|
metoprolol succinate 100 mg ER Tab [HMC]
|
Facility
|
IP
|
$7.99
|
|
|
Service Code
|
NDC 60687041365
|
| Hospital Charge Code |
3800832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.59
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 100 mg ER Tab [HMC]
|
Facility
|
OP
|
$7.99
|
|
|
Service Code
|
NDC 60687041365
|
| Hospital Charge Code |
3800832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna Commercial |
$7.19
|
| Rate for Payer: Humana Medicare Advantage |
$3.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.20
|
| Rate for Payer: WPPA Medicare Advantage |
$4.79
|
|
|
metoprolol succinate 100 mg ER Tab [HMC]
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
NDC 60687041301
|
| Hospital Charge Code |
3800832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Humana Medicare Advantage |
$4.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.01
|
| Rate for Payer: WPPA Medicare Advantage |
$6.01
|
|
|
metoprolol succinate 100 mg ER Tab [HMC]
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 00904632461
|
| Hospital Charge Code |
3800832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Humana Medicare Advantage |
$4.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.24
|
| Rate for Payer: WPPA Medicare Advantage |
$6.35
|
|
|
metoprolol succinate 100 mg ER Tab [HMC]
|
Facility
|
OP
|
$9.75
|
|
|
Service Code
|
NDC 45963067711
|
| Hospital Charge Code |
3800832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Humana Medicare Advantage |
$4.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.90
|
| Rate for Payer: WPPA Medicare Advantage |
$5.85
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.78
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Humana Medicare Advantage |
$3.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.51
|
| Rate for Payer: WPPA Medicare Advantage |
$5.27
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Humana Medicare Advantage |
$3.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.49
|
| Rate for Payer: WPPA Medicare Advantage |
$5.23
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$8.78
|
|
|
Service Code
|
NDC 70436020201
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.34
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 00904632206
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Aetna Commercial |
$6.26
|
| Rate for Payer: Humana Medicare Advantage |
$2.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.78
|
| Rate for Payer: WPPA Medicare Advantage |
$4.18
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 00904632206
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.61
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
NDC 00527260037
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.75
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
NDC 60687039065
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.93
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
NDC 70436020202
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Humana Medicare Advantage |
$3.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.46
|
| Rate for Payer: WPPA Medicare Advantage |
$5.20
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.28
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
NDC 00527260037
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Humana Medicare Advantage |
$3.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.26
|
| Rate for Payer: WPPA Medicare Advantage |
$4.90
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
NDC 60687039065
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Humana Medicare Advantage |
$3.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.92
|
| Rate for Payer: WPPA Medicare Advantage |
$4.38
|
|
|
metoprolol succinate 25 mg ER Tab [HMC]
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
NDC 70436020202
|
| Hospital Charge Code |
3809551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.23
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
IP
|
$28.12
|
|
|
Service Code
|
NDC 36000003310
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$25.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.71
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
OP
|
$30.80
|
|
|
Service Code
|
NDC 70860030005
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$29.26 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Humana Medicare Advantage |
$12.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.32
|
| Rate for Payer: WPPA Medicare Advantage |
$18.48
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
NDC 72611074010
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.59
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
OP
|
$26.71
|
|
|
Service Code
|
NDC 00409201610
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Humana Medicare Advantage |
$11.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.68
|
| Rate for Payer: WPPA Medicare Advantage |
$16.03
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
NDC 72611074010
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$24.59 |
| Rate for Payer: Aetna Commercial |
$23.29
|
| Rate for Payer: Humana Medicare Advantage |
$10.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.35
|
| Rate for Payer: WPPA Medicare Advantage |
$15.53
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
OP
|
$28.12
|
|
|
Service Code
|
NDC 36000003310
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$26.71 |
| Rate for Payer: Aetna Commercial |
$25.31
|
| Rate for Payer: Humana Medicare Advantage |
$11.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.25
|
| Rate for Payer: WPPA Medicare Advantage |
$16.87
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
IP
|
$26.71
|
|
|
Service Code
|
NDC 00409201610
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.37
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
metoprolol tartrate 1 mg/mL Inj Sol 5 mL [HMC]
|
Facility
|
IP
|
$30.80
|
|
|
Service Code
|
NDC 70860030005
|
| Hospital Charge Code |
3806243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.26
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|