|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 60687063111
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: ASR ASR |
$2.54
|
| Rate for Payer: ASR Commercial |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.03
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Whirlpool |
$2.54
|
| Rate for Payer: Mclaren Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.31
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: ASR ASR |
$10.60
|
| Rate for Payer: ASR ASR |
$16.23
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: ASR ASR |
$16.32
|
| Rate for Payer: ASR Commercial |
$16.23
|
| Rate for Payer: ASR Commercial |
$16.32
|
| Rate for Payer: ASR Commercial |
$14.69
|
| Rate for Payer: ASR Commercial |
$10.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.71
|
| Rate for Payer: BCBS Trust/PPO |
$8.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: BCN Commercial |
$8.47
|
| Rate for Payer: BCN Commercial |
$12.97
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$10.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$16.73
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Whirlpool |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$14.69
|
| Rate for Payer: Healthscope Whirlpool |
$16.23
|
| Rate for Payer: Healthscope Whirlpool |
$10.60
|
| Rate for Payer: Mclaren Commercial |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$9.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.29
|
| Rate for Payer: Nomi Health Commercial |
$8.96
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.72
|
| Rate for Payer: Nomi Health Commercial |
$12.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.62
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.82
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: ASR ASR |
$10.60
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: ASR ASR |
$16.23
|
| Rate for Payer: ASR ASR |
$16.32
|
| Rate for Payer: ASR Commercial |
$10.60
|
| Rate for Payer: ASR Commercial |
$16.23
|
| Rate for Payer: ASR Commercial |
$16.32
|
| Rate for Payer: ASR Commercial |
$14.69
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.70
|
| Rate for Payer: BCN Commercial |
$8.47
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: BCN Commercial |
$12.97
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$10.27
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$16.73
|
| Rate for Payer: Healthscope Whirlpool |
$14.69
|
| Rate for Payer: Healthscope Whirlpool |
$10.60
|
| Rate for Payer: Healthscope Whirlpool |
$16.23
|
| Rate for Payer: Healthscope Whirlpool |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$9.84
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$12.41
|
| Rate for Payer: Nomi Health Commercial |
$13.72
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$10.94
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Aetna Commercial |
$9.85
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: ASR ASR |
$10.61
|
| Rate for Payer: ASR Commercial |
$10.61
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.59
|
| Rate for Payer: Priority Health Narrow Network |
$7.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.63
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$301.44
|
|
|
Service Code
|
NDC 00185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.94 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$271.30
|
| Rate for Payer: ASR ASR |
$292.40
|
| Rate for Payer: ASR Commercial |
$292.40
|
| Rate for Payer: BCBS Trust/PPO |
$245.64
|
| Rate for Payer: BCN Commercial |
$233.71
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$301.44
|
| Rate for Payer: Healthscope Whirlpool |
$292.40
|
| Rate for Payer: Mclaren Commercial |
$271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Nomi Health Commercial |
$247.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.27
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
IP
|
$10.94
|
|
|
Service Code
|
NDC 51079002401
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Aetna Commercial |
$9.85
|
| Rate for Payer: ASR ASR |
$10.61
|
| Rate for Payer: ASR Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.92
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Cofinity Commercial |
$10.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.30
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.63
|
|
|
METOLAZONE 5 MG TABLET
|
Facility
|
OP
|
$301.44
|
|
|
Service Code
|
NDC 00185005501
|
| Hospital Charge Code |
10588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.58 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$271.30
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: ASR ASR |
$292.40
|
| Rate for Payer: ASR Commercial |
$292.40
|
| Rate for Payer: BCBS Complete |
$120.58
|
| Rate for Payer: BCBS Trust/PPO |
$246.85
|
| Rate for Payer: BCN Commercial |
$233.71
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Commercial |
$283.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$301.44
|
| Rate for Payer: Healthscope Whirlpool |
$292.40
|
| Rate for Payer: Mclaren Commercial |
$271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Nomi Health Commercial |
$247.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.12
|
| Rate for Payer: Priority Health Narrow Network |
$211.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.27
|
|
|
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 |
$148.58 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna Medicare |
$185.72
|
| Rate for Payer: ASR ASR |
$360.31
|
| Rate for Payer: ASR Commercial |
$360.31
|
| Rate for Payer: BCBS Complete |
$148.58
|
| Rate for Payer: BCBS Trust/PPO |
$304.18
|
| Rate for Payer: BCN Commercial |
$287.99
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Healthscope Commercial |
$371.45
|
| Rate for Payer: Healthscope Whirlpool |
$360.31
|
| Rate for Payer: Mclaren Commercial |
$334.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.46
|
| Rate for Payer: Priority Health Narrow Network |
$260.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.88
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
NDC 50742061510
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.32
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: ASR Commercial |
$148.17
|
| Rate for Payer: BCBS Trust/PPO |
$124.48
|
| Rate for Payer: BCN Commercial |
$118.43
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$152.75
|
| Rate for Payer: Healthscope Whirlpool |
$148.17
|
| Rate for Payer: Mclaren Commercial |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: ASR Commercial |
$148.17
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.09
|
| Rate for Payer: BCN Commercial |
$118.43
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$152.75
|
| Rate for Payer: Healthscope Whirlpool |
$148.17
|
| Rate for Payer: Mclaren Commercial |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
NDC 50742061510
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$958.80 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Aetna Medicare |
$1,198.50
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Complete |
$958.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.90
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,100.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,680.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
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 |
$371.45 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: ASR ASR |
$360.31
|
| Rate for Payer: ASR Commercial |
$360.31
|
| Rate for Payer: BCBS Trust/PPO |
$302.69
|
| Rate for Payer: BCN Commercial |
$287.99
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Healthscope Commercial |
$371.45
|
| Rate for Payer: Healthscope Whirlpool |
$360.31
|
| Rate for Payer: Mclaren Commercial |
$334.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.88
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$411.35
|
|
|
Service Code
|
NDC 51079017020
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.54 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna Commercial |
$370.22
|
| Rate for Payer: Aetna Medicare |
$205.68
|
| Rate for Payer: ASR ASR |
$399.01
|
| Rate for Payer: ASR Commercial |
$399.01
|
| Rate for Payer: BCBS Complete |
$164.54
|
| Rate for Payer: BCBS Trust/PPO |
$336.85
|
| Rate for Payer: BCN Commercial |
$318.92
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$386.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$411.35
|
| Rate for Payer: Healthscope Whirlpool |
$399.01
|
| Rate for Payer: Mclaren Commercial |
$370.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Nomi Health Commercial |
$337.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.42
|
| Rate for Payer: Priority Health Narrow Network |
$288.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.99
|
|
|
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 |
$372.40 |
| Rate for Payer: Aetna Commercial |
$335.16
|
| Rate for Payer: ASR ASR |
$361.23
|
| Rate for Payer: ASR Commercial |
$361.23
|
| Rate for Payer: BCBS Trust/PPO |
$303.47
|
| Rate for Payer: BCN Commercial |
$288.72
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$350.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$372.40
|
| Rate for Payer: Healthscope Whirlpool |
$361.23
|
| Rate for Payer: Mclaren Commercial |
$335.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.71
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 51079017001
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: ASR ASR |
$3.99
|
| Rate for Payer: ASR Commercial |
$3.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: Healthscope Whirlpool |
$3.99
|
| Rate for Payer: Mclaren Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.62
|
|
|
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 |
$148.96 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Aetna Commercial |
$335.16
|
| Rate for Payer: Aetna Medicare |
$186.20
|
| Rate for Payer: ASR ASR |
$361.23
|
| Rate for Payer: ASR Commercial |
$361.23
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: BCBS Trust/PPO |
$304.96
|
| Rate for Payer: BCN Commercial |
$288.72
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$350.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$372.40
|
| Rate for Payer: Healthscope Whirlpool |
$361.23
|
| Rate for Payer: Mclaren Commercial |
$335.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.30
|
| Rate for Payer: Priority Health Narrow Network |
$261.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.71
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$411.35
|
|
|
Service Code
|
NDC 51079017020
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.38 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna Commercial |
$370.22
|
| Rate for Payer: ASR ASR |
$399.01
|
| Rate for Payer: ASR Commercial |
$399.01
|
| Rate for Payer: BCBS Trust/PPO |
$335.21
|
| Rate for Payer: BCN Commercial |
$318.92
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$386.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$411.35
|
| Rate for Payer: Healthscope Whirlpool |
$399.01
|
| Rate for Payer: Mclaren Commercial |
$370.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Nomi Health Commercial |
$337.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.99
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 51079017001
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: ASR ASR |
$3.99
|
| Rate for Payer: ASR Commercial |
$3.99
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: Healthscope Whirlpool |
$3.99
|
| Rate for Payer: Mclaren Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.60
|
| Rate for Payer: Priority Health Narrow Network |
$2.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.62
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
NDC 51079025501
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna Commercial |
$1.55
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: ASR ASR |
$1.67
|
| Rate for Payer: ASR Commercial |
$1.67
|
| Rate for Payer: BCBS Complete |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.41
|
| Rate for Payer: BCN Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.38
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Healthscope Whirlpool |
$1.67
|
| Rate for Payer: Mclaren Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.46
|
| Rate for Payer: Nomi Health Commercial |
$1.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.51
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
NDC 51079025501
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna Commercial |
$1.55
|
| Rate for Payer: ASR ASR |
$1.67
|
| Rate for Payer: ASR Commercial |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.38
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Healthscope Whirlpool |
$1.67
|
| Rate for Payer: Mclaren Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.46
|
| Rate for Payer: Nomi Health Commercial |
$1.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.51
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 62584026511
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: Aetna Medicare |
$95.18
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$155.88
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 62584026511
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
METOPROLOL TARTRATE 25 MG TABLET
|
Facility
|
OP
|
$171.55
|
|
|
Service Code
|
NDC 51079025520
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$171.55 |
| Rate for Payer: Aetna Commercial |
$154.40
|
| Rate for Payer: Aetna Medicare |
$85.78
|
| Rate for Payer: ASR ASR |
$166.40
|
| Rate for Payer: ASR Commercial |
$166.40
|
| Rate for Payer: BCBS Complete |
$68.62
|
| Rate for Payer: BCBS Trust/PPO |
$140.48
|
| Rate for Payer: BCN Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$171.55
|
| Rate for Payer: Healthscope Whirlpool |
$166.40
|
| Rate for Payer: Mclaren Commercial |
$154.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Nomi Health Commercial |
$140.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.31
|
| Rate for Payer: Priority Health Narrow Network |
$120.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.96
|
|
