|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
NDC 09900001004
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.52
|
| Rate for Payer: BCBS Complete |
$0.31
|
| Rate for Payer: BCBS MAPPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.41
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Mclaren Medicaid |
$0.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.43
|
| Rate for Payer: Meridian Medicaid |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Nomi Health Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.39
|
| Rate for Payer: PACE SWMI |
$0.41
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: PHP Medicare Advantage |
$0.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$0.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicaid |
$0.29
|
| Rate for Payer: UHC Medicare Advantage |
$0.41
|
| Rate for Payer: UHCCP Medicaid |
$0.29
|
| Rate for Payer: VA VA |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
NDC 09900000010
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: BCBS Trust/PPO |
$36.36
|
| Rate for Payer: BCN Commercial |
$36.36
|
| 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 Commercial |
$37.43
|
| Rate for Payer: Nomi Health Commercial |
$36.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.02
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.64
|
| 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 00527192736
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.79 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$108.92
|
| Rate for Payer: BCN Commercial |
$108.92
|
| 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 Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.91
|
| Rate for Payer: PHP Commercial |
$112.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.79
|
| 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/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$131.88
|
|
|
Service Code
|
NDC 00527192736
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Medicare |
$34.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.21
|
| Rate for Payer: BCBS Complete |
$24.41
|
| Rate for Payer: BCBS MAPPO |
$32.97
|
| Rate for Payer: BCBS Trust/PPO |
$108.42
|
| Rate for Payer: BCN Commercial |
$108.42
|
| Rate for Payer: BCN Medicare Advantage |
$32.97
|
| 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: Health Alliance Plan Medicare Advantage |
$32.97
|
| Rate for Payer: Healthscope Commercial |
$118.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.91
|
| Rate for Payer: Mclaren Medicaid |
$23.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.62
|
| Rate for Payer: Meridian Medicaid |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.91
|
| Rate for Payer: PACE Senior Care Partners |
$31.32
|
| Rate for Payer: PACE SWMI |
$32.97
|
| Rate for Payer: PHP Commercial |
$112.10
|
| Rate for Payer: PHP Medicare Advantage |
$32.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.74
|
| Rate for Payer: Priority Health Medicare |
$33.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.79
|
| Rate for Payer: Railroad Medicare Medicare |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.05
|
| Rate for Payer: UHC Core |
$110.12
|
| Rate for Payer: UHC Exchange |
$32.97
|
| Rate for Payer: UHC Medicaid |
$23.25
|
| Rate for Payer: UHC Medicare Advantage |
$32.97
|
| Rate for Payer: UHCCP Medicaid |
$23.25
|
| Rate for Payer: VA VA |
$32.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.91
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 09900001004
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Nomi Health Commercial |
$1.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.45
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$5.78
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.91
|
| Rate for Payer: Nomi Health Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.09
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.33
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.94 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$476.96
|
| Rate for Payer: BCN Commercial |
$476.96
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: Nomi Health Commercial |
$473.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.12
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$502.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.20
|
| Rate for Payer: UHC Core |
$482.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$5.78
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.75
|
| Rate for Payer: BCN Commercial |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.33
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.91
|
| Rate for Payer: Nomi Health Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.37
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.03
|
| Rate for Payer: Priority Health Medicare |
$1.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.09
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.33
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna Medicare |
$150.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.47
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS MAPPO |
$144.38
|
| Rate for Payer: BCBS Trust/PPO |
$474.76
|
| Rate for Payer: BCN Commercial |
$474.76
|
| Rate for Payer: BCN Medicare Advantage |
$144.38
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.38
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Mclaren Medicaid |
$101.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.59
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$158.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: Nomi Health Commercial |
$473.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.12
|
| Rate for Payer: PACE Senior Care Partners |
$137.16
|
| Rate for Payer: PACE SWMI |
$144.38
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: PHP Medicare Advantage |
$144.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$502.43
|
| Rate for Payer: Priority Health Medicare |
$145.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.94
|
| Rate for Payer: Railroad Medicare Medicare |
$144.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.20
|
| Rate for Payer: UHC Core |
$482.21
|
| Rate for Payer: UHC Exchange |
$144.38
|
| Rate for Payer: UHC Medicaid |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$144.38
|
| Rate for Payer: UHCCP Medicaid |
$101.81
|
| Rate for Payer: VA VA |
$144.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
NDC 00904741761
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.81 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.06
|
| Rate for Payer: BCBS Complete |
$76.45
|
| Rate for Payer: BCBS MAPPO |
$103.25
|
| Rate for Payer: BCBS Trust/PPO |
$339.53
|
| Rate for Payer: BCN Commercial |
$339.53
|
| Rate for Payer: BCN Medicare Advantage |
$103.25
|
| 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: Health Alliance Plan Medicare Advantage |
$103.25
|
| Rate for Payer: Healthscope Commercial |
$371.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.75
|
| Rate for Payer: Mclaren Medicaid |
$72.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.41
|
| Rate for Payer: Meridian Medicaid |
$76.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.05
|
| Rate for Payer: Nomi Health Commercial |
$338.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PACE Senior Care Partners |
$98.09
|
| Rate for Payer: PACE SWMI |
$103.25
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: PHP Medicare Advantage |
$103.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$359.31
|
| Rate for Payer: Priority Health Medicare |
$104.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.45
|
| Rate for Payer: Railroad Medicare Medicare |
$103.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.44
|
| Rate for Payer: UHC Core |
$344.86
|
| Rate for Payer: UHC Exchange |
$103.25
|
| Rate for Payer: UHC Medicaid |
$72.81
|
| Rate for Payer: UHC Medicare Advantage |
$103.25
|
| Rate for Payer: UHCCP Medicaid |
$72.81
|
| Rate for Payer: VA VA |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
NDC 00904741761
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.45 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: BCBS Trust/PPO |
$341.10
|
| Rate for Payer: BCN Commercial |
$341.10
|
| 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 Commercial |
$351.05
|
| Rate for Payer: Nomi Health Commercial |
$338.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$359.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.45
|
| 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
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$236.21
|
|
|
Service Code
|
NDC 60687069421
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$212.59 |
| Rate for Payer: Aetna Commercial |
$200.78
|
| Rate for Payer: BCBS Trust/PPO |
$195.09
|
| Rate for Payer: BCN Commercial |
$195.09
|
| Rate for Payer: Cash Price |
$188.97
|
| Rate for Payer: Cofinity Commercial |
$203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.97
|
| Rate for Payer: Healthscope Commercial |
$212.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.78
|
| Rate for Payer: Nomi Health Commercial |
$193.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.16
|
| Rate for Payer: PHP Commercial |
$200.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.86
|
| Rate for Payer: UHC Core |
$197.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.16
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$236.21
|
|
|
Service Code
|
NDC 60687069421
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.64 |
| Max. Negotiated Rate |
$212.59 |
| Rate for Payer: Aetna Commercial |
$200.78
|
| Rate for Payer: Aetna Medicare |
$61.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.82
|
| Rate for Payer: BCBS Complete |
$43.72
|
| Rate for Payer: BCBS MAPPO |
$59.05
|
| Rate for Payer: BCBS Trust/PPO |
$194.19
|
| Rate for Payer: BCN Commercial |
$194.19
|
| Rate for Payer: BCN Medicare Advantage |
$59.05
|
| Rate for Payer: Cash Price |
$188.97
|
| Rate for Payer: Cofinity Commercial |
$203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.05
|
| Rate for Payer: Healthscope Commercial |
$212.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.16
|
| Rate for Payer: Mclaren Medicaid |
$41.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.01
|
| Rate for Payer: Meridian Medicaid |
$43.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.78
|
| Rate for Payer: Nomi Health Commercial |
$193.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.16
|
| Rate for Payer: PACE Senior Care Partners |
$56.10
|
| Rate for Payer: PACE SWMI |
$59.05
|
| Rate for Payer: PHP Commercial |
$200.78
|
| Rate for Payer: PHP Medicare Advantage |
$59.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.50
|
| Rate for Payer: Priority Health Medicare |
$59.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$59.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.86
|
| Rate for Payer: UHC Core |
$197.24
|
| Rate for Payer: UHC Exchange |
$59.05
|
| Rate for Payer: UHC Medicaid |
$41.64
|
| Rate for Payer: UHC Medicare Advantage |
$59.05
|
| Rate for Payer: UHCCP Medicaid |
$41.64
|
| Rate for Payer: VA VA |
$59.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.16
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
NDC 60687069411
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.48
|
| Rate for Payer: BCN Commercial |
$6.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.93
|
| Rate for Payer: UHC Core |
$6.58
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicaid |
$1.39
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: UHCCP Medicaid |
$1.39
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
NDC 60687069411
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.93
|
| Rate for Payer: UHC Core |
$6.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.99 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: BCBS Trust/PPO |
$250.37
|
| Rate for Payer: BCN Commercial |
$250.37
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.36
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$78.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.73
|
| Rate for Payer: BCBS Complete |
$56.11
|
| Rate for Payer: BCBS MAPPO |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$75.79
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.79
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.58
|
| Rate for Payer: Meridian Medicaid |
$56.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.36
|
| Rate for Payer: PACE Senior Care Partners |
$72.00
|
| Rate for Payer: PACE SWMI |
$75.79
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Medicare |
$76.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.99
|
| Rate for Payer: Railroad Medicare Medicare |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: UHC Exchange |
$75.79
|
| Rate for Payer: UHC Medicaid |
$53.45
|
| Rate for Payer: UHC Medicare Advantage |
$75.79
|
| Rate for Payer: UHCCP Medicaid |
$53.45
|
| Rate for Payer: VA VA |
$75.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.90
|
| Rate for Payer: BCBS Complete |
$0.53
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: BCN Medicare Advantage |
$0.72
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.72
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Mclaren Medicaid |
$0.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.72
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.51
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicaid |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: UHCCP Medicaid |
$0.51
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: BCBS Trust/PPO |
$174.68
|
| Rate for Payer: BCN Commercial |
$174.68
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.12
|
| Rate for Payer: UHC Core |
$176.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$288.48
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna Commercial |
$245.21
|
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.15
|
| Rate for Payer: BCBS Complete |
$53.40
|
| Rate for Payer: BCBS MAPPO |
$72.12
|
| Rate for Payer: BCBS Trust/PPO |
$237.16
|
| Rate for Payer: BCN Commercial |
$237.16
|
| Rate for Payer: BCN Medicare Advantage |
$72.12
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Commercial |
$248.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.12
|
| Rate for Payer: Healthscope Commercial |
$259.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.36
|
| Rate for Payer: Mclaren Medicaid |
$50.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.73
|
| Rate for Payer: Meridian Medicaid |
$53.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Nomi Health Commercial |
$236.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: PACE Senior Care Partners |
$68.51
|
| Rate for Payer: PACE SWMI |
$72.12
|
| Rate for Payer: PHP Commercial |
$245.21
|
| Rate for Payer: PHP Medicare Advantage |
$72.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.98
|
| Rate for Payer: Priority Health Medicare |
$72.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.78
|
| Rate for Payer: Railroad Medicare Medicare |
$72.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.86
|
| Rate for Payer: UHC Core |
$240.88
|
| Rate for Payer: UHC Exchange |
$72.12
|
| Rate for Payer: UHC Medicaid |
$50.86
|
| Rate for Payer: UHC Medicare Advantage |
$72.12
|
| Rate for Payer: UHCCP Medicaid |
$50.86
|
| Rate for Payer: VA VA |
$72.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$288.48
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna Commercial |
$245.21
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$238.26
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Commercial |
$248.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Healthscope Commercial |
$259.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Nomi Health Commercial |
$236.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: PHP Commercial |
$245.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.86
|
| Rate for Payer: UHC Core |
$240.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$54.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.09
|
| Rate for Payer: BCBS Complete |
$39.15
|
| Rate for Payer: BCBS MAPPO |
$52.88
|
| Rate for Payer: BCBS Trust/PPO |
$173.87
|
| Rate for Payer: BCN Commercial |
$173.87
|
| Rate for Payer: BCN Medicare Advantage |
$52.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Mclaren Medicaid |
$37.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.52
|
| Rate for Payer: Meridian Medicaid |
$39.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PACE Senior Care Partners |
$50.23
|
| Rate for Payer: PACE SWMI |
$52.88
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: PHP Medicare Advantage |
$52.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.00
|
| Rate for Payer: Priority Health Medicare |
$53.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.20
|
| Rate for Payer: Railroad Medicare Medicare |
$52.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.12
|
| Rate for Payer: UHC Core |
$176.60
|
| Rate for Payer: UHC Exchange |
$52.88
|
| Rate for Payer: UHC Medicaid |
$37.29
|
| Rate for Payer: UHC Medicare Advantage |
$52.88
|
| Rate for Payer: UHCCP Medicaid |
$37.29
|
| Rate for Payer: VA VA |
$52.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.35
|
| Rate for Payer: BCBS Trust/PPO |
$38.30
|
| Rate for Payer: BCN Commercial |
$27.35
|
| Rate for Payer: BCN Commercial |
$38.30
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$39.88
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$41.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.78
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.81
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Core |
$38.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.78
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$12.06
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.49
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCBS Trust/PPO |
$38.12
|
| Rate for Payer: BCN Commercial |
$38.12
|
| Rate for Payer: BCN Commercial |
$27.22
|
| Rate for Payer: BCN Medicare Advantage |
$11.59
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$39.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$41.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.78
|
| Rate for Payer: Mclaren Medicaid |
$8.18
|
| Rate for Payer: Mclaren Medicaid |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: Meridian Medicaid |
$6.13
|
| Rate for Payer: Meridian Medicaid |
$8.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.78
|
| Rate for Payer: PACE Senior Care Partners |
$11.01
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE SWMI |
$11.59
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: PHP Medicare Advantage |
$11.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: Railroad Medicare Medicare |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.81
|
| Rate for Payer: UHC Core |
$38.72
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Medicaid |
$8.18
|
| Rate for Payer: UHC Medicaid |
$5.84
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: UHCCP Medicaid |
$5.84
|
| Rate for Payer: UHCCP Medicaid |
$8.18
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: VA VA |
$11.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
