|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$822.50
|
|
|
Service Code
|
NDC 00054039268
|
| 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 Advantage |
$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 Commercial |
$699.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.88
|
| Rate for Payer: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health SBD |
$518.17
|
| 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
|
OP
|
$132.09
|
|
|
Service Code
|
NDC 00054355344
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$118.88 |
| Rate for Payer: Aetna American Axle |
$85.86
|
| Rate for Payer: Aetna Commercial |
$112.28
|
| Rate for Payer: Aetna Medicare |
$66.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.86
|
| Rate for Payer: BCBS Complete |
$52.84
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Advantage |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$113.60
|
| 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: MI Amish Medical Board Commercial |
$105.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: PHP Commercial |
$112.28
|
| Rate for Payer: Priority Health SBD |
$83.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.86
|
| Rate for Payer: UHC Core |
$68.82
|
| Rate for Payer: UHC Exchange |
$51.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.07
|
|
|
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 |
$0.61 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Advantage |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Core |
$0.86
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UMR Bronson Commercial |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$1,540.00
|
|
|
Service Code
|
NDC 00406052710
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna American Axle |
$1,001.00
|
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Aetna Medicare |
$770.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.00
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Advantage |
$1,078.00
|
| Rate for Payer: Cofinity Commercial |
$1,324.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.00
|
| Rate for Payer: Healthscope Commercial |
$1,386.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,078.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,155.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,232.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,155.00
|
| Rate for Payer: PHP Commercial |
$1,309.00
|
| Rate for Payer: Priority Health SBD |
$970.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.00
|
| Rate for Payer: UHC Core |
$802.34
|
| Rate for Payer: UHC Exchange |
$605.22
|
| Rate for Payer: UMR Bronson Commercial |
$569.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,155.00
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 00054355344
|
| 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 Advantage |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$113.60
|
| 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 Commercial |
$112.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: PHP Commercial |
$112.28
|
| 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
|
OP
|
$822.50
|
|
|
Service Code
|
NDC 00054039268
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.32 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Aetna American Axle |
$534.62
|
| Rate for Payer: Aetna Commercial |
$699.12
|
| Rate for Payer: Aetna Medicare |
$411.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.62
|
| Rate for Payer: BCBS Complete |
$329.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$658.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.88
|
| Rate for Payer: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health SBD |
$518.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.62
|
| Rate for Payer: UHC Core |
$428.52
|
| Rate for Payer: UHC Exchange |
$323.24
|
| Rate for Payer: UMR Bronson Commercial |
$304.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.88
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
NDC 00406052710
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$677.60 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna American Axle |
$1,001.00
|
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Advantage |
$1,078.00
|
| Rate for Payer: Cofinity Commercial |
$1,324.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.00
|
| Rate for Payer: Healthscope Commercial |
$1,386.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,078.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,155.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,155.00
|
| Rate for Payer: PHP Commercial |
$1,309.00
|
| Rate for Payer: Priority Health SBD |
$970.20
|
| Rate for Payer: UMR Bronson Commercial |
$677.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,155.00
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$519.75
|
|
|
Service Code
|
NDC 68084073801
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.31 |
| Max. Negotiated Rate |
$467.77 |
| Rate for Payer: Aetna American Axle |
$337.84
|
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Medicare |
$259.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.84
|
| Rate for Payer: BCBS Complete |
$207.90
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cofinity Advantage |
$363.82
|
| Rate for Payer: Cofinity Commercial |
$446.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.80
|
| Rate for Payer: Healthscope Commercial |
$467.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.81
|
| Rate for Payer: PHP Commercial |
$441.79
|
| Rate for Payer: Priority Health SBD |
$327.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.84
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: UHC Exchange |
$204.26
|
| Rate for Payer: UMR Bronson Commercial |
$192.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.81
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.68 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna American Axle |
$375.38
|
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: BCBS Complete |
$231.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Advantage |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$462.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.12
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health SBD |
$363.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.38
|
| Rate for Payer: UHC Core |
$300.88
|
| Rate for Payer: UHC Exchange |
$226.96
|
| Rate for Payer: UMR Bronson Commercial |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna American Axle |
$375.38
|
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Advantage |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.12
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health SBD |
$363.82
|
| Rate for Payer: UMR Bronson Commercial |
$254.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Advantage |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.00
|
| Rate for Payer: PHP Commercial |
$285.60
|
| Rate for Payer: Priority Health SBD |
$211.68
|
| Rate for Payer: UMR Bronson Commercial |
$147.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
NDC 68084073811
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna American Axle |
$3.38
|
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.38
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health SBD |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: UHC Exchange |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.90
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$281.75
|
|
|
Service Code
|
NDC 00054071025
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$253.57 |
| Rate for Payer: Aetna American Axle |
$183.14
|
| Rate for Payer: Aetna Commercial |
$239.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.14
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: Cofinity Advantage |
$197.22
|
| Rate for Payer: Cofinity Commercial |
$242.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.40
|
| Rate for Payer: Healthscope Commercial |
$253.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.31
|
| Rate for Payer: PHP Commercial |
$239.49
|
| Rate for Payer: Priority Health SBD |
$177.50
|
| Rate for Payer: UMR Bronson Commercial |
$123.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.31
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$281.75
|
|
|
Service Code
|
NDC 00054071025
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$253.57 |
| Rate for Payer: Aetna American Axle |
$183.14
|
| Rate for Payer: Aetna Commercial |
$239.49
|
| Rate for Payer: Aetna Medicare |
$140.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.14
|
| Rate for Payer: BCBS Complete |
$112.70
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: Cofinity Advantage |
$197.22
|
| Rate for Payer: Cofinity Commercial |
$242.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.40
|
| Rate for Payer: Healthscope Commercial |
$253.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.31
|
| Rate for Payer: PHP Commercial |
$239.49
|
| Rate for Payer: Priority Health SBD |
$177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.14
|
| Rate for Payer: UHC Core |
$146.79
|
| Rate for Payer: UHC Exchange |
$110.73
|
| Rate for Payer: UMR Bronson Commercial |
$104.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.31
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
NDC 00904741761
|
| 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 Advantage |
$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 Commercial |
$351.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PHP Commercial |
$351.05
|
| 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
|
OP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$168.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Advantage |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.80
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.00
|
| Rate for Payer: PHP Commercial |
$285.60
|
| Rate for Payer: Priority Health SBD |
$211.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.40
|
| Rate for Payer: UHC Core |
$175.06
|
| Rate for Payer: UHC Exchange |
$132.05
|
| Rate for Payer: UMR Bronson Commercial |
$124.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$519.75
|
|
|
Service Code
|
NDC 68084073801
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$467.77 |
| 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 Advantage |
$363.82
|
| Rate for Payer: Cofinity Commercial |
$446.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.80
|
| Rate for Payer: Healthscope Commercial |
$467.77
|
| 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 Commercial |
$441.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.81
|
| Rate for Payer: PHP Commercial |
$441.79
|
| 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 68084073811
|
| 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 Advantage |
$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 Commercial |
$4.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.42
|
| 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
|
OP
|
$413.00
|
|
|
Service Code
|
NDC 00904741761
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.81 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna American Axle |
$268.45
|
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: Aetna Medicare |
$206.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.45
|
| Rate for Payer: BCBS Complete |
$165.20
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$330.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: Priority Health SBD |
$260.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.45
|
| Rate for Payer: UHC Core |
$215.17
|
| Rate for Payer: UHC Exchange |
$162.31
|
| Rate for Payer: UMR Bronson Commercial |
$152.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$11.55
|
|
|
Service Code
|
NDC 00990000101
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna American Axle |
$7.51
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cofinity Advantage |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$10.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.66
|
| Rate for Payer: PHP Commercial |
$9.82
|
| Rate for Payer: Priority Health SBD |
$7.28
|
| Rate for Payer: UMR Bronson Commercial |
$5.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.66
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$36.58
|
|
|
Service Code
|
NDC 68094003159
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna American Axle |
$23.78
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Advantage |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$36.58
|
|
|
Service Code
|
NDC 68094003162
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna American Axle |
$23.78
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Advantage |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC Core |
$19.06
|
| Rate for Payer: UHC Exchange |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$36.58
|
|
|
Service Code
|
NDC 68094003159
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna American Axle |
$23.78
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Advantage |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC Core |
$19.06
|
| Rate for Payer: UHC Exchange |
$14.38
|
| Rate for Payer: UMR Bronson Commercial |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.78
|
|
|
Service Code
|
NDC 00990000171
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna American Axle |
$3.76
|
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.76
|
| Rate for Payer: BCBS Complete |
$2.31
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Advantage |
$4.05
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: Priority Health SBD |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.76
|
| Rate for Payer: UHC Core |
$3.01
|
| Rate for Payer: UHC Exchange |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.33
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
NDC 60687081840
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Advantage |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
