|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: BCBS Trust/PPO |
$210.02
|
| Rate for Payer: BCN Commercial |
$198.83
|
| 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: Healthscope Commercial |
$231.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.41
|
| Rate for Payer: UHC Core |
$214.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 60687062011
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| 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 |
$1.03
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.19
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| 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 Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.73
|
| 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 Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00093220401
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.03
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS MAPPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$54.81
|
| Rate for Payer: BCN Medicare Advantage |
$17.62
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: PACE Senior Care Partners |
$16.74
|
| Rate for Payer: PACE SWMI |
$17.62
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.82
|
| Rate for Payer: Priority Health HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Medicare |
$17.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.24
|
| Rate for Payer: Railroad Medicare Medicare |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.62
|
| Rate for Payer: UHC Exchange |
$17.62
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
| Rate for Payer: VA VA |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
METOCLOPRAMIDE 5 MG TABLET
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| 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 |
$102.91
|
| Rate for Payer: BCBS MAPPO |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$211.51
|
| Rate for Payer: BCN Commercial |
$200.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Nomi Health Commercial |
$210.97
|
| 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 Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health HMO/PPO |
$223.83
|
| Rate for Payer: Priority Health Medicare |
$64.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.38
|
| 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 Dual Complete DSNP |
$64.32
|
| Rate for Payer: UHC Exchange |
$64.32
|
| Rate for Payer: UHC Medicare Advantage |
$64.32
|
| Rate for Payer: VA VA |
$64.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$710.92 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: BCBS Trust/PPO |
$892.80
|
| Rate for Payer: BCN Commercial |
$845.23
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: Nomi Health Commercial |
$896.85
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health HMO/PPO |
$951.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$962.47
|
| Rate for Payer: UHC Core |
$913.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.76 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: Aetna Medicare |
$284.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.79
|
| Rate for Payer: BCBS Complete |
$437.49
|
| Rate for Payer: BCBS MAPPO |
$273.43
|
| Rate for Payer: BCBS Trust/PPO |
$899.15
|
| Rate for Payer: BCN Commercial |
$850.37
|
| Rate for Payer: BCN Medicare Advantage |
$273.43
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.43
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: Nomi Health Commercial |
$896.85
|
| Rate for Payer: PACE Senior Care Partners |
$259.76
|
| Rate for Payer: PACE SWMI |
$273.43
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: PHP Medicare Advantage |
$273.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health HMO/PPO |
$951.54
|
| Rate for Payer: Priority Health Medicare |
$276.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.79
|
| Rate for Payer: Railroad Medicare Medicare |
$273.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$962.47
|
| Rate for Payer: UHC Core |
$913.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.43
|
| Rate for Payer: UHC Exchange |
$273.43
|
| Rate for Payer: UHC Medicare Advantage |
$273.43
|
| Rate for Payer: VA VA |
$273.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
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 |
$57.11 |
| 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 |
$96.19
|
| Rate for Payer: BCBS MAPPO |
$60.12
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$186.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Nomi Health Commercial |
$197.19
|
| 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 Cigna Priority Health |
$156.31
|
| Rate for Payer: Priority Health HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Medicare |
$60.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| 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 Dual Complete DSNP |
$60.12
|
| Rate for Payer: UHC Exchange |
$60.12
|
| Rate for Payer: UHC Medicare Advantage |
$60.12
|
| 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 |
$156.31 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: BCBS Trust/PPO |
$196.30
|
| Rate for Payer: BCN Commercial |
$185.84
|
| 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: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.31
|
| Rate for Payer: Priority Health HMO/PPO |
$209.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| 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
|
$221.35
|
|
|
Service Code
|
NDC 45963070911
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.57 |
| 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 |
$88.54
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$172.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| 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 Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Medicare |
$55.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| 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 Dual Complete DSNP |
$55.34
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| 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 |
$143.88 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.69
|
| Rate for Payer: BCN Commercial |
$171.06
|
| 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: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| 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 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$289.44
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.74 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.02
|
| Rate for Payer: Aetna Medicare |
$75.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.45
|
| Rate for Payer: BCBS Complete |
$115.78
|
| Rate for Payer: BCBS MAPPO |
$72.36
|
| Rate for Payer: BCBS Trust/PPO |
$237.95
|
| Rate for Payer: BCN Commercial |
$225.04
|
| Rate for Payer: BCN Medicare Advantage |
$72.36
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Cofinity Commercial |
$248.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.36
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.02
|
| Rate for Payer: Nomi Health Commercial |
$237.34
|
| Rate for Payer: PACE Senior Care Partners |
$68.74
|
| Rate for Payer: PACE SWMI |
$72.36
|
| Rate for Payer: PHP Commercial |
$246.02
|
| Rate for Payer: PHP Medicare Advantage |
$72.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health HMO/PPO |
$251.81
|
| Rate for Payer: Priority Health Medicare |
$73.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.92
|
| Rate for Payer: Railroad Medicare Medicare |
$72.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.71
|
| Rate for Payer: UHC Core |
$241.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.36
|
| Rate for Payer: UHC Exchange |
$72.36
|
| Rate for Payer: UHC Medicare Advantage |
$72.36
|
| Rate for Payer: VA VA |
$72.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.08
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$371.45
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$334.30 |
| Rate for Payer: Aetna Commercial |
$315.73
|
| Rate for Payer: Aetna Medicare |
$96.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.08
|
| Rate for Payer: BCBS Complete |
$148.58
|
| Rate for Payer: BCBS MAPPO |
$92.86
|
| Rate for Payer: BCBS Trust/PPO |
$305.37
|
| Rate for Payer: BCN Commercial |
$288.80
|
| Rate for Payer: BCN Medicare Advantage |
$92.86
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$319.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.86
|
| Rate for Payer: Healthscope Commercial |
$334.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: PACE Senior Care Partners |
$88.22
|
| Rate for Payer: PACE SWMI |
$92.86
|
| Rate for Payer: PHP Commercial |
$315.73
|
| Rate for Payer: PHP Medicare Advantage |
$92.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$323.16
|
| Rate for Payer: Priority Health Medicare |
$93.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.87
|
| Rate for Payer: Railroad Medicare Medicare |
$92.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.88
|
| Rate for Payer: UHC Core |
$310.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.86
|
| Rate for Payer: UHC Exchange |
$92.86
|
| Rate for Payer: UHC Medicare Advantage |
$92.86
|
| Rate for Payer: VA VA |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.59
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$371.45
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$334.30 |
| Rate for Payer: Aetna Commercial |
$315.73
|
| Rate for Payer: BCBS Trust/PPO |
$303.21
|
| Rate for Payer: BCN Commercial |
$287.06
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$319.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Healthscope Commercial |
$334.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: PHP Commercial |
$315.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$323.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.88
|
| Rate for Payer: UHC Core |
$310.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.59
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 60687039011
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.94
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$289.44
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.14 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.02
|
| Rate for Payer: BCBS Trust/PPO |
$236.27
|
| Rate for Payer: BCN Commercial |
$223.68
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Cofinity Commercial |
$248.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.55
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.02
|
| Rate for Payer: Nomi Health Commercial |
$237.34
|
| Rate for Payer: PHP Commercial |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health HMO/PPO |
$251.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.71
|
| Rate for Payer: UHC Core |
$241.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.08
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 60687039011
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.38
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
NDC 50268054111
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.73
|
| Rate for Payer: UHC Core |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.32
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$372.40
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: Aetna Medicare |
$96.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.38
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: BCBS MAPPO |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$306.15
|
| Rate for Payer: BCN Commercial |
$289.54
|
| Rate for Payer: BCN Medicare Advantage |
$93.10
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: PACE Senior Care Partners |
$88.44
|
| Rate for Payer: PACE SWMI |
$93.10
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: PHP Medicare Advantage |
$93.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: Priority Health HMO/PPO |
$323.99
|
| Rate for Payer: Priority Health Medicare |
$94.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.51
|
| Rate for Payer: Railroad Medicare Medicare |
$93.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.71
|
| Rate for Payer: UHC Core |
$310.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.10
|
| Rate for Payer: UHC Exchange |
$93.10
|
| Rate for Payer: UHC Medicare Advantage |
$93.10
|
| Rate for Payer: VA VA |
$93.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$154.85
|
|
|
Service Code
|
NDC 50268054115
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$139.36 |
| Rate for Payer: Aetna Commercial |
$131.62
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.39
|
| Rate for Payer: BCBS Complete |
$61.94
|
| Rate for Payer: BCBS MAPPO |
$38.71
|
| Rate for Payer: BCBS Trust/PPO |
$127.30
|
| Rate for Payer: BCN Commercial |
$120.40
|
| Rate for Payer: BCN Medicare Advantage |
$38.71
|
| Rate for Payer: Cash Price |
$123.88
|
| Rate for Payer: Cofinity Commercial |
$133.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$139.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.62
|
| Rate for Payer: Nomi Health Commercial |
$126.98
|
| Rate for Payer: PACE Senior Care Partners |
$36.78
|
| Rate for Payer: PACE SWMI |
$38.71
|
| Rate for Payer: PHP Commercial |
$131.62
|
| Rate for Payer: PHP Medicare Advantage |
$38.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.65
|
| Rate for Payer: Priority Health HMO/PPO |
$134.72
|
| Rate for Payer: Priority Health Medicare |
$39.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.75
|
| Rate for Payer: Railroad Medicare Medicare |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.27
|
| Rate for Payer: UHC Core |
$129.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.71
|
| Rate for Payer: UHC Exchange |
$38.71
|
| Rate for Payer: UHC Medicare Advantage |
$38.71
|
| Rate for Payer: VA VA |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$372.40
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: BCBS Trust/PPO |
$303.99
|
| Rate for Payer: BCN Commercial |
$287.79
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: Priority Health HMO/PPO |
$323.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.71
|
| Rate for Payer: UHC Core |
$310.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$154.85
|
|
|
Service Code
|
NDC 50268054115
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$139.36 |
| Rate for Payer: Aetna Commercial |
$131.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.40
|
| Rate for Payer: BCN Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$123.88
|
| Rate for Payer: Cofinity Commercial |
$133.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.88
|
| Rate for Payer: Healthscope Commercial |
$139.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.62
|
| Rate for Payer: Nomi Health Commercial |
$126.98
|
| Rate for Payer: PHP Commercial |
$131.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.65
|
| Rate for Payer: Priority Health HMO/PPO |
$134.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.27
|
| Rate for Payer: UHC Core |
$129.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
NDC 50268054111
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.97
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.54
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2.70
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.73
|
| Rate for Payer: UHC Core |
$2.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.32
|
|
|
METOPROLOL TARTRATE 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 00990000038
|
| Hospital Charge Code |
500250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: BCBS Trust/PPO |
$134.28
|
| 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 Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health HMO/PPO |
$143.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.22
|
| 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 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 00990000038
|
| Hospital Charge Code |
500250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.07 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna Medicare |
$42.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.41
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: BCBS MAPPO |
$41.12
|
| Rate for Payer: BCBS Trust/PPO |
$135.24
|
| Rate for Payer: BCN Commercial |
$127.90
|
| Rate for Payer: BCN Medicare Advantage |
$41.12
|
| 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: Health Alliance Plan Medicare Advantage |
$41.12
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: PACE Senior Care Partners |
$39.07
|
| Rate for Payer: PACE SWMI |
$41.12
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: PHP Medicare Advantage |
$41.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health HMO/PPO |
$143.12
|
| Rate for Payer: Priority Health Medicare |
$41.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.22
|
| Rate for Payer: Railroad Medicare Medicare |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.76
|
| Rate for Payer: UHC Core |
$137.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.12
|
| Rate for Payer: UHC Exchange |
$41.12
|
| Rate for Payer: UHC Medicare Advantage |
$41.12
|
| Rate for Payer: VA VA |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$171.32 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$49.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.48
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS MAPPO |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$156.49
|
| Rate for Payer: BCN Commercial |
$148.00
|
| Rate for Payer: BCN Medicare Advantage |
$47.59
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.59
|
| Rate for Payer: Healthscope Commercial |
$171.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: PACE Senior Care Partners |
$45.21
|
| Rate for Payer: PACE SWMI |
$47.59
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO |
$165.60
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.51
|
| Rate for Payer: UHC Core |
$158.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.59
|
| Rate for Payer: UHC Exchange |
$47.59
|
| Rate for Payer: UHC Medicare Advantage |
$47.59
|
| Rate for Payer: VA VA |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
