|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$46.79
|
|
|
Service Code
|
NDC 60687-408-95
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.16
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$42.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: PHP Commercial |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.18
|
| Rate for Payer: UHC Core |
$39.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.09
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,403.49
|
|
|
Service Code
|
NDC 60687-408-25
|
| Hospital Charge Code |
96949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$855.99 |
| Max. Negotiated Rate |
$1,263.14 |
| Rate for Payer: Aetna Commercial |
$1,192.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.62
|
| Rate for Payer: BCN Commercial |
$1,084.62
|
| Rate for Payer: Cash Price |
$1,122.79
|
| Rate for Payer: Cofinity Commercial |
$1,207.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,122.79
|
| Rate for Payer: Healthscope Commercial |
$1,263.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,052.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,192.97
|
| Rate for Payer: PHP Commercial |
$1,192.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,221.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,235.07
|
| Rate for Payer: UHC Core |
$1,171.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,052.62
|
|
|
METATARSECTOMY
|
Facility
|
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 70010-063-01
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.69
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.96
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$256.15
|
|
|
Service Code
|
NDC 60687-155-01
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$230.54 |
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: BCBS Trust/PPO |
$197.95
|
| Rate for Payer: BCN Commercial |
$197.95
|
| Rate for Payer: Cash Price |
$204.92
|
| Rate for Payer: Cofinity Commercial |
$220.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.92
|
| Rate for Payer: Healthscope Commercial |
$230.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.73
|
| Rate for Payer: PHP Commercial |
$217.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.41
|
| Rate for Payer: UHC Core |
$213.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.11
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 60687-155-11
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 0904-7162-61
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$107.15
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 0904-6689-61
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.40
|
| Rate for Payer: UHC Core |
$98.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
METFORMIN 850 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 0904-7163-61
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.06 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: BCBS Trust/PPO |
$297.84
|
| Rate for Payer: BCN Commercial |
$297.84
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
METFORMIN 850 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 0904-6690-61
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.42 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: BCBS Trust/PPO |
$274.23
|
| Rate for Payer: BCN Commercial |
$274.23
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.27
|
| Rate for Payer: UHC Core |
$296.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
METFORMIN 850 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 60687-143-11
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
METFORMIN 850 MG TABLET
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
NDC 60687-143-01
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: BCBS Trust/PPO |
$326.89
|
| Rate for Payer: BCN Commercial |
$326.89
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$363.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.40
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.55
|
| Rate for Payer: PHP Commercial |
$359.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.24
|
| Rate for Payer: UHC Core |
$353.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.25
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 62756-142-01
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$171.32 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$147.10
|
| Rate for Payer: BCN Commercial |
$147.10
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.80
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.51
|
| Rate for Payer: UHC Core |
$158.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 60687-640-11
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.15
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.78
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 60687-640-01
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.97 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.92
|
| Rate for Payer: BCBS Trust/PPO |
$286.32
|
| Rate for Payer: BCN Commercial |
$286.32
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.92
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
NDC 9900-0000-10
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: BCBS Trust/PPO |
$34.03
|
| Rate for Payer: BCN Commercial |
$34.03
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.22
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.43
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.75
|
| Rate for Payer: UHC Core |
$36.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.02
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$131.88
|
|
|
Service Code
|
NDC 0527-1927-36
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.43 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$101.92
|
| Rate for Payer: BCN Commercial |
$101.92
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cofinity Commercial |
$113.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.50
|
| Rate for Payer: Healthscope Commercial |
$118.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.10
|
| Rate for Payer: PHP Commercial |
$112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.05
|
| Rate for Payer: UHC Core |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.91
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
NDC 0406-5771-62
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.89 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: BCBS Trust/PPO |
$319.17
|
| Rate for Payer: BCN Commercial |
$319.17
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$355.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.40
|
| Rate for Payer: Healthscope Commercial |
$371.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.05
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.44
|
| Rate for Payer: UHC Core |
$344.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 0406-5771-23
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 60687-370-11
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 23155-071-01
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.02 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$230.64
|
| Rate for Payer: BCN Commercial |
$230.64
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 60687-370-01
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: BCBS Trust/PPO |
$194.00
|
| Rate for Payer: BCN Commercial |
$194.00
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687-357-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: BCBS Trust/PPO |
$265.03
|
| Rate for Payer: BCN Commercial |
$265.03
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$308.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.51
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.80
|
| Rate for Payer: UHC Core |
$286.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687-357-11
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 23155-070-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$116.23
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.35
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
