500MG/100ML] PREMIX
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METRONIDAZOLE TAB [500 MG]
|
Facility
IP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
METRONIDAZOLE TAB [500 MG]
|
Facility
OP
|
$8.00
|
|
Service Code
|
CPT J3490
|
Hospital Charge Code |
20221105
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$5.60 |
Max. Negotiated Rate |
$8.00 |
Rate for Payer: AETNA Commercial |
$7.60
|
Rate for Payer: AETNA Medicare |
$7.20
|
Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
Rate for Payer: BCBS Healthlink |
$7.20
|
Rate for Payer: BCBS HMK CHIP |
$7.20
|
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
Rate for Payer: BCBS POS |
$7.60
|
Rate for Payer: BCBS Traditional |
$8.00
|
Rate for Payer: CASH_PRICE |
$6.40
|
Rate for Payer: CIGNA Commercial |
$7.60
|
Rate for Payer: CIGNA Medicare |
$7.20
|
Rate for Payer: HUMANA Commercial |
$7.20
|
Rate for Payer: MEDICAID Medicaid |
$7.36
|
Rate for Payer: MEDICARE Medicare |
$5.60
|
Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|