|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$467.25
|
|
|
Service Code
|
NDC 57664-229-88
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.59 |
| Max. Negotiated Rate |
$420.52 |
| Rate for Payer: Aetna American Axle |
$303.71
|
| Rate for Payer: Aetna Commercial |
$397.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.71
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cofinity Commercial |
$327.08
|
| Rate for Payer: Cofinity Commercial |
$401.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.80
|
| Rate for Payer: Healthscope Commercial |
$420.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.16
|
| Rate for Payer: PHP Commercial |
$397.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.08
|
| Rate for Payer: Priority Health SBD |
$294.37
|
| Rate for Payer: UMR Bronson Commercial |
$205.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.44
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 0406-1144-01
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$411.08 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.24
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.72
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UMR Bronson Commercial |
$200.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 10702-101-01
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna American Axle |
$141.05
|
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.05
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$151.90
|
| Rate for Payer: Cofinity Commercial |
$186.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.45
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health SBD |
$136.71
|
| Rate for Payer: UMR Bronson Commercial |
$95.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$208.68
|
|
|
Service Code
|
NDC 5409-2553-01
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna American Axle |
$135.64
|
| Rate for Payer: Aetna Commercial |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.64
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cofinity Commercial |
$179.46
|
| Rate for Payer: Cofinity Commercial |
$146.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.94
|
| Rate for Payer: Healthscope Commercial |
$187.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.38
|
| Rate for Payer: PHP Commercial |
$177.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health SBD |
$131.47
|
| Rate for Payer: UMR Bronson Commercial |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.51
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$621.38
|
|
|
Service Code
|
NDC 68968-5553-3
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.41 |
| Max. Negotiated Rate |
$559.24 |
| Rate for Payer: Aetna American Axle |
$403.90
|
| Rate for Payer: Aetna Commercial |
$528.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.90
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$434.97
|
| Rate for Payer: Cofinity Commercial |
$534.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.10
|
| Rate for Payer: Healthscope Commercial |
$559.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.17
|
| Rate for Payer: PHP Commercial |
$528.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.97
|
| Rate for Payer: Priority Health SBD |
$391.47
|
| Rate for Payer: UMR Bronson Commercial |
$273.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.04
|
|
|
METHYLPHENIDATE 2.5 MG CUSTOM TAB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
NDC 9900-0000-12
|
| Hospital Charge Code |
150703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna American Axle |
$63.70
|
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: UMR Bronson Commercial |
$43.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$357.63
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$321.87 |
| Rate for Payer: Aetna American Axle |
$232.46
|
| Rate for Payer: Aetna Commercial |
$303.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.46
|
| Rate for Payer: Cash Price |
$286.10
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$307.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.10
|
| Rate for Payer: Healthscope Commercial |
$321.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.99
|
| Rate for Payer: PHP Commercial |
$303.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.34
|
| Rate for Payer: Priority Health SBD |
$225.31
|
| Rate for Payer: UMR Bronson Commercial |
$157.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.22
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$11.93
|
|
|
Service Code
|
NDC 68084-805-11
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna American Axle |
$7.75
|
| Rate for Payer: Aetna Commercial |
$10.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.75
|
| Rate for Payer: Cash Price |
$9.54
|
| Rate for Payer: Cofinity Commercial |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.54
|
| Rate for Payer: Healthscope Commercial |
$10.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.14
|
| Rate for Payer: PHP Commercial |
$10.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.35
|
| Rate for Payer: Priority Health SBD |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$5.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.95
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$162.75
|
|
|
Service Code
|
NDC 10702-100-01
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.61 |
| Max. Negotiated Rate |
$146.48 |
| Rate for Payer: Aetna American Axle |
$105.79
|
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.79
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$139.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$146.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.34
|
| Rate for Payer: PHP Commercial |
$138.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.92
|
| Rate for Payer: Priority Health SBD |
$102.53
|
| Rate for Payer: UMR Bronson Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.06
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$320.25
|
|
|
Service Code
|
NDC 0406-1142-01
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$288.22 |
| Rate for Payer: Aetna American Axle |
$208.16
|
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.16
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.21
|
| Rate for Payer: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.18
|
| Rate for Payer: Priority Health SBD |
$201.76
|
| Rate for Payer: UMR Bronson Commercial |
$140.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$327.25
|
|
|
Service Code
|
NDC 31722-173-01
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna American Axle |
$212.71
|
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.71
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cofinity Commercial |
$229.08
|
| Rate for Payer: Cofinity Commercial |
$281.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.80
|
| Rate for Payer: Healthscope Commercial |
$294.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.16
|
| Rate for Payer: PHP Commercial |
$278.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.08
|
| Rate for Payer: Priority Health SBD |
$206.17
|
| Rate for Payer: UMR Bronson Commercial |
$143.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.44
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,958.68
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,741.82 |
| Max. Negotiated Rate |
$3,562.81 |
| Rate for Payer: Aetna American Axle |
$2,573.14
|
| Rate for Payer: Aetna Commercial |
$3,364.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,573.14
|
| Rate for Payer: Cash Price |
$3,166.94
|
| Rate for Payer: Cofinity Commercial |
$2,771.08
|
| Rate for Payer: Cofinity Commercial |
$3,404.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,166.94
|
| Rate for Payer: Healthscope Commercial |
$3,562.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,771.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,969.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,364.88
|
| Rate for Payer: PHP Commercial |
$3,364.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,771.08
|
| Rate for Payer: Priority Health SBD |
$2,493.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,741.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,969.01
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$470.40
|
|
|
Service Code
|
NDC 13811-706-10
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.98 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna American Axle |
$305.76
|
| Rate for Payer: Aetna Commercial |
$399.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.76
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Commercial |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.32
|
| Rate for Payer: Healthscope Commercial |
$423.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.84
|
| Rate for Payer: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.28
|
| Rate for Payer: Priority Health SBD |
$296.35
|
| Rate for Payer: UMR Bronson Commercial |
$206.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.80
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,340.50
|
|
|
Service Code
|
NDC 65580-594-01
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.82 |
| Max. Negotiated Rate |
$1,206.45 |
| Rate for Payer: Aetna American Axle |
$871.32
|
| Rate for Payer: Aetna Commercial |
$1,139.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.32
|
| Rate for Payer: Cash Price |
$1,072.40
|
| Rate for Payer: Cofinity Commercial |
$1,152.83
|
| Rate for Payer: Cofinity Commercial |
$938.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.40
|
| Rate for Payer: Healthscope Commercial |
$1,206.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$938.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,139.42
|
| Rate for Payer: PHP Commercial |
$1,139.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.35
|
| Rate for Payer: Priority Health SBD |
$844.52
|
| Rate for Payer: UMR Bronson Commercial |
$589.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.38
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
NDC 0406-1473-01
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.56 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna American Axle |
$486.85
|
| Rate for Payer: Aetna Commercial |
$636.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.85
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cofinity Commercial |
$524.30
|
| Rate for Payer: Cofinity Commercial |
$644.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.20
|
| Rate for Payer: Healthscope Commercial |
$674.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$636.65
|
| Rate for Payer: PHP Commercial |
$636.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.30
|
| Rate for Payer: Priority Health SBD |
$471.87
|
| Rate for Payer: UMR Bronson Commercial |
$329.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.75
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$929.25
|
|
|
Service Code
|
NDC 10702-076-01
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.87 |
| Max. Negotiated Rate |
$836.32 |
| Rate for Payer: Aetna American Axle |
$604.01
|
| Rate for Payer: Aetna Commercial |
$789.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.01
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cofinity Commercial |
$650.48
|
| Rate for Payer: Cofinity Commercial |
$799.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.40
|
| Rate for Payer: Healthscope Commercial |
$836.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$789.86
|
| Rate for Payer: PHP Commercial |
$789.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.48
|
| Rate for Payer: Priority Health SBD |
$585.43
|
| Rate for Payer: UMR Bronson Commercial |
$408.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.94
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,058.01
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,785.52 |
| Max. Negotiated Rate |
$3,652.21 |
| Rate for Payer: Aetna American Axle |
$2,637.71
|
| Rate for Payer: Aetna Commercial |
$3,449.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.71
|
| Rate for Payer: Cash Price |
$3,246.41
|
| Rate for Payer: Cofinity Commercial |
$2,840.61
|
| Rate for Payer: Cofinity Commercial |
$3,489.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,246.41
|
| Rate for Payer: Healthscope Commercial |
$3,652.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,840.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,043.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,449.31
|
| Rate for Payer: PHP Commercial |
$3,449.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,840.61
|
| Rate for Payer: Priority Health SBD |
$2,556.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,785.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,043.51
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$486.50
|
|
|
Service Code
|
NDC 13811-707-10
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.06 |
| Max. Negotiated Rate |
$437.85 |
| Rate for Payer: Aetna American Axle |
$316.22
|
| Rate for Payer: Aetna Commercial |
$413.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.22
|
| Rate for Payer: Cash Price |
$389.20
|
| Rate for Payer: Cofinity Commercial |
$340.55
|
| Rate for Payer: Cofinity Commercial |
$418.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.20
|
| Rate for Payer: Healthscope Commercial |
$437.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.52
|
| Rate for Payer: PHP Commercial |
$413.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.55
|
| Rate for Payer: Priority Health SBD |
$306.50
|
| Rate for Payer: UMR Bronson Commercial |
$214.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.88
|
|
|
METHYLPHENIDATE ER 54 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$565.60
|
|
|
Service Code
|
NDC 13811-709-10
|
| Hospital Charge Code |
29388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.86 |
| Max. Negotiated Rate |
$509.04 |
| Rate for Payer: Aetna American Axle |
$367.64
|
| Rate for Payer: Aetna Commercial |
$480.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.64
|
| Rate for Payer: Cash Price |
$452.48
|
| Rate for Payer: Cofinity Commercial |
$395.92
|
| Rate for Payer: Cofinity Commercial |
$486.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.48
|
| Rate for Payer: Healthscope Commercial |
$509.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.76
|
| Rate for Payer: PHP Commercial |
$480.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.92
|
| Rate for Payer: Priority Health SBD |
$356.33
|
| Rate for Payer: UMR Bronson Commercial |
$248.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.20
|
|
|
METHYLPHENIDATE ER 54 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,554.66
|
|
|
Service Code
|
NDC 50458-587-01
|
| Hospital Charge Code |
29388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,004.05 |
| Max. Negotiated Rate |
$4,099.19 |
| Rate for Payer: Aetna American Axle |
$2,960.53
|
| Rate for Payer: Aetna Commercial |
$3,871.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,960.53
|
| Rate for Payer: Cash Price |
$3,643.73
|
| Rate for Payer: Cofinity Commercial |
$3,188.26
|
| Rate for Payer: Cofinity Commercial |
$3,917.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,643.73
|
| Rate for Payer: Healthscope Commercial |
$4,099.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,188.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,416.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,871.46
|
| Rate for Payer: PHP Commercial |
$3,871.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,188.26
|
| Rate for Payer: Priority Health SBD |
$2,869.44
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,416.00
|
|
|
METHYLPHENIDATE LA 10 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$3,524.40
|
|
|
Service Code
|
NDC 0078-0424-05
|
| Hospital Charge Code |
38387
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,550.74 |
| Max. Negotiated Rate |
$3,171.96 |
| Rate for Payer: Aetna American Axle |
$2,290.86
|
| Rate for Payer: Aetna Commercial |
$2,995.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,290.86
|
| Rate for Payer: Cash Price |
$2,819.52
|
| Rate for Payer: Cofinity Commercial |
$2,467.08
|
| Rate for Payer: Cofinity Commercial |
$3,030.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,819.52
|
| Rate for Payer: Healthscope Commercial |
$3,171.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,467.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,643.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,995.74
|
| Rate for Payer: PHP Commercial |
$2,995.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,467.08
|
| Rate for Payer: Priority Health SBD |
$2,220.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,550.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,643.30
|
|
|
METHYLPREDNISOLONE 16 MG TABLET
|
Facility
|
IP
|
$389.04
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna American Axle |
$252.88
|
| Rate for Payer: Aetna American Axle |
$277.90
|
| Rate for Payer: Aetna American Axle |
$321.55
|
| Rate for Payer: Aetna Commercial |
$420.49
|
| Rate for Payer: Aetna Commercial |
$363.41
|
| Rate for Payer: Aetna Commercial |
$330.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.55
|
| Rate for Payer: Cash Price |
$311.23
|
| Rate for Payer: Cash Price |
$342.03
|
| Rate for Payer: Cash Price |
$395.75
|
| Rate for Payer: Cofinity Commercial |
$346.28
|
| Rate for Payer: Cofinity Commercial |
$425.43
|
| Rate for Payer: Cofinity Commercial |
$334.57
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Cofinity Commercial |
$367.68
|
| Rate for Payer: Cofinity Commercial |
$272.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.23
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: Healthscope Commercial |
$384.79
|
| Rate for Payer: Healthscope Commercial |
$445.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.49
|
| Rate for Payer: PHP Commercial |
$330.68
|
| Rate for Payer: PHP Commercial |
$420.49
|
| Rate for Payer: PHP Commercial |
$363.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.28
|
| Rate for Payer: Priority Health SBD |
$269.35
|
| Rate for Payer: Priority Health SBD |
$245.10
|
| Rate for Payer: Priority Health SBD |
$311.65
|
| Rate for Payer: UMR Bronson Commercial |
$188.12
|
| Rate for Payer: UMR Bronson Commercial |
$171.18
|
| Rate for Payer: UMR Bronson Commercial |
$217.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.02
|
|
|
METHYLPREDNISOLONE 2 MG TABLET
|
Facility
|
IP
|
$732.96
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
10573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$659.66 |
| Rate for Payer: Aetna American Axle |
$476.42
|
| Rate for Payer: Aetna Commercial |
$623.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.42
|
| Rate for Payer: Cash Price |
$586.37
|
| Rate for Payer: Cofinity Commercial |
$513.07
|
| Rate for Payer: Cofinity Commercial |
$630.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.37
|
| Rate for Payer: Healthscope Commercial |
$659.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.02
|
| Rate for Payer: PHP Commercial |
$623.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.07
|
| Rate for Payer: Priority Health SBD |
$461.76
|
| Rate for Payer: UMR Bronson Commercial |
$322.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.72
|
|
|
METHYLPREDNISOLONE 4 MG TABLET
|
Facility
|
IP
|
$250.80
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
4993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna American Axle |
$413.40
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Commercial |
$540.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$445.20
|
| Rate for Payer: Cofinity Commercial |
$546.96
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$572.40
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: PHP Commercial |
$540.60
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.56
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: Priority Health SBD |
$400.68
|
| Rate for Payer: UMR Bronson Commercial |
$279.84
|
| Rate for Payer: UMR Bronson Commercial |
$224.51
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
METHYLPREDNISOLONE 8 MG TABLET
|
Facility
|
IP
|
$179.52
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
10576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.99 |
| Max. Negotiated Rate |
$161.57 |
| Rate for Payer: Aetna American Axle |
$116.69
|
| Rate for Payer: Aetna American Axle |
$86.19
|
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: Aetna Commercial |
$152.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.69
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cash Price |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$154.39
|
| Rate for Payer: Cofinity Commercial |
$125.66
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$161.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.71
|
| Rate for Payer: PHP Commercial |
$152.59
|
| Rate for Payer: PHP Commercial |
$112.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.66
|
| Rate for Payer: Priority Health SBD |
$83.54
|
| Rate for Payer: Priority Health SBD |
$113.10
|
| Rate for Payer: UMR Bronson Commercial |
$58.34
|
| Rate for Payer: UMR Bronson Commercial |
$78.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.64
|
|
