|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$207.58
|
|
|
Service Code
|
NDC 50268055015
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$176.44
|
| Rate for Payer: Aetna Medicare |
$53.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.87
|
| Rate for Payer: BCBS Complete |
$83.03
|
| Rate for Payer: BCBS MAPPO |
$51.90
|
| Rate for Payer: BCBS Trust/PPO |
$170.65
|
| Rate for Payer: BCN Commercial |
$161.39
|
| Rate for Payer: BCN Medicare Advantage |
$51.90
|
| Rate for Payer: Cash Price |
$166.06
|
| Rate for Payer: Cofinity Commercial |
$178.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.90
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.44
|
| Rate for Payer: Nomi Health Commercial |
$170.22
|
| Rate for Payer: PACE Senior Care Partners |
$49.30
|
| Rate for Payer: PACE SWMI |
$51.90
|
| Rate for Payer: PHP Commercial |
$176.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.93
|
| Rate for Payer: Priority Health HMO/PPO |
$180.59
|
| Rate for Payer: Priority Health Medicare |
$52.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.08
|
| Rate for Payer: Railroad Medicare Medicare |
$51.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.67
|
| Rate for Payer: UHC Core |
$173.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.90
|
| Rate for Payer: UHC Exchange |
$51.90
|
| Rate for Payer: UHC Medicare Advantage |
$51.90
|
| Rate for Payer: VA VA |
$51.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.69
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
NDC 50268055011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Medicare |
$1.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.04
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$207.58
|
|
|
Service Code
|
NDC 50268055015
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.93 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$176.44
|
| Rate for Payer: BCBS Trust/PPO |
$169.45
|
| Rate for Payer: BCN Commercial |
$160.42
|
| Rate for Payer: Cash Price |
$166.06
|
| Rate for Payer: Cofinity Commercial |
$178.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.06
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.44
|
| Rate for Payer: Nomi Health Commercial |
$170.22
|
| Rate for Payer: PHP Commercial |
$176.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.93
|
| Rate for Payer: Priority Health HMO/PPO |
$180.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.67
|
| Rate for Payer: UHC Core |
$173.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.69
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 60687064001
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: BCBS Trust/PPO |
$302.44
|
| 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 Commercial |
$314.93
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.24
|
| 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
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 62756014201
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| 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 |
$171.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO |
$165.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.53
|
| 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
|
$4.16
|
|
|
Service Code
|
NDC 50268055011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| 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: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: Priority Health HMO/PPO |
$3.23
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.78
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 62756014201
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$49.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.48
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS MAPPO |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$156.49
|
| Rate for Payer: BCN Commercial |
$148.00
|
| Rate for Payer: BCN Medicare Advantage |
$47.59
|
| 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: Health Alliance Plan Medicare Advantage |
$47.59
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: PACE Senior Care Partners |
$45.21
|
| Rate for Payer: PACE SWMI |
$47.59
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO |
$165.60
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.51
|
| Rate for Payer: UHC Core |
$158.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.59
|
| Rate for Payer: UHC Exchange |
$47.59
|
| Rate for Payer: UHC Medicare Advantage |
$47.59
|
| Rate for Payer: VA VA |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 67877015901
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Nomi Health Commercial |
$65.52
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health HMO/PPO |
$69.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.31
|
| Rate for Payer: UHC Core |
$66.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 67877015901
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.97
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$65.69
|
| Rate for Payer: BCN Commercial |
$62.12
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Nomi Health Commercial |
$65.52
|
| Rate for Payer: PACE Senior Care Partners |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health HMO/PPO |
$69.51
|
| Rate for Payer: Priority Health Medicare |
$20.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.31
|
| Rate for Payer: UHC Core |
$66.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: VA VA |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
NDC 60687064001
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$96.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.78
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS MAPPO |
$92.62
|
| Rate for Payer: BCBS Trust/PPO |
$304.59
|
| Rate for Payer: BCN Commercial |
$288.06
|
| Rate for Payer: BCN Medicare Advantage |
$92.62
|
| 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: Health Alliance Plan Medicare Advantage |
$92.62
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: PACE Senior Care Partners |
$87.99
|
| Rate for Payer: PACE SWMI |
$92.62
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Medicare Advantage |
$92.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Medicare |
$93.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.24
|
| Rate for Payer: Railroad Medicare Medicare |
$92.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.62
|
| Rate for Payer: UHC Exchange |
$92.62
|
| Rate for Payer: UHC Medicare Advantage |
$92.62
|
| Rate for Payer: VA VA |
$92.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| 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 Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: Priority Health HMO/PPO |
$3.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| 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
|
|
|
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 |
$31.32 |
| 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 |
$52.75
|
| Rate for Payer: BCBS MAPPO |
$32.97
|
| Rate for Payer: BCBS Trust/PPO |
$108.42
|
| Rate for Payer: BCN Commercial |
$102.54
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| 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 Cigna Priority Health |
$85.72
|
| Rate for Payer: Priority Health HMO/PPO |
$114.74
|
| Rate for Payer: Priority Health Medicare |
$33.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.36
|
| 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 Dual Complete DSNP |
$32.97
|
| Rate for Payer: UHC Exchange |
$32.97
|
| Rate for Payer: UHC Medicare Advantage |
$32.97
|
| 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
|
$44.03
|
|
|
Service Code
|
NDC 09900000010
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: BCBS Trust/PPO |
$35.94
|
| 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 Commercial |
$37.43
|
| Rate for Payer: Nomi Health Commercial |
$36.10
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.62
|
| Rate for Payer: Priority Health HMO/PPO |
$38.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.50
|
| 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 |
$85.72 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$107.65
|
| 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 Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: PHP Commercial |
$112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.72
|
| Rate for Payer: Priority Health HMO/PPO |
$114.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.36
|
| 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
|
$1.65
|
|
|
Service Code
|
NDC 09900001004
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| 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 |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Nomi Health Commercial |
$1.35
|
| 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 Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Medicare |
$0.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.11
|
| 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 Dual Complete DSNP |
$0.41
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.41
|
| 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
|
OP
|
$44.03
|
|
|
Service Code
|
NDC 09900000010
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.76
|
| Rate for Payer: BCBS Complete |
$17.61
|
| Rate for Payer: BCBS MAPPO |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$36.20
|
| Rate for Payer: BCN Commercial |
$34.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.01
|
| 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: Health Alliance Plan Medicare Advantage |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.43
|
| Rate for Payer: Nomi Health Commercial |
$36.10
|
| Rate for Payer: PACE Senior Care Partners |
$10.46
|
| Rate for Payer: PACE SWMI |
$11.01
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: PHP Medicare Advantage |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.62
|
| Rate for Payer: Priority Health HMO/PPO |
$38.31
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.75
|
| Rate for Payer: UHC Core |
$36.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.01
|
| Rate for Payer: UHC Exchange |
$11.01
|
| Rate for Payer: UHC Medicare Advantage |
$11.01
|
| Rate for Payer: VA VA |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.02
|
|
|
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 |
$1.07 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.35
|
| Rate for Payer: BCN Commercial |
$1.28
|
| 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: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.11
|
| 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
|
$4.33
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.96 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: BCBS Trust/PPO |
$352.85
|
| Rate for Payer: BCN Commercial |
$334.04
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Nomi Health Commercial |
$354.44
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.96
|
| Rate for Payer: Priority Health HMO/PPO |
$376.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.66 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Medicare |
$112.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.08
|
| Rate for Payer: BCBS Complete |
$172.90
|
| Rate for Payer: BCBS MAPPO |
$108.06
|
| Rate for Payer: BCBS Trust/PPO |
$355.35
|
| Rate for Payer: BCN Commercial |
$336.07
|
| Rate for Payer: BCN Medicare Advantage |
$108.06
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.06
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Nomi Health Commercial |
$354.44
|
| Rate for Payer: PACE Senior Care Partners |
$102.66
|
| Rate for Payer: PACE SWMI |
$108.06
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: PHP Medicare Advantage |
$108.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.96
|
| Rate for Payer: Priority Health HMO/PPO |
$376.06
|
| Rate for Payer: Priority Health Medicare |
$109.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.61
|
| Rate for Payer: Railroad Medicare Medicare |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.06
|
| Rate for Payer: UHC Exchange |
$108.06
|
| Rate for Payer: UHC Medicare Advantage |
$108.06
|
| Rate for Payer: VA VA |
$108.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: BCBS Trust/PPO |
$247.46
|
| Rate for Payer: BCN Commercial |
$234.27
|
| 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: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| 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
|
$251.04
|
|
|
Service Code
|
NDC 60687037001
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna Medicare |
$65.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.45
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$62.76
|
| Rate for Payer: BCBS Trust/PPO |
$206.38
|
| Rate for Payer: BCN Commercial |
$195.18
|
| Rate for Payer: BCN Medicare Advantage |
$62.76
|
| 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: Health Alliance Plan Medicare Advantage |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: Nomi Health Commercial |
$205.85
|
| Rate for Payer: PACE Senior Care Partners |
$59.62
|
| Rate for Payer: PACE SWMI |
$62.76
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: PHP Medicare Advantage |
$62.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health HMO/PPO |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.20
|
| Rate for Payer: Railroad Medicare Medicare |
$62.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.76
|
| Rate for Payer: UHC Exchange |
$62.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.76
|
| Rate for Payer: VA VA |
$62.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 60687037011
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| 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 Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| 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
|
|
