|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 62584-265-01
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: BCBS Trust/PPO |
$136.21
|
| Rate for Payer: BCN Commercial |
$136.21
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.10
|
| Rate for Payer: UHC Core |
$147.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 62584-265-11
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: BCBS Trust/PPO |
$136.21
|
| Rate for Payer: BCN Commercial |
$136.21
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.10
|
| Rate for Payer: UHC Core |
$147.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 62332-112-31
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.53 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$39.95
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.50
|
| Rate for Payer: UHC Core |
$43.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 51079-255-01
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.21
|
| Rate for Payer: UHC Core |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 51079-255-20
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.33
|
| Rate for Payer: BCN Commercial |
$105.33
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 51079-801-01
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.50
|
| Rate for Payer: UHC Core |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 62584-266-01
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 62584-266-11
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 0904-7118-61
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.33 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: BCBS Trust/PPO |
$127.13
|
| Rate for Payer: BCN Commercial |
$127.13
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.76
|
| Rate for Payer: UHC Core |
$137.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
NDC 51079-801-20
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: BCBS Trust/PPO |
$130.76
|
| Rate for Payer: BCN Commercial |
$130.76
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.82
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.90
|
| Rate for Payer: UHC Core |
$141.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.90
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-1778-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.34
|
| Rate for Payer: BCN Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.77
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.88
|
|
|
Service Code
|
NDC 72611-740-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.27
|
| Rate for Payer: BCN Commercial |
$12.27
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.50
|
| Rate for Payer: PHP Commercial |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.97
|
| Rate for Payer: UHC Core |
$13.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.91
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
NDC 36000-033-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.40
|
| Rate for Payer: Healthscope Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.24
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.74
|
| Rate for Payer: UHC Core |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.56
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-2016-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.34
|
| Rate for Payer: BCN Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.77
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-1778-15
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.34
|
| Rate for Payer: BCN Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.77
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.38
|
|
|
Service Code
|
NDC 0409-2016-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna Commercial |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.34
|
| Rate for Payer: BCN Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.37
|
| Rate for Payer: PHP Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.77
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.04
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.88
|
|
|
Service Code
|
NDC 72611-740-01
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.27
|
| Rate for Payer: BCN Commercial |
$12.27
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cofinity Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.50
|
| Rate for Payer: PHP Commercial |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.97
|
| Rate for Payer: UHC Core |
$13.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.91
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLORIDE IVPB (PARTIAL PACKAGE)
|
Facility
|
IP
|
$62.93
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
165987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$48.63
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$48.63
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$52.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: BCBS Trust/PPO |
$48.63
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$48.63
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.49
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC Core |
$52.55
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 42292-001-01
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.78
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687-550-01
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.89 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: BCBS Trust/PPO |
$189.92
|
| Rate for Payer: BCN Commercial |
$189.92
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.27
|
| Rate for Payer: UHC Core |
$205.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687-550-11
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.90
|
| Rate for Payer: BCN Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$444.60
|
|
|
Service Code
|
NDC 42292-001-20
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.16 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: BCBS Trust/PPO |
$343.59
|
| Rate for Payer: BCN Commercial |
$343.59
|
| Rate for Payer: Cash Price |
$355.68
|
| Rate for Payer: Cofinity Commercial |
$382.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.68
|
| Rate for Payer: Healthscope Commercial |
$400.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.91
|
| Rate for Payer: PHP Commercial |
$377.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.25
|
| Rate for Payer: UHC Core |
$371.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.45
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$438.90
|
|
|
Service Code
|
NDC 0904-7126-61
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.69 |
| Max. Negotiated Rate |
$395.01 |
| Rate for Payer: Aetna Commercial |
$373.06
|
| Rate for Payer: BCBS Trust/PPO |
$339.18
|
| Rate for Payer: BCN Commercial |
$339.18
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Commercial |
$377.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$395.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.06
|
| Rate for Payer: PHP Commercial |
$373.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.23
|
| Rate for Payer: UHC Core |
$366.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.18
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 50111-334-01
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.01 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: BCBS Trust/PPO |
$188.81
|
| Rate for Payer: BCN Commercial |
$188.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.00
|
| Rate for Payer: UHC Core |
$204.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
