Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

METOLAZONE 5 MG TABLET

Facility

$991.97

Service Code	NDC 00904732961
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$396.79
Max. Negotiated Rate	$892.77
Rate for Payer: Aetna Commercial	$843.17
Rate for Payer: Aetna Medicare	$495.99
Rate for Payer: Aetna New Business (MI Preferred)	$644.78
Rate for Payer: BCBS Complete	$396.79
Rate for Payer: Cash Price	$793.58
Rate for Payer: Cofinity Commercial	$694.38
Rate for Payer: Cofinity Commercial	$853.09
Rate for Payer: Cofinity Medicare Advantage	$694.38
Rate for Payer: Encore Health Key Benefits Commercial	$793.58
Rate for Payer: Healthscope Commercial	$892.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$843.17
Rate for Payer: PHP Commercial	$843.17
Rate for Payer: Priority Health Cigna Priority Health	$644.78
Rate for Payer: Priority Health SBD	$624.94

METOLAZONE 5 MG TABLET

Facility

$991.97

Service Code	NDC 00904732961
Hospital Charge Code	10588
Hospital Revenue Code	637
Min. Negotiated Rate	$624.94
Max. Negotiated Rate	$892.77
Rate for Payer: Aetna Commercial	$843.17
Rate for Payer: Aetna New Business (MI Preferred)	$644.78
Rate for Payer: Cash Price	$793.58
Rate for Payer: Cofinity Commercial	$694.38
Rate for Payer: Cofinity Commercial	$853.09
Rate for Payer: Cofinity Medicare Advantage	$694.38
Rate for Payer: Encore Health Key Benefits Commercial	$793.58
Rate for Payer: Healthscope Commercial	$892.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$843.17
Rate for Payer: PHP Commercial	$843.17
Rate for Payer: Priority Health Cigna Priority Health	$644.78
Rate for Payer: Priority Health SBD	$624.94

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$316.80

Service Code	NDC 00904632461
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$126.72
Max. Negotiated Rate	$285.12
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Aetna Medicare	$158.40
Rate for Payer: Aetna New Business (MI Preferred)	$205.92
Rate for Payer: BCBS Complete	$126.72
Rate for Payer: Cash Price	$253.44
Rate for Payer: Cofinity Commercial	$221.76
Rate for Payer: Cofinity Commercial	$272.45
Rate for Payer: Cofinity Medicare Advantage	$221.76
Rate for Payer: Encore Health Key Benefits Commercial	$253.44
Rate for Payer: Healthscope Commercial	$285.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.28
Rate for Payer: PHP Commercial	$269.28
Rate for Payer: Priority Health Cigna Priority Health	$205.92
Rate for Payer: Priority Health SBD	$199.58

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.68

Service Code	NDC 60687041311
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare	$1.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: BCBS Complete	$1.47
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.13
Rate for Payer: PHP Commercial	$3.13
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.32

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$202.10

Service Code	NDC 67877059201
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$80.84
Max. Negotiated Rate	$181.89
Rate for Payer: Aetna Commercial	$171.78
Rate for Payer: Aetna Medicare	$101.05
Rate for Payer: Aetna New Business (MI Preferred)	$131.37
Rate for Payer: BCBS Complete	$80.84
Rate for Payer: Cash Price	$161.68
Rate for Payer: Cofinity Commercial	$141.47
Rate for Payer: Cofinity Commercial	$173.81
Rate for Payer: Cofinity Medicare Advantage	$141.47
Rate for Payer: Encore Health Key Benefits Commercial	$161.68
Rate for Payer: Healthscope Commercial	$181.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.78
Rate for Payer: PHP Commercial	$171.78
Rate for Payer: Priority Health Cigna Priority Health	$131.37
Rate for Payer: Priority Health SBD	$127.32

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$202.10

Service Code	NDC 67877059201
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$127.32
Max. Negotiated Rate	$181.89
Rate for Payer: Aetna Commercial	$171.78
Rate for Payer: Aetna New Business (MI Preferred)	$131.37
Rate for Payer: Cash Price	$161.68
Rate for Payer: Cofinity Commercial	$141.47
Rate for Payer: Cofinity Commercial	$173.81
Rate for Payer: Cofinity Medicare Advantage	$141.47
Rate for Payer: Encore Health Key Benefits Commercial	$161.68
Rate for Payer: Healthscope Commercial	$181.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.78
Rate for Payer: PHP Commercial	$171.78
Rate for Payer: Priority Health Cigna Priority Health	$131.37
Rate for Payer: Priority Health SBD	$127.32

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$316.80

Service Code	NDC 00904632461
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$199.58
Max. Negotiated Rate	$285.12
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Aetna New Business (MI Preferred)	$205.92
Rate for Payer: Cash Price	$253.44
Rate for Payer: Cofinity Commercial	$221.76
Rate for Payer: Cofinity Commercial	$272.45
Rate for Payer: Cofinity Medicare Advantage	$221.76
Rate for Payer: Encore Health Key Benefits Commercial	$253.44
Rate for Payer: Healthscope Commercial	$285.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.28
Rate for Payer: PHP Commercial	$269.28
Rate for Payer: Priority Health Cigna Priority Health	$205.92
Rate for Payer: Priority Health SBD	$199.58

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$183.84

Service Code	NDC 60687041365
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$73.54
Max. Negotiated Rate	$165.46
Rate for Payer: Aetna Commercial	$156.26
Rate for Payer: Aetna Medicare	$91.92
Rate for Payer: Aetna New Business (MI Preferred)	$119.50
Rate for Payer: BCBS Complete	$73.54
Rate for Payer: Cash Price	$147.07
Rate for Payer: Cofinity Commercial	$128.69
Rate for Payer: Cofinity Commercial	$158.10
Rate for Payer: Cofinity Medicare Advantage	$128.69
Rate for Payer: Encore Health Key Benefits Commercial	$147.07
Rate for Payer: Healthscope Commercial	$165.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.26
Rate for Payer: PHP Commercial	$156.26
Rate for Payer: Priority Health Cigna Priority Health	$119.50
Rate for Payer: Priority Health SBD	$115.82

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$183.84

Service Code	NDC 60687041365
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$115.82
Max. Negotiated Rate	$165.46
Rate for Payer: Aetna Commercial	$156.26
Rate for Payer: Aetna New Business (MI Preferred)	$119.50
Rate for Payer: Cash Price	$147.07
Rate for Payer: Cofinity Commercial	$128.69
Rate for Payer: Cofinity Commercial	$158.10
Rate for Payer: Cofinity Medicare Advantage	$128.69
Rate for Payer: Encore Health Key Benefits Commercial	$147.07
Rate for Payer: Healthscope Commercial	$165.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.26
Rate for Payer: PHP Commercial	$156.26
Rate for Payer: Priority Health Cigna Priority Health	$119.50
Rate for Payer: Priority Health SBD	$115.82

METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.68

Service Code	NDC 60687041311
Hospital Charge Code	30071
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.13
Rate for Payer: PHP Commercial	$3.13
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.32

METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB

Facility

$240.48

Service Code	NDC 09900000013
Hospital Charge Code	150704
Hospital Revenue Code	637
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$216.43
Rate for Payer: Aetna Commercial	$204.41
Rate for Payer: Aetna New Business (MI Preferred)	$156.31
Rate for Payer: Cash Price	$192.38
Rate for Payer: Cofinity Commercial	$168.34
Rate for Payer: Cofinity Commercial	$206.81
Rate for Payer: Cofinity Medicare Advantage	$168.34
Rate for Payer: Encore Health Key Benefits Commercial	$192.38
Rate for Payer: Healthscope Commercial	$216.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.41
Rate for Payer: PHP Commercial	$204.41
Rate for Payer: Priority Health Cigna Priority Health	$156.31
Rate for Payer: Priority Health SBD	$151.50

METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB

Facility

$240.48

Service Code	NDC 09900000013
Hospital Charge Code	150704
Hospital Revenue Code	637
Min. Negotiated Rate	$96.19
Max. Negotiated Rate	$216.43
Rate for Payer: Aetna Commercial	$204.41
Rate for Payer: Aetna Medicare	$120.24
Rate for Payer: Aetna New Business (MI Preferred)	$156.31
Rate for Payer: BCBS Complete	$96.19
Rate for Payer: Cash Price	$192.38
Rate for Payer: Cofinity Commercial	$168.34
Rate for Payer: Cofinity Commercial	$206.81
Rate for Payer: Cofinity Medicare Advantage	$168.34
Rate for Payer: Encore Health Key Benefits Commercial	$192.38
Rate for Payer: Healthscope Commercial	$216.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.41
Rate for Payer: PHP Commercial	$204.41
Rate for Payer: Priority Health Cigna Priority Health	$156.31
Rate for Payer: Priority Health SBD	$151.50

METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB

Facility

$245.28

Service Code	NDC 09999001501
Hospital Charge Code	150704
Hospital Revenue Code	637
Min. Negotiated Rate	$154.53
Max. Negotiated Rate	$220.75
Rate for Payer: Aetna Commercial	$208.49
Rate for Payer: Aetna New Business (MI Preferred)	$159.43
Rate for Payer: Cash Price	$196.22
Rate for Payer: Cofinity Commercial	$171.70
Rate for Payer: Cofinity Commercial	$210.94
Rate for Payer: Cofinity Medicare Advantage	$171.70
Rate for Payer: Encore Health Key Benefits Commercial	$196.22
Rate for Payer: Healthscope Commercial	$220.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.49
Rate for Payer: PHP Commercial	$208.49
Rate for Payer: Priority Health Cigna Priority Health	$159.43
Rate for Payer: Priority Health SBD	$154.53

METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB

Facility

$245.28

Service Code	NDC 09999001501
Hospital Charge Code	150704
Hospital Revenue Code	637
Min. Negotiated Rate	$98.11
Max. Negotiated Rate	$220.75
Rate for Payer: Aetna Commercial	$208.49
Rate for Payer: Aetna Medicare	$122.64
Rate for Payer: Aetna New Business (MI Preferred)	$159.43
Rate for Payer: BCBS Complete	$98.11
Rate for Payer: Cash Price	$196.22
Rate for Payer: Cofinity Commercial	$171.70
Rate for Payer: Cofinity Commercial	$210.94
Rate for Payer: Cofinity Medicare Advantage	$171.70
Rate for Payer: Encore Health Key Benefits Commercial	$196.22
Rate for Payer: Healthscope Commercial	$220.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.49
Rate for Payer: PHP Commercial	$208.49
Rate for Payer: Priority Health Cigna Priority Health	$159.43
Rate for Payer: Priority Health SBD	$154.53

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$371.45

Service Code	NDC 00904632261
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$334.31
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna Medicare	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: BCBS Complete	$148.58
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.01
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.01
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$221.35

Service Code	NDC 45963070911
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$371.45

Service Code	NDC 00904632261
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$234.01
Max. Negotiated Rate	$334.31
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.01
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.01
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$239.70

Service Code	NDC 50742061501
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$95.88
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$203.75
Rate for Payer: Aetna Medicare	$119.85
Rate for Payer: Aetna New Business (MI Preferred)	$155.81
Rate for Payer: BCBS Complete	$95.88
Rate for Payer: Cash Price	$191.76
Rate for Payer: Cofinity Commercial	$167.79
Rate for Payer: Cofinity Commercial	$206.14
Rate for Payer: Cofinity Medicare Advantage	$167.79
Rate for Payer: Encore Health Key Benefits Commercial	$191.76
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.75
Rate for Payer: PHP Commercial	$203.75
Rate for Payer: Priority Health Cigna Priority Health	$155.81
Rate for Payer: Priority Health SBD	$151.01

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$221.35

Service Code	NDC 45963070911
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna Medicare	$110.67
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: BCBS Complete	$88.54
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$152.75

Service Code	NDC 70436020201
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna Medicare	$76.38
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: BCBS Complete	$61.10
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Commercial	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Cofinity Medicare Advantage	$106.92
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health Cigna Priority Health	$99.29
Rate for Payer: Priority Health SBD	$96.23

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$152.75

Service Code	NDC 70436020201
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$96.23
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Commercial	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Cofinity Medicare Advantage	$106.92
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health Cigna Priority Health	$99.29
Rate for Payer: Priority Health SBD	$96.23

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$239.70

Service Code	NDC 50742061501
Hospital Charge Code	29858
Hospital Revenue Code	637
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$203.75
Rate for Payer: Aetna New Business (MI Preferred)	$155.81
Rate for Payer: Cash Price	$191.76
Rate for Payer: Cofinity Commercial	$167.79
Rate for Payer: Cofinity Commercial	$206.14
Rate for Payer: Cofinity Medicare Advantage	$167.79
Rate for Payer: Encore Health Key Benefits Commercial	$191.76
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.75
Rate for Payer: PHP Commercial	$203.75
Rate for Payer: Priority Health Cigna Priority Health	$155.81
Rate for Payer: Priority Health SBD	$151.01

METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$411.35

Service Code	NDC 51079017020
Hospital Charge Code	30070
Hospital Revenue Code	637
Min. Negotiated Rate	$259.15
Max. Negotiated Rate	$370.21
Rate for Payer: Aetna Commercial	$349.65
Rate for Payer: Aetna New Business (MI Preferred)	$267.38
Rate for Payer: Cash Price	$329.08
Rate for Payer: Cofinity Commercial	$287.94
Rate for Payer: Cofinity Commercial	$353.76
Rate for Payer: Cofinity Medicare Advantage	$287.94
Rate for Payer: Encore Health Key Benefits Commercial	$329.08
Rate for Payer: Healthscope Commercial	$370.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$349.65
Rate for Payer: PHP Commercial	$349.65
Rate for Payer: Priority Health Cigna Priority Health	$267.38
Rate for Payer: Priority Health SBD	$259.15

METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,078.25

Service Code	NDC 55111046705
Hospital Charge Code	30070
Hospital Revenue Code	637
Min. Negotiated Rate	$679.30
Max. Negotiated Rate	$970.42
Rate for Payer: Aetna Commercial	$916.51
Rate for Payer: Aetna New Business (MI Preferred)	$700.86
Rate for Payer: Cash Price	$862.60
Rate for Payer: Cofinity Commercial	$754.77
Rate for Payer: Cofinity Commercial	$927.29
Rate for Payer: Cofinity Medicare Advantage	$754.77
Rate for Payer: Encore Health Key Benefits Commercial	$862.60
Rate for Payer: Healthscope Commercial	$970.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$916.51
Rate for Payer: PHP Commercial	$916.51
Rate for Payer: Priority Health Cigna Priority Health	$700.86
Rate for Payer: Priority Health SBD	$679.30

METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$372.40

Service Code	NDC 00904632361
Hospital Charge Code	30070
Hospital Revenue Code	637
Min. Negotiated Rate	$234.61
Max. Negotiated Rate	$335.16
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna New Business (MI Preferred)	$242.06
Rate for Payer: Cash Price	$297.92
Rate for Payer: Cofinity Commercial	$260.68
Rate for Payer: Cofinity Commercial	$320.26
Rate for Payer: Cofinity Medicare Advantage	$260.68
Rate for Payer: Encore Health Key Benefits Commercial	$297.92
Rate for Payer: Healthscope Commercial	$335.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.54
Rate for Payer: PHP Commercial	$316.54
Rate for Payer: Priority Health Cigna Priority Health	$242.06
Rate for Payer: Priority Health SBD	$234.61

Know your out-of-pocket cost for care.

All Charges