Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION

Facility

$290.54

Service Code	NDC 00517037405
Hospital Charge Code	180747
Hospital Revenue Code	250
Min. Negotiated Rate	$114.18
Max. Negotiated Rate	$261.49
Rate for Payer: Aetna Commercial	$246.96
Rate for Payer: Aetna Medicare	$145.27
Rate for Payer: Aetna New Business (MI Preferred)	$188.85
Rate for Payer: BCBS Complete	$116.22
Rate for Payer: Cash Price	$232.43
Rate for Payer: Cofinity Advantage	$203.38
Rate for Payer: Cofinity Commercial	$249.86
Rate for Payer: Encore Health Key Benefits Commercial	$232.43
Rate for Payer: Healthscope Commercial	$261.49
Rate for Payer: MI Amish Medical Board Commercial	$232.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.91
Rate for Payer: PHP Commercial	$246.96
Rate for Payer: Priority Health SBD	$183.04
Rate for Payer: UHC All Payor (Choice/PPO)	$188.85
Rate for Payer: UHC Core	$151.37
Rate for Payer: UHC Exchange	$114.18

METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION

Facility

$290.54

Service Code	NDC 00517037401
Hospital Charge Code	180747
Hospital Revenue Code	250
Min. Negotiated Rate	$183.04
Max. Negotiated Rate	$261.49
Rate for Payer: Aetna Commercial	$246.96
Rate for Payer: Aetna New Business (MI Preferred)	$188.85
Rate for Payer: Cash Price	$232.43
Rate for Payer: Cofinity Advantage	$203.38
Rate for Payer: Cofinity Commercial	$249.86
Rate for Payer: Encore Health Key Benefits Commercial	$232.43
Rate for Payer: Healthscope Commercial	$261.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.91
Rate for Payer: PHP Commercial	$246.96
Rate for Payer: Priority Health SBD	$183.04

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION

Facility

$92.46

Service Code	HCPCS J2210
Hospital Charge Code	10571
Hospital Revenue Code	636
Min. Negotiated Rate	$35.24
Max. Negotiated Rate	$83.21
Rate for Payer: Aetna Commercial	$78.59
Rate for Payer: Aetna Medicare	$46.23
Rate for Payer: Aetna New Business (MI Preferred)	$60.10
Rate for Payer: BCBS Complete	$36.98
Rate for Payer: BCBS Trust/PPO	$53.58
Rate for Payer: BCN Commercial	$53.58
Rate for Payer: Cash Price	$73.97
Rate for Payer: Cash Price	$73.97
Rate for Payer: Cofinity Advantage	$64.72
Rate for Payer: Cofinity Commercial	$79.52
Rate for Payer: Encore Health Key Benefits Commercial	$73.97
Rate for Payer: Healthscope Commercial	$83.21
Rate for Payer: MI Amish Medical Board Commercial	$73.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.34
Rate for Payer: PHP Commercial	$78.59
Rate for Payer: Priority Health SBD	$58.25
Rate for Payer: UHC All Payor (Choice/PPO)	$35.24
Rate for Payer: UHC Core	$35.24
Rate for Payer: UHC Exchange	$35.24

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION

Facility

$92.46

Service Code	HCPCS J2210
Hospital Charge Code	10571
Hospital Revenue Code	636
Min. Negotiated Rate	$58.25
Max. Negotiated Rate	$83.21
Rate for Payer: Aetna Commercial	$78.59
Rate for Payer: Aetna New Business (MI Preferred)	$60.10
Rate for Payer: Cash Price	$73.97
Rate for Payer: Cofinity Advantage	$64.72
Rate for Payer: Cofinity Commercial	$79.52
Rate for Payer: Encore Health Key Benefits Commercial	$73.97
Rate for Payer: Healthscope Commercial	$83.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.34
Rate for Payer: PHP Commercial	$78.59
Rate for Payer: Priority Health SBD	$58.25

METHYLERGONOVINE 0.2 MG TABLET

Facility

$177.98

Service Code	NDC 60687041011
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$112.13
Max. Negotiated Rate	$160.18
Rate for Payer: Aetna Commercial	$151.28
Rate for Payer: Aetna New Business (MI Preferred)	$115.69
Rate for Payer: Cash Price	$142.38
Rate for Payer: Cofinity Advantage	$124.59
Rate for Payer: Cofinity Commercial	$153.06
Rate for Payer: Encore Health Key Benefits Commercial	$142.38
Rate for Payer: Healthscope Commercial	$160.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.49
Rate for Payer: PHP Commercial	$151.28
Rate for Payer: Priority Health SBD	$112.13

METHYLERGONOVINE 0.2 MG TABLET

Facility

$177.98

Service Code	NDC 60687041011
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$69.95
Max. Negotiated Rate	$160.18
Rate for Payer: Aetna Commercial	$151.28
Rate for Payer: Aetna Medicare	$88.99
Rate for Payer: Aetna New Business (MI Preferred)	$115.69
Rate for Payer: BCBS Complete	$71.19
Rate for Payer: Cash Price	$142.38
Rate for Payer: Cofinity Advantage	$124.59
Rate for Payer: Cofinity Commercial	$153.06
Rate for Payer: Encore Health Key Benefits Commercial	$142.38
Rate for Payer: Healthscope Commercial	$160.18
Rate for Payer: MI Amish Medical Board Commercial	$142.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.49
Rate for Payer: PHP Commercial	$151.28
Rate for Payer: Priority Health SBD	$112.13
Rate for Payer: UHC All Payor (Choice/PPO)	$115.69
Rate for Payer: UHC Core	$92.73
Rate for Payer: UHC Exchange	$69.95

METHYLERGONOVINE 0.2 MG TABLET

Facility

$549.19

Service Code	NDC 16571073521
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$345.99
Max. Negotiated Rate	$494.27
Rate for Payer: Aetna Commercial	$466.81
Rate for Payer: Aetna New Business (MI Preferred)	$356.97
Rate for Payer: Cash Price	$439.35
Rate for Payer: Cofinity Advantage	$384.43
Rate for Payer: Cofinity Commercial	$472.30
Rate for Payer: Encore Health Key Benefits Commercial	$439.35
Rate for Payer: Healthscope Commercial	$494.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$466.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.89
Rate for Payer: PHP Commercial	$466.81
Rate for Payer: Priority Health SBD	$345.99

METHYLERGONOVINE 0.2 MG TABLET

Facility

$3,559.48

Service Code	NDC 60687041094
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$1,398.88
Max. Negotiated Rate	$3,203.53
Rate for Payer: Aetna Commercial	$3,025.56
Rate for Payer: Aetna Medicare	$1,779.74
Rate for Payer: Aetna New Business (MI Preferred)	$2,313.66
Rate for Payer: BCBS Complete	$1,423.79
Rate for Payer: Cash Price	$2,847.58
Rate for Payer: Cofinity Advantage	$2,491.64
Rate for Payer: Cofinity Commercial	$3,061.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,847.58
Rate for Payer: Healthscope Commercial	$3,203.53
Rate for Payer: MI Amish Medical Board Commercial	$2,847.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,025.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,669.61
Rate for Payer: PHP Commercial	$3,025.56
Rate for Payer: Priority Health SBD	$2,242.47
Rate for Payer: UHC All Payor (Choice/PPO)	$2,313.66
Rate for Payer: UHC Core	$1,854.49
Rate for Payer: UHC Exchange	$1,398.88

METHYLERGONOVINE 0.2 MG TABLET

Facility

$681.32

Service Code	NDC 69238160502
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$267.76
Max. Negotiated Rate	$613.19
Rate for Payer: Aetna Commercial	$579.12
Rate for Payer: Aetna Medicare	$340.66
Rate for Payer: Aetna New Business (MI Preferred)	$442.86
Rate for Payer: BCBS Complete	$272.53
Rate for Payer: Cash Price	$545.06
Rate for Payer: Cofinity Advantage	$476.92
Rate for Payer: Cofinity Commercial	$585.94
Rate for Payer: Encore Health Key Benefits Commercial	$545.06
Rate for Payer: Healthscope Commercial	$613.19
Rate for Payer: MI Amish Medical Board Commercial	$545.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$579.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$510.99
Rate for Payer: PHP Commercial	$579.12
Rate for Payer: Priority Health SBD	$429.23
Rate for Payer: UHC All Payor (Choice/PPO)	$442.86
Rate for Payer: UHC Core	$354.97
Rate for Payer: UHC Exchange	$267.76

METHYLERGONOVINE 0.2 MG TABLET

Facility

$549.19

Service Code	NDC 16571073521
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$215.83
Max. Negotiated Rate	$494.27
Rate for Payer: Aetna Commercial	$466.81
Rate for Payer: Aetna Medicare	$274.60
Rate for Payer: Aetna New Business (MI Preferred)	$356.97
Rate for Payer: BCBS Complete	$219.68
Rate for Payer: Cash Price	$439.35
Rate for Payer: Cofinity Advantage	$384.43
Rate for Payer: Cofinity Commercial	$472.30
Rate for Payer: Encore Health Key Benefits Commercial	$439.35
Rate for Payer: Healthscope Commercial	$494.27
Rate for Payer: MI Amish Medical Board Commercial	$439.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$466.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.89
Rate for Payer: PHP Commercial	$466.81
Rate for Payer: Priority Health SBD	$345.99
Rate for Payer: UHC All Payor (Choice/PPO)	$356.97
Rate for Payer: UHC Core	$286.13
Rate for Payer: UHC Exchange	$215.83

METHYLERGONOVINE 0.2 MG TABLET

Facility

$681.32

Service Code	NDC 69238160502
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$429.23
Max. Negotiated Rate	$613.19
Rate for Payer: Aetna Commercial	$579.12
Rate for Payer: Aetna New Business (MI Preferred)	$442.86
Rate for Payer: Cash Price	$545.06
Rate for Payer: Cofinity Advantage	$476.92
Rate for Payer: Cofinity Commercial	$585.94
Rate for Payer: Encore Health Key Benefits Commercial	$545.06
Rate for Payer: Healthscope Commercial	$613.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$579.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$510.99
Rate for Payer: PHP Commercial	$579.12
Rate for Payer: Priority Health SBD	$429.23

METHYLERGONOVINE 0.2 MG TABLET

Facility

$3,559.48

Service Code	NDC 60687041094
Hospital Charge Code	10572
Hospital Revenue Code	637
Min. Negotiated Rate	$2,242.47
Max. Negotiated Rate	$3,203.53
Rate for Payer: Aetna Commercial	$3,025.56
Rate for Payer: Aetna New Business (MI Preferred)	$2,313.66
Rate for Payer: Cash Price	$2,847.58
Rate for Payer: Cofinity Advantage	$2,491.64
Rate for Payer: Cofinity Commercial	$3,061.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,847.58
Rate for Payer: Healthscope Commercial	$3,203.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,025.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,669.61
Rate for Payer: PHP Commercial	$3,025.56
Rate for Payer: Priority Health SBD	$2,242.47

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION

Facility

$616.53

Service Code	HCPCS J2212
Hospital Charge Code	91651
Hospital Revenue Code	636
Min. Negotiated Rate	$388.41
Max. Negotiated Rate	$554.88
Rate for Payer: Aetna Commercial	$524.05
Rate for Payer: Aetna New Business (MI Preferred)	$400.74
Rate for Payer: Cash Price	$493.22
Rate for Payer: Cofinity Advantage	$431.57
Rate for Payer: Cofinity Commercial	$530.22
Rate for Payer: Encore Health Key Benefits Commercial	$493.22
Rate for Payer: Healthscope Commercial	$554.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$524.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$462.40
Rate for Payer: PHP Commercial	$524.05
Rate for Payer: Priority Health SBD	$388.41

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION

Facility

$616.53

Service Code	HCPCS J2212
Hospital Charge Code	91651
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$554.88
Rate for Payer: Aetna Commercial	$524.05
Rate for Payer: Aetna Medicare	$308.26
Rate for Payer: Aetna New Business (MI Preferred)	$400.74
Rate for Payer: BCBS Complete	$246.61
Rate for Payer: BCBS Trust/PPO	$4.24
Rate for Payer: BCN Commercial	$4.24
Rate for Payer: Cash Price	$493.22
Rate for Payer: Cash Price	$493.22
Rate for Payer: Cofinity Advantage	$431.57
Rate for Payer: Cofinity Commercial	$530.22
Rate for Payer: Encore Health Key Benefits Commercial	$493.22
Rate for Payer: Healthscope Commercial	$554.88
Rate for Payer: MI Amish Medical Board Commercial	$493.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$524.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$462.40
Rate for Payer: PHP Commercial	$524.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1.65
Rate for Payer: Priority Health SBD	$388.41
Rate for Payer: Priority Health Tiered Network	$1.32
Rate for Payer: UHC All Payor (Choice/PPO)	$3.47
Rate for Payer: UHC Core	$3.47
Rate for Payer: UHC Exchange	$3.47

METHYLPHENIDATE 10 MG TABLET

Facility

$456.75

Service Code	NDC 00406114401
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$287.75
Max. Negotiated Rate	$411.07
Rate for Payer: Aetna Commercial	$388.24
Rate for Payer: Aetna New Business (MI Preferred)	$296.89
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cofinity Advantage	$319.73
Rate for Payer: Cofinity Commercial	$392.81
Rate for Payer: Encore Health Key Benefits Commercial	$365.40
Rate for Payer: Healthscope Commercial	$411.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$388.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.56
Rate for Payer: PHP Commercial	$388.24
Rate for Payer: Priority Health SBD	$287.75

METHYLPHENIDATE 10 MG TABLET

Facility

$348.60

Service Code	NDC 68084082321
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$219.62
Max. Negotiated Rate	$313.74
Rate for Payer: Aetna Commercial	$296.31
Rate for Payer: Aetna New Business (MI Preferred)	$226.59
Rate for Payer: Cash Price	$278.88
Rate for Payer: Cofinity Advantage	$244.02
Rate for Payer: Cofinity Commercial	$299.80
Rate for Payer: Encore Health Key Benefits Commercial	$278.88
Rate for Payer: Healthscope Commercial	$313.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$261.45
Rate for Payer: PHP Commercial	$296.31
Rate for Payer: Priority Health SBD	$219.62

METHYLPHENIDATE 10 MG TABLET

Facility

$453.25

Service Code	NDC 16729047901
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$178.13
Max. Negotiated Rate	$407.93
Rate for Payer: Aetna Commercial	$385.26
Rate for Payer: Aetna Medicare	$226.62
Rate for Payer: Aetna New Business (MI Preferred)	$294.61
Rate for Payer: BCBS Complete	$181.30
Rate for Payer: Cash Price	$362.60
Rate for Payer: Cofinity Advantage	$317.27
Rate for Payer: Cofinity Commercial	$389.80
Rate for Payer: Encore Health Key Benefits Commercial	$362.60
Rate for Payer: Healthscope Commercial	$407.93
Rate for Payer: MI Amish Medical Board Commercial	$362.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.94
Rate for Payer: PHP Commercial	$385.26
Rate for Payer: Priority Health SBD	$285.55
Rate for Payer: UHC All Payor (Choice/PPO)	$294.61
Rate for Payer: UHC Core	$236.14
Rate for Payer: UHC Exchange	$178.13

METHYLPHENIDATE 10 MG TABLET

Facility

$456.75

Service Code	NDC 00406114401
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$179.50
Max. Negotiated Rate	$411.07
Rate for Payer: Aetna Commercial	$388.24
Rate for Payer: Aetna Medicare	$228.38
Rate for Payer: Aetna New Business (MI Preferred)	$296.89
Rate for Payer: BCBS Complete	$182.70
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cofinity Advantage	$319.73
Rate for Payer: Cofinity Commercial	$392.81
Rate for Payer: Encore Health Key Benefits Commercial	$365.40
Rate for Payer: Healthscope Commercial	$411.07
Rate for Payer: MI Amish Medical Board Commercial	$365.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$388.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.56
Rate for Payer: PHP Commercial	$388.24
Rate for Payer: Priority Health SBD	$287.75
Rate for Payer: UHC All Payor (Choice/PPO)	$296.89
Rate for Payer: UHC Core	$237.97
Rate for Payer: UHC Exchange	$179.50

METHYLPHENIDATE 10 MG TABLET

Facility

$348.60

Service Code	NDC 68084082321
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$313.74
Rate for Payer: Aetna Commercial	$296.31
Rate for Payer: Aetna Medicare	$174.30
Rate for Payer: Aetna New Business (MI Preferred)	$226.59
Rate for Payer: BCBS Complete	$139.44
Rate for Payer: Cash Price	$278.88
Rate for Payer: Cofinity Advantage	$244.02
Rate for Payer: Cofinity Commercial	$299.80
Rate for Payer: Encore Health Key Benefits Commercial	$278.88
Rate for Payer: Healthscope Commercial	$313.74
Rate for Payer: MI Amish Medical Board Commercial	$278.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$261.45
Rate for Payer: PHP Commercial	$296.31
Rate for Payer: Priority Health SBD	$219.62
Rate for Payer: UHC All Payor (Choice/PPO)	$226.59
Rate for Payer: UHC Core	$181.62
Rate for Payer: UHC Exchange	$137.00

METHYLPHENIDATE 10 MG TABLET

Facility

$453.25

Service Code	NDC 16729047901
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$285.55
Max. Negotiated Rate	$407.93
Rate for Payer: Aetna Commercial	$385.26
Rate for Payer: Aetna New Business (MI Preferred)	$294.61
Rate for Payer: Cash Price	$362.60
Rate for Payer: Cofinity Advantage	$317.27
Rate for Payer: Cofinity Commercial	$389.80
Rate for Payer: Encore Health Key Benefits Commercial	$362.60
Rate for Payer: Healthscope Commercial	$407.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.94
Rate for Payer: PHP Commercial	$385.26
Rate for Payer: Priority Health SBD	$285.55

METHYLPHENIDATE 10 MG TABLET

Facility

$456.75

Service Code	NDC 31722017401
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$179.50
Max. Negotiated Rate	$411.07
Rate for Payer: Aetna Commercial	$388.24
Rate for Payer: Aetna Medicare	$228.38
Rate for Payer: Aetna New Business (MI Preferred)	$296.89
Rate for Payer: BCBS Complete	$182.70
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cofinity Advantage	$319.73
Rate for Payer: Cofinity Commercial	$392.81
Rate for Payer: Encore Health Key Benefits Commercial	$365.40
Rate for Payer: Healthscope Commercial	$411.07
Rate for Payer: MI Amish Medical Board Commercial	$365.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$388.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.56
Rate for Payer: PHP Commercial	$388.24
Rate for Payer: Priority Health SBD	$287.75
Rate for Payer: UHC All Payor (Choice/PPO)	$296.89
Rate for Payer: UHC Core	$237.97
Rate for Payer: UHC Exchange	$179.50

METHYLPHENIDATE 10 MG TABLET

Facility

$11.62

Service Code	NDC 68084082311
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$10.46
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare	$5.81
Rate for Payer: Aetna New Business (MI Preferred)	$7.55
Rate for Payer: BCBS Complete	$4.65
Rate for Payer: Cash Price	$9.30
Rate for Payer: Cofinity Advantage	$8.13
Rate for Payer: Cofinity Commercial	$9.99
Rate for Payer: Encore Health Key Benefits Commercial	$9.30
Rate for Payer: Healthscope Commercial	$10.46
Rate for Payer: MI Amish Medical Board Commercial	$9.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.71
Rate for Payer: PHP Commercial	$9.88
Rate for Payer: Priority Health SBD	$7.32
Rate for Payer: UHC All Payor (Choice/PPO)	$7.55
Rate for Payer: UHC Core	$6.05
Rate for Payer: UHC Exchange	$4.57

METHYLPHENIDATE 10 MG TABLET

Facility

$456.75

Service Code	NDC 31722017401
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$287.75
Max. Negotiated Rate	$411.07
Rate for Payer: Aetna Commercial	$388.24
Rate for Payer: Aetna New Business (MI Preferred)	$296.89
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cofinity Advantage	$319.73
Rate for Payer: Cofinity Commercial	$392.81
Rate for Payer: Encore Health Key Benefits Commercial	$365.40
Rate for Payer: Healthscope Commercial	$411.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$388.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.56
Rate for Payer: PHP Commercial	$388.24
Rate for Payer: Priority Health SBD	$287.75

METHYLPHENIDATE 10 MG TABLET

Facility

$11.62

Service Code	NDC 68084082311
Hospital Charge Code	4986
Hospital Revenue Code	637
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$10.46
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna New Business (MI Preferred)	$7.55
Rate for Payer: Cash Price	$9.30
Rate for Payer: Cofinity Advantage	$8.13
Rate for Payer: Cofinity Commercial	$9.99
Rate for Payer: Encore Health Key Benefits Commercial	$9.30
Rate for Payer: Healthscope Commercial	$10.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.71
Rate for Payer: PHP Commercial	$9.88
Rate for Payer: Priority Health SBD	$7.32

METHYLPHENIDATE 5 MG TABLET

Facility

$295.78

Service Code	NDC 68084080521
Hospital Charge Code	4988
Hospital Revenue Code	637
Min. Negotiated Rate	$186.34
Max. Negotiated Rate	$266.20
Rate for Payer: Aetna Commercial	$251.41
Rate for Payer: Aetna New Business (MI Preferred)	$192.26
Rate for Payer: Cash Price	$236.62
Rate for Payer: Cofinity Advantage	$207.05
Rate for Payer: Cofinity Commercial	$254.37
Rate for Payer: Encore Health Key Benefits Commercial	$236.62
Rate for Payer: Healthscope Commercial	$266.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$251.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$221.84
Rate for Payer: PHP Commercial	$251.41
Rate for Payer: Priority Health SBD	$186.34

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