|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$67.93
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$66.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.40
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$211.51
|
| Rate for Payer: BCN Commercial |
$211.51
|
| Rate for Payer: BCN Medicare Advantage |
$64.32
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.32
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Mclaren Medicaid |
$45.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.54
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: PACE Senior Care Partners |
$61.10
|
| Rate for Payer: PACE SWMI |
$64.32
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Medicare Advantage |
$64.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Medicare |
$64.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.07
|
| Rate for Payer: Railroad Medicare Medicare |
$64.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: UHC Exchange |
$64.32
|
| Rate for Payer: UHC Medicaid |
$45.36
|
| Rate for Payer: UHC Medicare Advantage |
$64.32
|
| Rate for Payer: UHCCP Medicaid |
$45.36
|
| Rate for Payer: VA VA |
$64.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$21.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$20.56
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$67.62
|
| Rate for Payer: BCN Medicare Advantage |
$20.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Mclaren Medicaid |
$14.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.59
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.53
|
| Rate for Payer: PACE SWMI |
$20.56
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Medicare |
$20.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.25
|
| Rate for Payer: Railroad Medicare Medicare |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: UHC Exchange |
$20.56
|
| Rate for Payer: UHC Medicaid |
$14.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.56
|
| Rate for Payer: UHCCP Medicaid |
$14.50
|
| Rate for Payer: VA VA |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Mclaren Medicaid |
$0.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.45
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,200.28
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$835.39 |
| Max. Negotiated Rate |
$1,080.25 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: BCBS Trust/PPO |
$991.31
|
| Rate for Payer: BCN Commercial |
$991.31
|
| Rate for Payer: Cash Price |
$960.22
|
| Rate for Payer: Cofinity Commercial |
$1,032.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.22
|
| Rate for Payer: Healthscope Commercial |
$1,080.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.24
|
| Rate for Payer: Nomi Health Commercial |
$984.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.21
|
| Rate for Payer: PHP Commercial |
$1,020.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,044.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$835.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.25
|
| Rate for Payer: UHC Core |
$1,002.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.21
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cofinity Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.01
|
| Rate for Payer: PHP Commercial |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.57
|
| Rate for Payer: UHC Core |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.01
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,200.28
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.61 |
| Max. Negotiated Rate |
$1,080.25 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna Medicare |
$312.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.09
|
| Rate for Payer: BCBS Complete |
$222.17
|
| Rate for Payer: BCBS MAPPO |
$300.07
|
| Rate for Payer: BCBS Trust/PPO |
$986.75
|
| Rate for Payer: BCN Commercial |
$986.75
|
| Rate for Payer: BCN Medicare Advantage |
$300.07
|
| Rate for Payer: Cash Price |
$960.22
|
| Rate for Payer: Cofinity Commercial |
$1,032.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.07
|
| Rate for Payer: Healthscope Commercial |
$1,080.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.21
|
| Rate for Payer: Mclaren Medicaid |
$211.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.07
|
| Rate for Payer: Meridian Medicaid |
$222.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$330.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.24
|
| Rate for Payer: Nomi Health Commercial |
$984.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.21
|
| Rate for Payer: PACE Senior Care Partners |
$285.07
|
| Rate for Payer: PACE SWMI |
$300.07
|
| Rate for Payer: PHP Commercial |
$1,020.24
|
| Rate for Payer: PHP Medicare Advantage |
$300.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,044.24
|
| Rate for Payer: Priority Health Medicare |
$303.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$835.39
|
| Rate for Payer: Railroad Medicare Medicare |
$300.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.25
|
| Rate for Payer: UHC Core |
$1,002.23
|
| Rate for Payer: UHC Exchange |
$300.07
|
| Rate for Payer: UHC Medicaid |
$211.61
|
| Rate for Payer: UHC Medicare Advantage |
$300.07
|
| Rate for Payer: UHCCP Medicaid |
$211.61
|
| Rate for Payer: VA VA |
$300.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.21
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.75
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: BCN Medicare Advantage |
$3.00
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cofinity Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.01
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.15
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.01
|
| Rate for Payer: PACE Senior Care Partners |
$2.85
|
| Rate for Payer: PACE SWMI |
$3.00
|
| Rate for Payer: PHP Commercial |
$10.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.45
|
| Rate for Payer: Priority Health Medicare |
$3.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.57
|
| Rate for Payer: UHC Core |
$10.03
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UHC Medicaid |
$2.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.00
|
| Rate for Payer: UHCCP Medicaid |
$2.12
|
| Rate for Payer: VA VA |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.01
|
|
|
METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$240.48
|
|
|
Service Code
|
NDC 09900000013
|
| Hospital Charge Code |
150704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: Aetna Medicare |
$62.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.15
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$60.12
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$60.12
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.12
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.36
|
| Rate for Payer: Mclaren Medicaid |
$42.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.13
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.36
|
| Rate for Payer: PACE Senior Care Partners |
$57.11
|
| Rate for Payer: PACE SWMI |
$60.12
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: PHP Medicare Advantage |
$60.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Medicare |
$60.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.37
|
| Rate for Payer: Railroad Medicare Medicare |
$60.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.62
|
| Rate for Payer: UHC Core |
$200.80
|
| Rate for Payer: UHC Exchange |
$60.12
|
| Rate for Payer: UHC Medicaid |
$42.40
|
| Rate for Payer: UHC Medicare Advantage |
$60.12
|
| Rate for Payer: UHCCP Medicaid |
$42.40
|
| Rate for Payer: VA VA |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.36
|
|
|
METOPROLOL SUCCINATE ER 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$240.48
|
|
|
Service Code
|
NDC 09900000013
|
| Hospital Charge Code |
150704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.37 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: BCBS Trust/PPO |
$198.61
|
| Rate for Payer: BCN Commercial |
$198.61
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.36
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.62
|
| Rate for Payer: UHC Core |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$304.32
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.65 |
| Max. Negotiated Rate |
$273.89 |
| Rate for Payer: Aetna Commercial |
$258.67
|
| Rate for Payer: Aetna Medicare |
$79.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.10
|
| Rate for Payer: BCBS Complete |
$56.33
|
| Rate for Payer: BCBS MAPPO |
$76.08
|
| Rate for Payer: BCBS Trust/PPO |
$250.18
|
| Rate for Payer: BCN Commercial |
$250.18
|
| Rate for Payer: BCN Medicare Advantage |
$76.08
|
| Rate for Payer: Cash Price |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$261.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.08
|
| Rate for Payer: Healthscope Commercial |
$273.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.24
|
| Rate for Payer: Mclaren Medicaid |
$53.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.88
|
| Rate for Payer: Meridian Medicaid |
$56.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.67
|
| Rate for Payer: Nomi Health Commercial |
$249.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.24
|
| Rate for Payer: PACE Senior Care Partners |
$72.28
|
| Rate for Payer: PACE SWMI |
$76.08
|
| Rate for Payer: PHP Commercial |
$258.67
|
| Rate for Payer: PHP Medicare Advantage |
$76.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.76
|
| Rate for Payer: Priority Health Medicare |
$76.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.81
|
| Rate for Payer: Railroad Medicare Medicare |
$76.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.80
|
| Rate for Payer: UHC Core |
$254.11
|
| Rate for Payer: UHC Exchange |
$76.08
|
| Rate for Payer: UHC Medicaid |
$53.65
|
| Rate for Payer: UHC Medicare Advantage |
$76.08
|
| Rate for Payer: UHCCP Medicaid |
$53.65
|
| Rate for Payer: VA VA |
$76.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.24
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$276.48
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.43 |
| Max. Negotiated Rate |
$248.83 |
| Rate for Payer: Aetna Commercial |
$235.01
|
| Rate for Payer: BCBS Trust/PPO |
$228.34
|
| Rate for Payer: BCN Commercial |
$228.34
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cofinity Commercial |
$237.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.18
|
| Rate for Payer: Healthscope Commercial |
$248.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.01
|
| Rate for Payer: Nomi Health Commercial |
$226.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.36
|
| Rate for Payer: PHP Commercial |
$235.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.30
|
| Rate for Payer: UHC Core |
$230.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$276.48
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$248.83 |
| Rate for Payer: Aetna Commercial |
$235.01
|
| Rate for Payer: Aetna Medicare |
$71.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.40
|
| Rate for Payer: BCBS Complete |
$51.18
|
| Rate for Payer: BCBS MAPPO |
$69.12
|
| Rate for Payer: BCBS Trust/PPO |
$227.29
|
| Rate for Payer: BCN Commercial |
$227.29
|
| Rate for Payer: BCN Medicare Advantage |
$69.12
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cofinity Commercial |
$237.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.12
|
| Rate for Payer: Healthscope Commercial |
$248.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.36
|
| Rate for Payer: Mclaren Medicaid |
$48.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.58
|
| Rate for Payer: Meridian Medicaid |
$51.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.01
|
| Rate for Payer: Nomi Health Commercial |
$226.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.36
|
| Rate for Payer: PACE Senior Care Partners |
$65.66
|
| Rate for Payer: PACE SWMI |
$69.12
|
| Rate for Payer: PHP Commercial |
$235.01
|
| Rate for Payer: PHP Medicare Advantage |
$69.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.54
|
| Rate for Payer: Priority Health Medicare |
$69.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.43
|
| Rate for Payer: Railroad Medicare Medicare |
$69.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.30
|
| Rate for Payer: UHC Core |
$230.86
|
| Rate for Payer: UHC Exchange |
$69.12
|
| Rate for Payer: UHC Medicaid |
$48.74
|
| Rate for Payer: UHC Medicare Advantage |
$69.12
|
| Rate for Payer: UHCCP Medicaid |
$48.74
|
| Rate for Payer: VA VA |
$69.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$304.32
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.81 |
| Max. Negotiated Rate |
$273.89 |
| Rate for Payer: Aetna Commercial |
$258.67
|
| Rate for Payer: BCBS Trust/PPO |
$251.34
|
| Rate for Payer: BCN Commercial |
$251.34
|
| Rate for Payer: Cash Price |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$261.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.46
|
| Rate for Payer: Healthscope Commercial |
$273.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.67
|
| Rate for Payer: Nomi Health Commercial |
$249.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.24
|
| Rate for Payer: PHP Commercial |
$258.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.80
|
| Rate for Payer: UHC Core |
$254.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.24
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
NDC 60687039011
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.59
|
| Rate for Payer: Nomi Health Commercial |
$2.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.05
|
|
|
Service Code
|
NDC 60687039011
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Mclaren Medicaid |
$0.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Meridian Medicaid |
$0.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.59
|
| Rate for Payer: Nomi Health Commercial |
$2.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.29
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$2.59
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.65
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.55
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicaid |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: UHCCP Medicaid |
$0.54
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 45963070911
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.17
|
| Rate for Payer: BCBS Complete |
$40.97
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$181.97
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Mclaren Medicaid |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.10
|
| Rate for Payer: Meridian Medicaid |
$40.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PACE Senior Care Partners |
$52.57
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Medicare |
$55.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.06
|
| Rate for Payer: Railroad Medicare Medicare |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicaid |
$39.02
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| Rate for Payer: UHCCP Medicaid |
$39.02
|
| Rate for Payer: VA VA |
$55.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 45963070911
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.06 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$182.81
|
| Rate for Payer: BCN Commercial |
$182.81
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 50268054111
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.25
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.28
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.05
|
| Rate for Payer: Meridian Medicaid |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Nomi Health Commercial |
$3.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.47
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.51
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$259.68
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna Commercial |
$220.73
|
| Rate for Payer: Aetna Medicare |
$67.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.15
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: BCBS MAPPO |
$64.92
|
| Rate for Payer: BCBS Trust/PPO |
$213.48
|
| Rate for Payer: BCN Commercial |
$213.48
|
| Rate for Payer: BCN Medicare Advantage |
$64.92
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Commercial |
$223.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$233.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.76
|
| Rate for Payer: Mclaren Medicaid |
$45.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.17
|
| Rate for Payer: Meridian Medicaid |
$48.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$212.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: PACE Senior Care Partners |
$61.67
|
| Rate for Payer: PACE SWMI |
$64.92
|
| Rate for Payer: PHP Commercial |
$220.73
|
| Rate for Payer: PHP Medicare Advantage |
$64.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.92
|
| Rate for Payer: Priority Health Medicare |
$65.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.74
|
| Rate for Payer: Railroad Medicare Medicare |
$64.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.52
|
| Rate for Payer: UHC Core |
$216.83
|
| Rate for Payer: UHC Exchange |
$64.92
|
| Rate for Payer: UHC Medicaid |
$45.78
|
| Rate for Payer: UHC Medicare Advantage |
$64.92
|
| Rate for Payer: UHCCP Medicaid |
$45.78
|
| Rate for Payer: VA VA |
$64.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.76
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$199.03
|
|
|
Service Code
|
NDC 50268054115
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$179.13 |
| Rate for Payer: Aetna Commercial |
$169.18
|
| Rate for Payer: Aetna Medicare |
$51.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.20
|
| Rate for Payer: BCBS Complete |
$36.84
|
| Rate for Payer: BCBS MAPPO |
$49.76
|
| Rate for Payer: BCBS Trust/PPO |
$163.62
|
| Rate for Payer: BCN Commercial |
$163.62
|
| Rate for Payer: BCN Medicare Advantage |
$49.76
|
| Rate for Payer: Cash Price |
$159.22
|
| Rate for Payer: Cofinity Commercial |
$171.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.76
|
| Rate for Payer: Healthscope Commercial |
$179.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.27
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.25
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.18
|
| Rate for Payer: Nomi Health Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.27
|
| Rate for Payer: PACE Senior Care Partners |
$47.27
|
| Rate for Payer: PACE SWMI |
$49.76
|
| Rate for Payer: PHP Commercial |
$169.18
|
| Rate for Payer: PHP Medicare Advantage |
$49.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.16
|
| Rate for Payer: Priority Health Medicare |
$50.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.52
|
| Rate for Payer: Railroad Medicare Medicare |
$49.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.15
|
| Rate for Payer: UHC Core |
$166.19
|
| Rate for Payer: UHC Exchange |
$49.76
|
| Rate for Payer: UHC Medicaid |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$49.76
|
| Rate for Payer: UHCCP Medicaid |
$35.09
|
| Rate for Payer: VA VA |
$49.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.27
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 50268054111
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.30
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Nomi Health Commercial |
$3.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.51
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$259.68
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.74 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna Commercial |
$220.73
|
| Rate for Payer: BCBS Trust/PPO |
$214.47
|
| Rate for Payer: BCN Commercial |
$214.47
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Commercial |
$223.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Healthscope Commercial |
$233.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$212.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: PHP Commercial |
$220.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.52
|
| Rate for Payer: UHC Core |
$216.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.76
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$199.03
|
|
|
Service Code
|
NDC 50268054115
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$179.13 |
| Rate for Payer: Aetna Commercial |
$169.18
|
| Rate for Payer: BCBS Trust/PPO |
$164.38
|
| Rate for Payer: BCN Commercial |
$164.38
|
| Rate for Payer: Cash Price |
$159.22
|
| Rate for Payer: Cofinity Commercial |
$171.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.22
|
| Rate for Payer: Healthscope Commercial |
$179.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.18
|
| Rate for Payer: Nomi Health Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.27
|
| Rate for Payer: PHP Commercial |
$169.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.15
|
| Rate for Payer: UHC Core |
$166.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.27
|
|
