Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

METOCLOPRAMIDE 10 MG TABLET

Facility

$326.40

Service Code	NDC 51079088820
Hospital Charge Code	5005
Hospital Revenue Code	637
Min. Negotiated Rate	$130.56
Max. Negotiated Rate	$293.76
Rate for Payer: Aetna Commercial	$277.44
Rate for Payer: Aetna Medicare	$163.20
Rate for Payer: Aetna New Business (MI Preferred)	$212.16
Rate for Payer: BCBS Complete	$130.56
Rate for Payer: Cash Price	$261.12
Rate for Payer: Cofinity Commercial	$228.48
Rate for Payer: Cofinity Commercial	$280.70
Rate for Payer: Cofinity Medicare Advantage	$228.48
Rate for Payer: Encore Health Key Benefits Commercial	$261.12
Rate for Payer: Healthscope Commercial	$293.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.44
Rate for Payer: PHP Commercial	$277.44
Rate for Payer: Priority Health Cigna Priority Health	$212.16
Rate for Payer: Priority Health SBD	$205.63

METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION

Facility

$30.50

Service Code	NDC 00121157610
Hospital Charge Code	77725
Hospital Revenue Code	637
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$27.45
Rate for Payer: Aetna Commercial	$25.93
Rate for Payer: Aetna Medicare	$15.25
Rate for Payer: Aetna New Business (MI Preferred)	$19.82
Rate for Payer: BCBS Complete	$12.20
Rate for Payer: Cash Price	$24.40
Rate for Payer: Cofinity Commercial	$21.35
Rate for Payer: Cofinity Commercial	$26.23
Rate for Payer: Cofinity Medicare Advantage	$21.35
Rate for Payer: Encore Health Key Benefits Commercial	$24.40
Rate for Payer: Healthscope Commercial	$27.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.93
Rate for Payer: PHP Commercial	$25.93
Rate for Payer: Priority Health Cigna Priority Health	$19.82
Rate for Payer: Priority Health SBD	$19.21

METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION

Facility

$30.50

Service Code	NDC 00121157610
Hospital Charge Code	77725
Hospital Revenue Code	637
Min. Negotiated Rate	$19.21
Max. Negotiated Rate	$27.45
Rate for Payer: Aetna Commercial	$25.93
Rate for Payer: Aetna New Business (MI Preferred)	$19.82
Rate for Payer: Cash Price	$24.40
Rate for Payer: Cofinity Commercial	$21.35
Rate for Payer: Cofinity Commercial	$26.23
Rate for Payer: Cofinity Medicare Advantage	$21.35
Rate for Payer: Encore Health Key Benefits Commercial	$24.40
Rate for Payer: Healthscope Commercial	$27.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.93
Rate for Payer: PHP Commercial	$25.93
Rate for Payer: Priority Health Cigna Priority Health	$19.82
Rate for Payer: Priority Health SBD	$19.21

METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION

Facility

$10.79

Service Code	HCPCS J2765
Hospital Charge Code	5002
Hospital Revenue Code	636
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Commercial	$14.30
Rate for Payer: Aetna Commercial	$12.88
Rate for Payer: Aetna Medicare	$8.41
Rate for Payer: Aetna Medicare	$5.39
Rate for Payer: Aetna Medicare	$7.58
Rate for Payer: Aetna New Business (MI Preferred)	$10.93
Rate for Payer: Aetna New Business (MI Preferred)	$7.01
Rate for Payer: Aetna New Business (MI Preferred)	$9.85
Rate for Payer: BCBS Complete	$6.06
Rate for Payer: BCBS Complete	$4.32
Rate for Payer: BCBS Complete	$6.73
Rate for Payer: Cash Price	$13.46
Rate for Payer: Cash Price	$8.63
Rate for Payer: Cash Price	$12.12
Rate for Payer: Cofinity Commercial	$14.47
Rate for Payer: Cofinity Commercial	$9.28
Rate for Payer: Cofinity Commercial	$7.55
Rate for Payer: Cofinity Commercial	$13.03
Rate for Payer: Cofinity Commercial	$10.61
Rate for Payer: Cofinity Commercial	$11.77
Rate for Payer: Cofinity Medicare Advantage	$10.61
Rate for Payer: Cofinity Medicare Advantage	$7.55
Rate for Payer: Cofinity Medicare Advantage	$11.77
Rate for Payer: Encore Health Key Benefits Commercial	$12.12
Rate for Payer: Encore Health Key Benefits Commercial	$13.46
Rate for Payer: Encore Health Key Benefits Commercial	$8.63
Rate for Payer: Healthscope Commercial	$13.63
Rate for Payer: Healthscope Commercial	$9.71
Rate for Payer: Healthscope Commercial	$15.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.17
Rate for Payer: PHP Commercial	$12.88
Rate for Payer: PHP Commercial	$9.17
Rate for Payer: PHP Commercial	$14.30
Rate for Payer: Priority Health Cigna Priority Health	$7.01
Rate for Payer: Priority Health Cigna Priority Health	$10.93
Rate for Payer: Priority Health Cigna Priority Health	$9.85
Rate for Payer: Priority Health SBD	$10.60
Rate for Payer: Priority Health SBD	$9.54
Rate for Payer: Priority Health SBD	$6.80

METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION

Facility

$10.79

Service Code	HCPCS J2765
Hospital Charge Code	5002
Hospital Revenue Code	636
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Commercial	$12.88
Rate for Payer: Aetna Commercial	$14.30
Rate for Payer: Aetna New Business (MI Preferred)	$9.85
Rate for Payer: Aetna New Business (MI Preferred)	$7.01
Rate for Payer: Aetna New Business (MI Preferred)	$10.93
Rate for Payer: Cash Price	$8.63
Rate for Payer: Cash Price	$12.12
Rate for Payer: Cash Price	$13.46
Rate for Payer: Cofinity Commercial	$11.77
Rate for Payer: Cofinity Commercial	$7.55
Rate for Payer: Cofinity Commercial	$9.28
Rate for Payer: Cofinity Commercial	$14.47
Rate for Payer: Cofinity Commercial	$10.61
Rate for Payer: Cofinity Commercial	$13.03
Rate for Payer: Cofinity Medicare Advantage	$10.61
Rate for Payer: Cofinity Medicare Advantage	$11.77
Rate for Payer: Cofinity Medicare Advantage	$7.55
Rate for Payer: Encore Health Key Benefits Commercial	$12.12
Rate for Payer: Encore Health Key Benefits Commercial	$8.63
Rate for Payer: Encore Health Key Benefits Commercial	$13.46
Rate for Payer: Healthscope Commercial	$13.63
Rate for Payer: Healthscope Commercial	$15.14
Rate for Payer: Healthscope Commercial	$9.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.30
Rate for Payer: PHP Commercial	$14.30
Rate for Payer: PHP Commercial	$9.17
Rate for Payer: PHP Commercial	$12.88
Rate for Payer: Priority Health Cigna Priority Health	$7.01
Rate for Payer: Priority Health Cigna Priority Health	$10.93
Rate for Payer: Priority Health Cigna Priority Health	$9.85
Rate for Payer: Priority Health SBD	$10.60
Rate for Payer: Priority Health SBD	$6.80
Rate for Payer: Priority Health SBD	$9.54

METOCLOPRAMIDE 5 MG TABLET

Facility

$257.28

Service Code	NDC 60687062001
Hospital Charge Code	5006
Hospital Revenue Code	637
Min. Negotiated Rate	$162.09
Max. Negotiated Rate	$231.55
Rate for Payer: Aetna Commercial	$218.69
Rate for Payer: Aetna New Business (MI Preferred)	$167.23
Rate for Payer: Cash Price	$205.82
Rate for Payer: Cofinity Commercial	$180.10
Rate for Payer: Cofinity Commercial	$221.26
Rate for Payer: Cofinity Medicare Advantage	$180.10
Rate for Payer: Encore Health Key Benefits Commercial	$205.82
Rate for Payer: Healthscope Commercial	$231.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.69
Rate for Payer: PHP Commercial	$218.69
Rate for Payer: Priority Health Cigna Priority Health	$167.23
Rate for Payer: Priority Health SBD	$162.09

METOCLOPRAMIDE 5 MG TABLET

Facility

$257.28

Service Code	NDC 60687062001
Hospital Charge Code	5006
Hospital Revenue Code	637
Min. Negotiated Rate	$102.91
Max. Negotiated Rate	$231.55
Rate for Payer: Aetna Commercial	$218.69
Rate for Payer: Aetna Medicare	$128.64
Rate for Payer: Aetna New Business (MI Preferred)	$167.23
Rate for Payer: BCBS Complete	$102.91
Rate for Payer: Cash Price	$205.82
Rate for Payer: Cofinity Commercial	$180.10
Rate for Payer: Cofinity Commercial	$221.26
Rate for Payer: Cofinity Medicare Advantage	$180.10
Rate for Payer: Encore Health Key Benefits Commercial	$205.82
Rate for Payer: Healthscope Commercial	$231.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.69
Rate for Payer: PHP Commercial	$218.69
Rate for Payer: Priority Health Cigna Priority Health	$167.23
Rate for Payer: Priority Health SBD	$162.09

METOCLOPRAMIDE 5 MG TABLET

Facility

$2.58

Service Code	NDC 60687062011
Hospital Charge Code	5006
Hospital Revenue Code	637
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.32
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare	$1.29
Rate for Payer: Aetna New Business (MI Preferred)	$1.68
Rate for Payer: BCBS Complete	$1.03
Rate for Payer: Cash Price	$2.06
Rate for Payer: Cofinity Commercial	$1.81
Rate for Payer: Cofinity Commercial	$2.22
Rate for Payer: Cofinity Medicare Advantage	$1.81
Rate for Payer: Encore Health Key Benefits Commercial	$2.06
Rate for Payer: Healthscope Commercial	$2.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.19
Rate for Payer: PHP Commercial	$2.19
Rate for Payer: Priority Health Cigna Priority Health	$1.68
Rate for Payer: Priority Health SBD	$1.63

METOCLOPRAMIDE 5 MG TABLET

Facility

$2.58

Service Code	NDC 60687062011
Hospital Charge Code	5006
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.32
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna New Business (MI Preferred)	$1.68
Rate for Payer: Cash Price	$2.06
Rate for Payer: Cofinity Commercial	$1.81
Rate for Payer: Cofinity Commercial	$2.22
Rate for Payer: Cofinity Medicare Advantage	$1.81
Rate for Payer: Encore Health Key Benefits Commercial	$2.06
Rate for Payer: Healthscope Commercial	$2.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.19
Rate for Payer: PHP Commercial	$2.19
Rate for Payer: Priority Health Cigna Priority Health	$1.68
Rate for Payer: Priority Health SBD	$1.63

METOLAZONE 2.5 MG TABLET

Facility

$10.15

Service Code	NDC 51079002301
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$9.13
Rate for Payer: Aetna Commercial	$8.63
Rate for Payer: Aetna Medicare	$5.08
Rate for Payer: Aetna New Business (MI Preferred)	$6.60
Rate for Payer: BCBS Complete	$4.06
Rate for Payer: Cash Price	$8.12
Rate for Payer: Cofinity Commercial	$7.11
Rate for Payer: Cofinity Commercial	$8.73
Rate for Payer: Cofinity Medicare Advantage	$7.11
Rate for Payer: Encore Health Key Benefits Commercial	$8.12
Rate for Payer: Healthscope Commercial	$9.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.63
Rate for Payer: PHP Commercial	$8.63
Rate for Payer: Priority Health Cigna Priority Health	$6.60
Rate for Payer: Priority Health SBD	$6.39

METOLAZONE 2.5 MG TABLET

Facility

$261.12

Service Code	NDC 00185505001
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$164.51
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Commercial	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Cofinity Medicare Advantage	$182.78
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health Cigna Priority Health	$169.73
Rate for Payer: Priority Health SBD	$164.51

METOLAZONE 2.5 MG TABLET

Facility

$261.12

Service Code	NDC 00185505001
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$104.45
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna Medicare	$130.56
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: BCBS Complete	$104.45
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Commercial	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Cofinity Medicare Advantage	$182.78
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health Cigna Priority Health	$169.73
Rate for Payer: Priority Health SBD	$164.51

METOLAZONE 2.5 MG TABLET

Facility

$752.21

Service Code	NDC 00904691661
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$473.89
Max. Negotiated Rate	$676.99
Rate for Payer: Aetna Commercial	$639.38
Rate for Payer: Aetna New Business (MI Preferred)	$488.94
Rate for Payer: Cash Price	$601.77
Rate for Payer: Cofinity Commercial	$526.55
Rate for Payer: Cofinity Commercial	$646.90
Rate for Payer: Cofinity Medicare Advantage	$526.55
Rate for Payer: Encore Health Key Benefits Commercial	$601.77
Rate for Payer: Healthscope Commercial	$676.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$639.38
Rate for Payer: PHP Commercial	$639.38
Rate for Payer: Priority Health Cigna Priority Health	$488.94
Rate for Payer: Priority Health SBD	$473.89

METOLAZONE 2.5 MG TABLET

Facility

$752.21

Service Code	NDC 00904691661
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$300.88
Max. Negotiated Rate	$676.99
Rate for Payer: Aetna Commercial	$639.38
Rate for Payer: Aetna Medicare	$376.11
Rate for Payer: Aetna New Business (MI Preferred)	$488.94
Rate for Payer: BCBS Complete	$300.88
Rate for Payer: Cash Price	$601.77
Rate for Payer: Cofinity Commercial	$526.55
Rate for Payer: Cofinity Commercial	$646.90
Rate for Payer: Cofinity Medicare Advantage	$526.55
Rate for Payer: Encore Health Key Benefits Commercial	$601.77
Rate for Payer: Healthscope Commercial	$676.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$639.38
Rate for Payer: PHP Commercial	$639.38
Rate for Payer: Priority Health Cigna Priority Health	$488.94
Rate for Payer: Priority Health SBD	$473.89

METOLAZONE 2.5 MG TABLET

Facility

$805.44

Service Code	NDC 00378617201
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$507.43
Max. Negotiated Rate	$724.90
Rate for Payer: Aetna Commercial	$684.62
Rate for Payer: Aetna New Business (MI Preferred)	$523.54
Rate for Payer: Cash Price	$644.35
Rate for Payer: Cofinity Commercial	$563.81
Rate for Payer: Cofinity Commercial	$692.68
Rate for Payer: Cofinity Medicare Advantage	$563.81
Rate for Payer: Encore Health Key Benefits Commercial	$644.35
Rate for Payer: Healthscope Commercial	$724.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$684.62
Rate for Payer: PHP Commercial	$684.62
Rate for Payer: Priority Health Cigna Priority Health	$523.54
Rate for Payer: Priority Health SBD	$507.43

METOLAZONE 2.5 MG TABLET

Facility

$1,014.54

Service Code	NDC 51079002320
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$405.82
Max. Negotiated Rate	$913.09
Rate for Payer: Aetna Commercial	$862.36
Rate for Payer: Aetna Medicare	$507.27
Rate for Payer: Aetna New Business (MI Preferred)	$659.45
Rate for Payer: BCBS Complete	$405.82
Rate for Payer: Cash Price	$811.63
Rate for Payer: Cofinity Commercial	$710.18
Rate for Payer: Cofinity Commercial	$872.50
Rate for Payer: Cofinity Medicare Advantage	$710.18
Rate for Payer: Encore Health Key Benefits Commercial	$811.63
Rate for Payer: Healthscope Commercial	$913.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$862.36
Rate for Payer: PHP Commercial	$862.36
Rate for Payer: Priority Health Cigna Priority Health	$659.45
Rate for Payer: Priority Health SBD	$639.16

METOLAZONE 2.5 MG TABLET

Facility

$1,014.54

Service Code	NDC 51079002320
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$639.16
Max. Negotiated Rate	$913.09
Rate for Payer: Aetna Commercial	$862.36
Rate for Payer: Aetna New Business (MI Preferred)	$659.45
Rate for Payer: Cash Price	$811.63
Rate for Payer: Cofinity Commercial	$710.18
Rate for Payer: Cofinity Commercial	$872.50
Rate for Payer: Cofinity Medicare Advantage	$710.18
Rate for Payer: Encore Health Key Benefits Commercial	$811.63
Rate for Payer: Healthscope Commercial	$913.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$862.36
Rate for Payer: PHP Commercial	$862.36
Rate for Payer: Priority Health Cigna Priority Health	$659.45
Rate for Payer: Priority Health SBD	$639.16

METOLAZONE 2.5 MG TABLET

Facility

$10.15

Service Code	NDC 51079002301
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$9.13
Rate for Payer: Aetna Commercial	$8.63
Rate for Payer: Aetna New Business (MI Preferred)	$6.60
Rate for Payer: Cash Price	$8.12
Rate for Payer: Cofinity Commercial	$7.11
Rate for Payer: Cofinity Commercial	$8.73
Rate for Payer: Cofinity Medicare Advantage	$7.11
Rate for Payer: Encore Health Key Benefits Commercial	$8.12
Rate for Payer: Healthscope Commercial	$9.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.63
Rate for Payer: PHP Commercial	$8.63
Rate for Payer: Priority Health Cigna Priority Health	$6.60
Rate for Payer: Priority Health SBD	$6.39

METOLAZONE 2.5 MG TABLET

Facility

$805.44

Service Code	NDC 00378617201
Hospital Charge Code	10587
Hospital Revenue Code	637
Min. Negotiated Rate	$322.18
Max. Negotiated Rate	$724.90
Rate for Payer: Aetna Commercial	$684.62
Rate for Payer: Aetna Medicare	$402.72
Rate for Payer: Aetna New Business (MI Preferred)	$523.54
Rate for Payer: BCBS Complete	$322.18
Rate for Payer: Cash Price	$644.35
Rate for Payer: Cofinity Commercial	$563.81
Rate for Payer: Cofinity Commercial	$692.68
Rate for Payer: Cofinity Medicare Advantage	$563.81
Rate for Payer: Encore Health Key Benefits Commercial	$644.35
Rate for Payer: Healthscope Commercial	$724.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$684.62
Rate for Payer: PHP Commercial	$684.62
Rate for Payer: Priority Health Cigna Priority Health	$523.54
Rate for Payer: Priority Health SBD	$507.43

METOLAZONE 5 MG TABLET

Facility

$1,093.72

Service Code	NDC 51079002420
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$437.49
Max. Negotiated Rate	$984.35
Rate for Payer: Aetna Commercial	$929.66
Rate for Payer: Aetna Medicare	$546.86
Rate for Payer: Aetna New Business (MI Preferred)	$710.92
Rate for Payer: BCBS Complete	$437.49
Rate for Payer: Cash Price	$874.98
Rate for Payer: Cofinity Commercial	$765.60
Rate for Payer: Cofinity Commercial	$940.60
Rate for Payer: Cofinity Medicare Advantage	$765.60
Rate for Payer: Encore Health Key Benefits Commercial	$874.98
Rate for Payer: Healthscope Commercial	$984.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$929.66
Rate for Payer: PHP Commercial	$929.66
Rate for Payer: Priority Health Cigna Priority Health	$710.92
Rate for Payer: Priority Health SBD	$689.04

METOLAZONE 5 MG TABLET

Facility

$1,093.72

Service Code	NDC 51079002420
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$689.04
Max. Negotiated Rate	$984.35
Rate for Payer: Aetna Commercial	$929.66
Rate for Payer: Aetna New Business (MI Preferred)	$710.92
Rate for Payer: Cash Price	$874.98
Rate for Payer: Cofinity Commercial	$765.60
Rate for Payer: Cofinity Commercial	$940.60
Rate for Payer: Cofinity Medicare Advantage	$765.60
Rate for Payer: Encore Health Key Benefits Commercial	$874.98
Rate for Payer: Healthscope Commercial	$984.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$929.66
Rate for Payer: PHP Commercial	$929.66
Rate for Payer: Priority Health Cigna Priority Health	$710.92
Rate for Payer: Priority Health SBD	$689.04

METOLAZONE 5 MG TABLET

Facility

$10.94

Service Code	NDC 51079002401
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$9.85
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare	$5.47
Rate for Payer: Aetna New Business (MI Preferred)	$7.11
Rate for Payer: BCBS Complete	$4.38
Rate for Payer: Cash Price	$8.75
Rate for Payer: Cofinity Commercial	$7.66
Rate for Payer: Cofinity Commercial	$9.41
Rate for Payer: Cofinity Medicare Advantage	$7.66
Rate for Payer: Encore Health Key Benefits Commercial	$8.75
Rate for Payer: Healthscope Commercial	$9.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.30
Rate for Payer: PHP Commercial	$9.30
Rate for Payer: Priority Health Cigna Priority Health	$7.11
Rate for Payer: Priority Health SBD	$6.89

METOLAZONE 5 MG TABLET

Facility

$895.40

Service Code	NDC 00904713961
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$358.16
Max. Negotiated Rate	$805.86
Rate for Payer: Aetna Commercial	$761.09
Rate for Payer: Aetna Medicare	$447.70
Rate for Payer: Aetna New Business (MI Preferred)	$582.01
Rate for Payer: BCBS Complete	$358.16
Rate for Payer: Cash Price	$716.32
Rate for Payer: Cofinity Commercial	$626.78
Rate for Payer: Cofinity Commercial	$770.04
Rate for Payer: Cofinity Medicare Advantage	$626.78
Rate for Payer: Encore Health Key Benefits Commercial	$716.32
Rate for Payer: Healthscope Commercial	$805.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$761.09
Rate for Payer: PHP Commercial	$761.09
Rate for Payer: Priority Health Cigna Priority Health	$582.01
Rate for Payer: Priority Health SBD	$564.10

METOLAZONE 5 MG TABLET

Facility

$895.40

Service Code	NDC 00904713961
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$564.10
Max. Negotiated Rate	$805.86
Rate for Payer: Aetna Commercial	$761.09
Rate for Payer: Aetna New Business (MI Preferred)	$582.01
Rate for Payer: Cash Price	$716.32
Rate for Payer: Cofinity Commercial	$626.78
Rate for Payer: Cofinity Commercial	$770.04
Rate for Payer: Cofinity Medicare Advantage	$626.78
Rate for Payer: Encore Health Key Benefits Commercial	$716.32
Rate for Payer: Healthscope Commercial	$805.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$761.09
Rate for Payer: PHP Commercial	$761.09
Rate for Payer: Priority Health Cigna Priority Health	$582.01
Rate for Payer: Priority Health SBD	$564.10

METOLAZONE 5 MG TABLET

Facility

$10.94

Service Code	NDC 51079002401
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$9.85
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna New Business (MI Preferred)	$7.11
Rate for Payer: Cash Price	$8.75
Rate for Payer: Cofinity Commercial	$7.66
Rate for Payer: Cofinity Commercial	$9.41
Rate for Payer: Cofinity Medicare Advantage	$7.66
Rate for Payer: Encore Health Key Benefits Commercial	$8.75
Rate for Payer: Healthscope Commercial	$9.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.30
Rate for Payer: PHP Commercial	$9.30
Rate for Payer: Priority Health Cigna Priority Health	$7.11
Rate for Payer: Priority Health SBD	$6.89

Know your out-of-pocket cost for care.

All Charges