|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 62584-265-11
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$136.65
|
| Rate for Payer: BCN Commercial |
$136.65
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$176.25
|
| Rate for Payer: Healthscope Whirlpool |
$170.96
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$1.36
|
|
|
Service Code
|
NDC 51079-255-01
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: ASR ASR |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$1.05
|
| Rate for Payer: BCN Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$1.36
|
| Rate for Payer: Healthscope Whirlpool |
$1.32
|
| Rate for Payer: Mclaren Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.20
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 51079-255-20
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.41 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$122.67
|
| Rate for Payer: ASR ASR |
$132.21
|
| Rate for Payer: BCBS Trust/PPO |
$105.67
|
| Rate for Payer: BCN Commercial |
$105.67
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$128.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Healthscope Whirlpool |
$132.21
|
| Rate for Payer: Mclaren Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.94
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 62584-266-01
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: BCBS Trust/PPO |
$174.91
|
| Rate for Payer: BCN Commercial |
$174.91
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$218.83
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 0378-0032-01
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.67 |
| Max. Negotiated Rate |
$108.10 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: ASR ASR |
$104.86
|
| Rate for Payer: BCBS Trust/PPO |
$83.81
|
| Rate for Payer: BCN Commercial |
$83.81
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$101.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$108.10
|
| Rate for Payer: Healthscope Whirlpool |
$104.86
|
| Rate for Payer: Mclaren Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 62332-113-31
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: ASR ASR |
$54.71
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$53.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$56.40
|
| Rate for Payer: Healthscope Whirlpool |
$54.71
|
| Rate for Payer: Mclaren Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.63
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 62584-266-11
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: BCBS Trust/PPO |
$174.91
|
| Rate for Payer: BCN Commercial |
$174.91
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$218.83
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 51079-801-01
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: ASR ASR |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.69
|
| Rate for Payer: Healthscope Whirlpool |
$1.64
|
| Rate for Payer: Mclaren Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.49
|
|
|
METOPROLOL TARTRATE 50 MG TABLET
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 0904-7118-61
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: BCBS Trust/PPO |
$127.54
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.29
|
|
|
Service Code
|
NDC 70860-300-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: Aetna Commercial |
$21.86
|
| Rate for Payer: ASR ASR |
$23.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.83
|
| Rate for Payer: BCN Commercial |
$18.83
|
| Rate for Payer: Cash Price |
$19.43
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.43
|
| Rate for Payer: Healthscope Commercial |
$24.29
|
| Rate for Payer: Healthscope Whirlpool |
$23.56
|
| Rate for Payer: Mclaren Commercial |
$21.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.38
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
NDC 0409-2016-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: ASR ASR |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$13.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Mclaren Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.99
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 0143-9660-01
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: ASR ASR |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.19
|
| Rate for Payer: Mclaren Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.69
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
NDC 0409-2016-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: ASR ASR |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$13.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Mclaren Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.99
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.12
|
|
|
Service Code
|
NDC 47781-587-20
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: ASR ASR |
$13.70
|
| Rate for Payer: BCBS Trust/PPO |
$10.95
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Whirlpool |
$13.70
|
| Rate for Payer: Mclaren Commercial |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.43
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 0143-9660-10
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: ASR ASR |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.19
|
| Rate for Payer: Mclaren Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.69
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
NDC 0409-1778-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: ASR ASR |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cofinity Commercial |
$12.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$13.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Mclaren Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.99
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.12
|
|
|
Service Code
|
NDC 47781-587-17
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: ASR ASR |
$13.70
|
| Rate for Payer: BCBS Trust/PPO |
$10.95
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.30
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Whirlpool |
$13.70
|
| Rate for Payer: Mclaren Commercial |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.43
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.94
|
|
|
Service Code
|
NDC 63323-660-05
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$19.94 |
| Rate for Payer: Aetna Commercial |
$17.95
|
| Rate for Payer: ASR ASR |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$18.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$19.94
|
| Rate for Payer: Healthscope Whirlpool |
$19.34
|
| Rate for Payer: Mclaren Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.55
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$6.98
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: ASR ASR |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.65
|
| Rate for Payer: BCN Commercial |
$5.58
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: BCN Commercial |
$4.65
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Healthscope Whirlpool |
$5.82
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Healthscope Whirlpool |
$6.98
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Mclaren Commercial |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.28
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$211.38
|
|
|
Service Code
|
NDC 50268-535-15
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$211.38 |
| Rate for Payer: Aetna Commercial |
$190.24
|
| Rate for Payer: ASR ASR |
$205.04
|
| Rate for Payer: BCBS Trust/PPO |
$163.88
|
| Rate for Payer: BCN Commercial |
$163.88
|
| Rate for Payer: Cash Price |
$169.10
|
| Rate for Payer: Cofinity Commercial |
$198.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.10
|
| Rate for Payer: Healthscope Commercial |
$211.38
|
| Rate for Payer: Healthscope Whirlpool |
$205.04
|
| Rate for Payer: Mclaren Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.01
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50268-535-11
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: ASR ASR |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.28
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Healthscope Whirlpool |
$4.10
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
|
|
METRONIDAZOLE 500 MG TABLET
|
Facility
|
IP
|
$438.90
|
|
|
Service Code
|
NDC 0904-7126-61
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: ASR ASR |
$425.73
|
| Rate for Payer: BCBS Trust/PPO |
$340.28
|
| Rate for Payer: BCN Commercial |
$340.28
|
| Rate for Payer: Cash Price |
$351.12
|
| Rate for Payer: Cofinity Commercial |
$412.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.12
|
| Rate for Payer: Healthscope Commercial |
$438.90
|
| Rate for Payer: Healthscope Whirlpool |
$425.73
|
| Rate for Payer: Mclaren Commercial |
$395.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.23
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.07
|
|
|
Service Code
|
NDC 61269-735-56
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: ASR ASR |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$7.03
|
| Rate for Payer: BCN Commercial |
$7.03
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Healthscope Whirlpool |
$8.80
|
| Rate for Payer: Mclaren Commercial |
$8.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$18.09
|
|
|
Service Code
|
NDC 51672-2001-2
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Aetna Commercial |
$16.28
|
| Rate for Payer: ASR ASR |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.03
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.47
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Whirlpool |
$17.55
|
| Rate for Payer: Mclaren Commercial |
$16.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.92
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$23.91
|
|
|
Service Code
|
NDC 43553-0003-2
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$18.54
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$23.19
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
