|
METOCLOPRAMIDE (BULK) POWDER
|
Facility
|
IP
|
$86.58
|
|
|
Service Code
|
NDC 38779040301
|
| Hospital Charge Code |
14955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$77.92 |
| Rate for Payer: Aetna American Axle |
$56.28
|
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.28
|
| Rate for Payer: Cash Price |
$69.26
|
| Rate for Payer: Cofinity Commercial |
$60.61
|
| Rate for Payer: Cofinity Commercial |
$74.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.26
|
| Rate for Payer: Healthscope Commercial |
$77.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.59
|
| Rate for Payer: PHP Commercial |
$73.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.28
|
| Rate for Payer: Priority Health SBD |
$54.55
|
| Rate for Payer: UMR Bronson Commercial |
$38.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.94
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
OP
|
$401.76
|
|
|
Service Code
|
NDC 00185560001
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.65 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
IP
|
$845.08
|
|
|
Service Code
|
NDC 00378617401
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.84 |
| Max. Negotiated Rate |
$760.57 |
| Rate for Payer: Aetna American Axle |
$549.30
|
| Rate for Payer: Aetna Commercial |
$718.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.30
|
| Rate for Payer: Cash Price |
$676.06
|
| Rate for Payer: Cofinity Commercial |
$591.56
|
| Rate for Payer: Cofinity Commercial |
$726.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$591.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.06
|
| Rate for Payer: Healthscope Commercial |
$760.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$591.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$633.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.32
|
| Rate for Payer: PHP Commercial |
$718.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.30
|
| Rate for Payer: Priority Health SBD |
$532.40
|
| Rate for Payer: UMR Bronson Commercial |
$371.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.81
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
NDC 00185560001
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
METOLAZONE 10 MG TABLET
|
Facility
|
OP
|
$845.08
|
|
|
Service Code
|
NDC 00378617401
|
| Hospital Charge Code |
10586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.68 |
| Max. Negotiated Rate |
$760.57 |
| Rate for Payer: Aetna American Axle |
$549.30
|
| Rate for Payer: Aetna Commercial |
$718.32
|
| Rate for Payer: Aetna Medicare |
$422.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.30
|
| Rate for Payer: BCBS Complete |
$338.03
|
| Rate for Payer: Cash Price |
$676.06
|
| Rate for Payer: Cofinity Commercial |
$591.56
|
| Rate for Payer: Cofinity Commercial |
$726.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$591.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.06
|
| Rate for Payer: Healthscope Commercial |
$760.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$591.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$633.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.32
|
| Rate for Payer: PHP Commercial |
$718.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.30
|
| Rate for Payer: Priority Health SBD |
$532.40
|
| Rate for Payer: UMR Bronson Commercial |
$312.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.81
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$10.15
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$9.14 |
| Rate for Payer: Aetna American Axle |
$6.60
|
| Rate for Payer: Aetna Commercial |
$8.63
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.60
|
| Rate for Payer: BCBS Complete |
$4.06
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.12
|
| Rate for Payer: Healthscope Commercial |
$9.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.63
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.60
|
| Rate for Payer: Priority Health SBD |
$6.39
|
| Rate for Payer: UMR Bronson Commercial |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.61
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$1,014.54
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Aetna American Axle |
$659.45
|
| Rate for Payer: Aetna Commercial |
$862.36
|
| Rate for Payer: Aetna Medicare |
$507.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.45
|
| Rate for Payer: BCBS Complete |
$405.82
|
| Rate for Payer: Cash Price |
$811.63
|
| Rate for Payer: Cofinity Commercial |
$710.18
|
| Rate for Payer: Cofinity Commercial |
$872.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.63
|
| Rate for Payer: Healthscope Commercial |
$913.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$760.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.36
|
| Rate for Payer: PHP Commercial |
$862.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.45
|
| Rate for Payer: Priority Health SBD |
$639.16
|
| Rate for Payer: UMR Bronson Commercial |
$375.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$760.90
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
OP
|
$261.12
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.61 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Aetna American Axle |
$169.73
|
| Rate for Payer: Aetna Commercial |
$221.95
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.73
|
| Rate for Payer: BCBS Complete |
$104.45
|
| Rate for Payer: Cash Price |
$208.90
|
| Rate for Payer: Cofinity Commercial |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$224.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.90
|
| Rate for Payer: Healthscope Commercial |
$235.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.95
|
| Rate for Payer: PHP Commercial |
$221.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.73
|
| Rate for Payer: Priority Health SBD |
$164.51
|
| Rate for Payer: UMR Bronson Commercial |
$96.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.84
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$1,014.54
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Aetna American Axle |
$659.45
|
| Rate for Payer: Aetna Commercial |
$862.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.45
|
| Rate for Payer: Cash Price |
$811.63
|
| Rate for Payer: Cofinity Commercial |
$710.18
|
| Rate for Payer: Cofinity Commercial |
$872.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.63
|
| Rate for Payer: Healthscope Commercial |
$913.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$760.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.36
|
| Rate for Payer: PHP Commercial |
$862.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.45
|
| Rate for Payer: Priority Health SBD |
$639.16
|
| Rate for Payer: UMR Bronson Commercial |
$446.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$760.90
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$261.12
|
|
|
Service Code
|
NDC 00185505001
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.89 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Aetna American Axle |
$169.73
|
| Rate for Payer: Aetna Commercial |
$221.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.73
|
| Rate for Payer: Cash Price |
$208.90
|
| Rate for Payer: Cofinity Commercial |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$224.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.90
|
| Rate for Payer: Healthscope Commercial |
$235.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.95
|
| Rate for Payer: PHP Commercial |
$221.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.73
|
| Rate for Payer: Priority Health SBD |
$164.51
|
| Rate for Payer: UMR Bronson Commercial |
$114.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.84
|
|
|
METOLAZONE 2.5 MG TABLET
|
Facility
|
IP
|
$10.15
|
|
|
Service Code
|
NDC 51079002301
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$9.14 |
| Rate for Payer: Aetna American Axle |
$6.60
|
| Rate for Payer: Aetna Commercial |
$8.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.60
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.12
|
| Rate for Payer: Healthscope Commercial |
$9.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.63
|
| Rate for Payer: PHP Commercial |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.60
|
| Rate for Payer: Priority Health SBD |
$6.39
|
| Rate for Payer: UMR Bronson Commercial |
$4.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.61
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$895.40
|
|
|
Service Code
|
NDC 00904713961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.30 |
| Max. Negotiated Rate |
$805.86 |
| Rate for Payer: Aetna American Axle |
$582.01
|
| Rate for Payer: Aetna Commercial |
$761.09
|
| Rate for Payer: Aetna Medicare |
$447.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.01
|
| Rate for Payer: BCBS Complete |
$358.16
|
| Rate for Payer: Cash Price |
$716.32
|
| Rate for Payer: Cofinity Commercial |
$626.78
|
| Rate for Payer: Cofinity Commercial |
$770.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.32
|
| Rate for Payer: Healthscope Commercial |
$805.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.09
|
| Rate for Payer: PHP Commercial |
$761.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.01
|
| Rate for Payer: Priority Health SBD |
$564.10
|
| Rate for Payer: UMR Bronson Commercial |
$331.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.55
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$991.97
|
|
|
Service Code
|
NDC 00904732961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.47 |
| Max. Negotiated Rate |
$892.77 |
| Rate for Payer: Aetna American Axle |
$644.78
|
| Rate for Payer: Aetna Commercial |
$843.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.78
|
| Rate for Payer: Cash Price |
$793.58
|
| Rate for Payer: Cofinity Commercial |
$694.38
|
| Rate for Payer: Cofinity Commercial |
$853.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$694.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.58
|
| Rate for Payer: Healthscope Commercial |
$892.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.17
|
| Rate for Payer: PHP Commercial |
$843.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.78
|
| Rate for Payer: Priority Health SBD |
$624.94
|
| Rate for Payer: UMR Bronson Commercial |
$436.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.98
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$301.44
|
|
|
Service Code
|
NDC 00185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna American Axle |
$195.94
|
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: BCBS Complete |
$120.58
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.94
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UMR Bronson Commercial |
$111.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.08
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$991.97
|
|
|
Service Code
|
NDC 00904732961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.03 |
| Max. Negotiated Rate |
$892.77 |
| Rate for Payer: Aetna American Axle |
$644.78
|
| Rate for Payer: Aetna Commercial |
$843.17
|
| Rate for Payer: Aetna Medicare |
$495.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.78
|
| Rate for Payer: BCBS Complete |
$396.79
|
| Rate for Payer: Cash Price |
$793.58
|
| Rate for Payer: Cofinity Commercial |
$694.38
|
| Rate for Payer: Cofinity Commercial |
$853.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$694.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.58
|
| Rate for Payer: Healthscope Commercial |
$892.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.17
|
| Rate for Payer: PHP Commercial |
$843.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.78
|
| Rate for Payer: Priority Health SBD |
$624.94
|
| Rate for Payer: UMR Bronson Commercial |
$367.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.98
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.24 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna American Axle |
$710.92
|
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.92
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$765.60
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$765.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health SBD |
$689.04
|
| Rate for Payer: UMR Bronson Commercial |
$481.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$895.40
|
|
|
Service Code
|
NDC 00904713961
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.98 |
| Max. Negotiated Rate |
$805.86 |
| Rate for Payer: Aetna American Axle |
$582.01
|
| Rate for Payer: Aetna Commercial |
$761.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.01
|
| Rate for Payer: Cash Price |
$716.32
|
| Rate for Payer: Cofinity Commercial |
$626.78
|
| Rate for Payer: Cofinity Commercial |
$770.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.32
|
| Rate for Payer: Healthscope Commercial |
$805.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.09
|
| Rate for Payer: PHP Commercial |
$761.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.01
|
| Rate for Payer: Priority Health SBD |
$564.10
|
| Rate for Payer: UMR Bronson Commercial |
$393.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.55
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$10.94
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna American Axle |
$7.11
|
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.11
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.20
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$10.94
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna American Axle |
$7.11
|
| Rate for Payer: Aetna Commercial |
$9.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$9.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.11
|
| Rate for Payer: Priority Health SBD |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$4.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.20
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$1,093.72
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.68 |
| Max. Negotiated Rate |
$984.35 |
| Rate for Payer: Aetna American Axle |
$710.92
|
| Rate for Payer: Aetna Commercial |
$929.66
|
| Rate for Payer: Aetna Medicare |
$546.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.92
|
| Rate for Payer: BCBS Complete |
$437.49
|
| Rate for Payer: Cash Price |
$874.98
|
| Rate for Payer: Cofinity Commercial |
$765.60
|
| Rate for Payer: Cofinity Commercial |
$940.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$765.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.98
|
| Rate for Payer: Healthscope Commercial |
$984.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.66
|
| Rate for Payer: PHP Commercial |
$929.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.92
|
| Rate for Payer: Priority Health SBD |
$689.04
|
| Rate for Payer: UMR Bronson Commercial |
$404.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.29
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$301.44
|
|
|
Service Code
|
NDC 00185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna American Axle |
$195.94
|
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.94
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UMR Bronson Commercial |
$132.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.08
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 24979003901
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$316.80
|
|
|
Service Code
|
NDC 00904632461
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.39 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Priority Health SBD |
$199.58
|
| Rate for Payer: UMR Bronson Commercial |
$139.39
|
| Rate for Payer: Aetna American Axle |
$205.92
|
| Rate for Payer: Aetna Commercial |
$269.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.92
|
| Rate for Payer: Cash Price |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$221.76
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$221.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.44
|
| Rate for Payer: Healthscope Commercial |
$285.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.28
|
| Rate for Payer: PHP Commercial |
$269.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.60
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 55111046801
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.51 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$119.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 55111046801
|
| Hospital Charge Code |
30071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
