|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
NDC 7043616601
|
| Hospital Charge Code |
7043616601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Brighton Health Commercial |
$1.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.01
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 6909740815
|
| Hospital Charge Code |
6909740815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Medicare |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 5107917103
|
| Hospital Charge Code |
5107917103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 5107917103
|
| Hospital Charge Code |
5107917103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 5511146801
|
| Hospital Charge Code |
5511146801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Medicare |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 6909740807
|
| Hospital Charge Code |
6909740807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 6068741301
|
| Hospital Charge Code |
6068741301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 5026854215
|
| Hospital Charge Code |
5026854215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 5026854215
|
| Hospital Charge Code |
5026854215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 5026854211
|
| Hospital Charge Code |
5026854211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 6909740815
|
| Hospital Charge Code |
6909740815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 5511146801
|
| Hospital Charge Code |
5511146801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.55
|
|
|
Service Code
|
NDC 7043616601
|
| Hospital Charge Code |
7043616601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
|
|
METOPROLOL SUCCINATE ER 100 MG PO TB24
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 5026854211
|
| Hospital Charge Code |
5026854211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 6787759001
|
| Hospital Charge Code |
6787759001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 4596370911
|
| Hospital Charge Code |
4596370911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: EmblemHealth Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 6787759001
|
| Hospital Charge Code |
6787759001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: EmblemHealth Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 4596370996
|
| Hospital Charge Code |
4596370996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: EmblemHealth Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 4596370911
|
| Hospital Charge Code |
4596370911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 0904632261
|
| Hospital Charge Code |
0904632261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: EmblemHealth Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.81
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 0904632261
|
| Hospital Charge Code |
0904632261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
NDC 5026854011
|
| Hospital Charge Code |
5026854011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.75
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.72
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0904632206
|
| Hospital Charge Code |
0904632206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 4596370996
|
| Hospital Charge Code |
4596370996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
|
|
METOPROLOL SUCCINATE ER 25 MG PO TB24
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0904632206
|
| Hospital Charge Code |
0904632206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
|