|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
NDC 50268-551-11
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna American Axle |
$1.98
|
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health SBD |
$1.92
|
| Rate for Payer: UMR Bronson Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$152.48
|
|
|
Service Code
|
NDC 50268-551-15
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$137.23 |
| Rate for Payer: Aetna American Axle |
$99.11
|
| Rate for Payer: Aetna Commercial |
$129.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.11
|
| Rate for Payer: Cash Price |
$121.98
|
| Rate for Payer: Cofinity Commercial |
$106.74
|
| Rate for Payer: Cofinity Commercial |
$131.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.98
|
| Rate for Payer: Healthscope Commercial |
$137.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.61
|
| Rate for Payer: PHP Commercial |
$129.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health SBD |
$96.06
|
| Rate for Payer: UMR Bronson Commercial |
$67.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.36
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 51224-107-50
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 49483-624-01
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.34
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$285.61
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Aetna American Axle |
$185.65
|
| Rate for Payer: Aetna Commercial |
$242.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.65
|
| Rate for Payer: Cash Price |
$228.49
|
| Rate for Payer: Cofinity Commercial |
$199.93
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.49
|
| Rate for Payer: Healthscope Commercial |
$257.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.77
|
| Rate for Payer: PHP Commercial |
$242.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.93
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: UMR Bronson Commercial |
$125.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.21
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,987.90
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$874.68 |
| Max. Negotiated Rate |
$1,789.11 |
| Rate for Payer: Aetna American Axle |
$1,292.14
|
| Rate for Payer: Aetna American Axle |
$928.07
|
| Rate for Payer: Aetna Commercial |
$1,689.72
|
| Rate for Payer: Aetna Commercial |
$1,213.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.14
|
| Rate for Payer: Cash Price |
$1,590.32
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cofinity Commercial |
$999.46
|
| Rate for Payer: Cofinity Commercial |
$1,391.53
|
| Rate for Payer: Cofinity Commercial |
$1,709.59
|
| Rate for Payer: Cofinity Commercial |
$1,227.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.24
|
| Rate for Payer: Healthscope Commercial |
$1,789.11
|
| Rate for Payer: Healthscope Commercial |
$1,285.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,391.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,689.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.63
|
| Rate for Payer: PHP Commercial |
$1,213.63
|
| Rate for Payer: PHP Commercial |
$1,689.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,391.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.46
|
| Rate for Payer: Priority Health SBD |
$1,252.38
|
| Rate for Payer: Priority Health SBD |
$899.51
|
| Rate for Payer: UMR Bronson Commercial |
$628.23
|
| Rate for Payer: UMR Bronson Commercial |
$874.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,490.92
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$822.50
|
|
|
Service Code
|
NDC 0054-0392-68
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.90 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Aetna American Axle |
$534.62
|
| Rate for Payer: Aetna Commercial |
$699.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.62
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cofinity Commercial |
$575.75
|
| Rate for Payer: Cofinity Commercial |
$707.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.00
|
| Rate for Payer: Healthscope Commercial |
$740.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.12
|
| Rate for Payer: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.75
|
| Rate for Payer: Priority Health SBD |
$518.18
|
| Rate for Payer: UMR Bronson Commercial |
$361.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.88
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
NDC 0406-0527-10
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna American Axle |
$773.50
|
| Rate for Payer: Aetna Commercial |
$1,011.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.50
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$1,023.40
|
| Rate for Payer: Cofinity Commercial |
$833.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.00
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$833.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$892.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.50
|
| Rate for Payer: PHP Commercial |
$1,011.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.00
|
| Rate for Payer: Priority Health SBD |
$749.70
|
| Rate for Payer: UMR Bronson Commercial |
$523.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$892.50
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 0054-3553-44
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna American Axle |
$85.86
|
| Rate for Payer: Aetna Commercial |
$112.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.86
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$118.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.28
|
| Rate for Payer: PHP Commercial |
$112.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.46
|
| Rate for Payer: Priority Health SBD |
$83.22
|
| Rate for Payer: UMR Bronson Commercial |
$58.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.07
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 9900-0010-04
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.16
|
| Rate for Payer: Priority Health SBD |
$1.04
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$519.75
|
|
|
Service Code
|
NDC 68084-738-01
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$467.78 |
| Rate for Payer: Aetna American Axle |
$337.84
|
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.84
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cofinity Commercial |
$363.82
|
| Rate for Payer: Cofinity Commercial |
$446.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.80
|
| Rate for Payer: Healthscope Commercial |
$467.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.79
|
| Rate for Payer: PHP Commercial |
$441.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.82
|
| Rate for Payer: Priority Health SBD |
$327.44
|
| Rate for Payer: UMR Bronson Commercial |
$228.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.81
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
NDC 68084-738-11
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna American Axle |
$3.38
|
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.38
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.42
|
| Rate for Payer: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.64
|
| Rate for Payer: Priority Health SBD |
$3.28
|
| Rate for Payer: UMR Bronson Commercial |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.90
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$568.75
|
|
|
Service Code
|
NDC 0054-8554-24
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$511.88 |
| Rate for Payer: Aetna American Axle |
$369.69
|
| Rate for Payer: Aetna Commercial |
$483.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.69
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cofinity Commercial |
$398.12
|
| Rate for Payer: Cofinity Commercial |
$489.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.00
|
| Rate for Payer: Healthscope Commercial |
$511.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.44
|
| Rate for Payer: PHP Commercial |
$483.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.12
|
| Rate for Payer: Priority Health SBD |
$358.31
|
| Rate for Payer: UMR Bronson Commercial |
$250.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.56
|
|
|
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 |
$181.72 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna American Axle |
$268.45
|
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.45
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$289.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$289.10
|
| 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 SBD |
$260.19
|
| Rate for Payer: UMR Bronson Commercial |
$181.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$332.50
|
|
|
Service Code
|
NDC 0904-6530-61
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna American Axle |
$216.12
|
| Rate for Payer: Aetna Commercial |
$282.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.12
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$232.75
|
| Rate for Payer: Cofinity Commercial |
$285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.00
|
| Rate for Payer: Healthscope Commercial |
$299.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.62
|
| Rate for Payer: PHP Commercial |
$282.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: Priority Health SBD |
$209.48
|
| Rate for Payer: UMR Bronson Commercial |
$146.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.38
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 0990-0001-01
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 9900-0000-27
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.73
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 0990-0001-71
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna American Axle |
$3.36
|
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.73
|
|
|
Service Code
|
NDC 68094-031-59
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$29.46 |
| Rate for Payer: Aetna American Axle |
$21.27
|
| Rate for Payer: Aetna Commercial |
$27.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.27
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cofinity Commercial |
$22.91
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.18
|
| Rate for Payer: Healthscope Commercial |
$29.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.82
|
| Rate for Payer: PHP Commercial |
$27.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$20.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.55
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.73
|
|
|
Service Code
|
NDC 68094-031-62
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$29.46 |
| Rate for Payer: Aetna American Axle |
$21.27
|
| Rate for Payer: Aetna Commercial |
$27.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.27
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cofinity Commercial |
$22.91
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.18
|
| Rate for Payer: Healthscope Commercial |
$29.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.82
|
| Rate for Payer: PHP Commercial |
$27.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health SBD |
$20.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.55
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$516.25
|
|
|
Service Code
|
NDC 0054-3555-63
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.15 |
| Max. Negotiated Rate |
$464.62 |
| Rate for Payer: Aetna American Axle |
$335.56
|
| Rate for Payer: Aetna Commercial |
$438.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.56
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cofinity Commercial |
$361.38
|
| Rate for Payer: Cofinity Commercial |
$443.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.00
|
| Rate for Payer: Healthscope Commercial |
$464.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.81
|
| Rate for Payer: PHP Commercial |
$438.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.38
|
| Rate for Payer: Priority Health SBD |
$325.24
|
| Rate for Payer: UMR Bronson Commercial |
$227.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.19
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 9900-0000-26
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna American Axle |
$0.07
|
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.07
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cofinity Commercial |
$0.08
|
| Rate for Payer: Cofinity Commercial |
$0.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.08
|
| Rate for Payer: Priority Health SBD |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$0.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.08
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 0406-5755-23
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$430.50
|
|
|
Service Code
|
NDC 0406-5755-62
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.42 |
| Max. Negotiated Rate |
$387.45 |
| Rate for Payer: Aetna American Axle |
$279.82
|
| Rate for Payer: Aetna Commercial |
$365.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.82
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cofinity Commercial |
$301.35
|
| Rate for Payer: Cofinity Commercial |
$370.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.40
|
| Rate for Payer: Healthscope Commercial |
$387.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.92
|
| Rate for Payer: PHP Commercial |
$365.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.35
|
| Rate for Payer: Priority Health SBD |
$271.22
|
| Rate for Payer: UMR Bronson Commercial |
$189.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.88
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$500.50
|
|
|
Service Code
|
NDC 0054-8553-24
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna American Axle |
$325.32
|
| Rate for Payer: Aetna Commercial |
$425.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.32
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cofinity Commercial |
$350.35
|
| Rate for Payer: Cofinity Commercial |
$430.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.40
|
| Rate for Payer: Healthscope Commercial |
$450.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.42
|
| Rate for Payer: PHP Commercial |
$425.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health SBD |
$315.32
|
| Rate for Payer: UMR Bronson Commercial |
$220.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
