|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 00054355563
|
| Hospital Charge Code |
4952
|
|
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 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$36.58
|
|
|
Service Code
|
NDC 68094003162
|
| 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
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 00054355563
|
| Hospital Charge Code |
4952
|
|
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 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
NDC 60687081886
|
| 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
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 09900000027
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna American Axle |
$0.75
|
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.75
|
| Rate for Payer: BCBS Complete |
$0.46
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cofinity Advantage |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$1.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.75
|
| Rate for Payer: UHC Core |
$0.60
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UMR Bronson Commercial |
$0.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.87
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 09900000026
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna American Axle |
$0.08
|
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cofinity Advantage |
$0.08
|
| Rate for Payer: Cofinity Commercial |
$0.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.10
|
| Rate for Payer: Healthscope Commercial |
$0.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: Priority Health SBD |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.09
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
NDC 60687081886
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| 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: MI Amish Medical Board Commercial |
$26.11
|
| 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: UHC All Payor (Choice/PPO) |
$21.22
|
| Rate for Payer: UHC Core |
$17.01
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
NDC 60687081840
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| 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: MI Amish Medical Board Commercial |
$26.11
|
| 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: UHC All Payor (Choice/PPO) |
$21.22
|
| Rate for Payer: UHC Core |
$17.01
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 09900000027
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna American Axle |
$0.75
|
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.75
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cofinity Advantage |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$1.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.73
|
| Rate for Payer: UMR Bronson Commercial |
$0.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.87
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$11.55
|
|
|
Service Code
|
NDC 00990000101
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna American Axle |
$7.51
|
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.51
|
| Rate for Payer: BCBS Complete |
$4.62
|
| 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: MI Amish Medical Board Commercial |
$9.24
|
| 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: UHC All Payor (Choice/PPO) |
$7.51
|
| Rate for Payer: UHC Core |
$6.02
|
| Rate for Payer: UHC Exchange |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.66
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.78
|
|
|
Service Code
|
NDC 00990000171
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna American Axle |
$3.76
|
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.76
|
| 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: 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: UMR Bronson Commercial |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.33
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 09900000026
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna American Axle |
$0.08
|
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna Medicare |
$0.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.08
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cofinity Advantage |
$0.08
|
| Rate for Payer: Cofinity Commercial |
$0.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.10
|
| Rate for Payer: Healthscope Commercial |
$0.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: Priority Health SBD |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.06
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.09
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 00406575523
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$607.25
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.19 |
| Max. Negotiated Rate |
$546.52 |
| Rate for Payer: Aetna American Axle |
$394.71
|
| Rate for Payer: Aetna Commercial |
$516.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.71
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cofinity Advantage |
$425.07
|
| Rate for Payer: Cofinity Commercial |
$522.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.80
|
| Rate for Payer: Healthscope Commercial |
$546.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$425.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.44
|
| Rate for Payer: PHP Commercial |
$516.16
|
| Rate for Payer: Priority Health SBD |
$382.57
|
| Rate for Payer: UMR Bronson Commercial |
$267.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.44
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 00406575523
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$2.43
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.95
|
| Rate for Payer: UHC Core |
$3.17
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$607.25
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$546.52 |
| Rate for Payer: Aetna American Axle |
$394.71
|
| Rate for Payer: Aetna Commercial |
$516.16
|
| Rate for Payer: Aetna Medicare |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.71
|
| Rate for Payer: BCBS Complete |
$242.90
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cofinity Advantage |
$425.07
|
| Rate for Payer: Cofinity Commercial |
$522.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.80
|
| Rate for Payer: Healthscope Commercial |
$546.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$425.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$485.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.44
|
| Rate for Payer: PHP Commercial |
$516.16
|
| Rate for Payer: Priority Health SBD |
$382.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.71
|
| Rate for Payer: UHC Core |
$316.38
|
| Rate for Payer: UHC Exchange |
$238.65
|
| Rate for Payer: UMR Bronson Commercial |
$224.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.44
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$711.36
|
|
|
Service Code
|
NDC 62559024001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$640.22 |
| Rate for Payer: Aetna American Axle |
$462.38
|
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.38
|
| Rate for Payer: Cash Price |
$569.09
|
| Rate for Payer: Cofinity Advantage |
$497.95
|
| Rate for Payer: Cofinity Commercial |
$611.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.09
|
| Rate for Payer: Healthscope Commercial |
$640.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$533.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$533.52
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: Priority Health SBD |
$448.16
|
| Rate for Payer: UMR Bronson Commercial |
$313.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$533.52
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$513.12
|
|
|
Service Code
|
NDC 68682002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.85 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna Medicare |
$256.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: BCBS Complete |
$205.25
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Advantage |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$384.84
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.53
|
| Rate for Payer: UHC Core |
$267.34
|
| Rate for Payer: UHC Exchange |
$201.66
|
| Rate for Payer: UMR Bronson Commercial |
$189.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$791.43
|
|
|
Service Code
|
NDC 00574079001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.23 |
| Max. Negotiated Rate |
$712.29 |
| Rate for Payer: Aetna American Axle |
$514.43
|
| Rate for Payer: Aetna Commercial |
$672.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.43
|
| Rate for Payer: Cash Price |
$633.14
|
| Rate for Payer: Cofinity Advantage |
$554.00
|
| Rate for Payer: Cofinity Commercial |
$680.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.14
|
| Rate for Payer: Healthscope Commercial |
$712.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.57
|
| Rate for Payer: PHP Commercial |
$672.72
|
| Rate for Payer: Priority Health SBD |
$498.60
|
| Rate for Payer: UMR Bronson Commercial |
$348.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.57
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$585.60
|
|
|
Service Code
|
NDC 24208002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.66 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Aetna American Axle |
$380.64
|
| Rate for Payer: Aetna Commercial |
$497.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.64
|
| Rate for Payer: Cash Price |
$468.48
|
| Rate for Payer: Cofinity Advantage |
$409.92
|
| Rate for Payer: Cofinity Commercial |
$503.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.48
|
| Rate for Payer: Healthscope Commercial |
$527.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.20
|
| Rate for Payer: PHP Commercial |
$497.76
|
| Rate for Payer: Priority Health SBD |
$368.93
|
| Rate for Payer: UMR Bronson Commercial |
$257.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.20
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$585.60
|
|
|
Service Code
|
NDC 24208002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.67 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Aetna American Axle |
$380.64
|
| Rate for Payer: Aetna Commercial |
$497.76
|
| Rate for Payer: Aetna Medicare |
$292.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.64
|
| Rate for Payer: BCBS Complete |
$234.24
|
| Rate for Payer: Cash Price |
$468.48
|
| Rate for Payer: Cofinity Advantage |
$409.92
|
| Rate for Payer: Cofinity Commercial |
$503.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.48
|
| Rate for Payer: Healthscope Commercial |
$527.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$468.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.20
|
| Rate for Payer: PHP Commercial |
$497.76
|
| Rate for Payer: Priority Health SBD |
$368.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.64
|
| Rate for Payer: UHC Core |
$305.10
|
| Rate for Payer: UHC Exchange |
$230.14
|
| Rate for Payer: UMR Bronson Commercial |
$216.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.20
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$711.36
|
|
|
Service Code
|
NDC 62559024001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$640.22 |
| Rate for Payer: Aetna American Axle |
$462.38
|
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Medicare |
$355.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.38
|
| Rate for Payer: BCBS Complete |
$284.54
|
| Rate for Payer: Cash Price |
$569.09
|
| Rate for Payer: Cofinity Advantage |
$497.95
|
| Rate for Payer: Cofinity Commercial |
$611.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.09
|
| Rate for Payer: Healthscope Commercial |
$640.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$533.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$569.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$533.52
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: Priority Health SBD |
$448.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.38
|
| Rate for Payer: UHC Core |
$370.62
|
| Rate for Payer: UHC Exchange |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$263.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$533.52
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$513.12
|
|
|
Service Code
|
NDC 68682002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.77 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Advantage |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$384.84
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UMR Bronson Commercial |
$225.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$791.43
|
|
|
Service Code
|
NDC 00574079001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.83 |
| Max. Negotiated Rate |
$712.29 |
| Rate for Payer: Aetna American Axle |
$514.43
|
| Rate for Payer: Aetna Commercial |
$672.72
|
| Rate for Payer: Aetna Medicare |
$395.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.43
|
| Rate for Payer: BCBS Complete |
$316.57
|
| Rate for Payer: Cash Price |
$633.14
|
| Rate for Payer: Cofinity Advantage |
$554.00
|
| Rate for Payer: Cofinity Commercial |
$680.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.14
|
| Rate for Payer: Healthscope Commercial |
$712.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.57
|
| Rate for Payer: PHP Commercial |
$672.72
|
| Rate for Payer: Priority Health SBD |
$498.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.43
|
| Rate for Payer: UHC Core |
$412.34
|
| Rate for Payer: UHC Exchange |
$311.03
|
| Rate for Payer: UMR Bronson Commercial |
$292.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.57
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$328.80
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.66 |
| Max. Negotiated Rate |
$295.92 |
| Rate for Payer: Aetna American Axle |
$213.72
|
| Rate for Payer: Aetna Commercial |
$279.48
|
| Rate for Payer: Aetna Medicare |
$164.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.72
|
| Rate for Payer: BCBS Complete |
$131.52
|
| Rate for Payer: Cash Price |
$263.04
|
| Rate for Payer: Cofinity Advantage |
$230.16
|
| Rate for Payer: Cofinity Commercial |
$282.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.04
|
| Rate for Payer: Healthscope Commercial |
$295.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.60
|
| Rate for Payer: PHP Commercial |
$279.48
|
| Rate for Payer: Priority Health SBD |
$207.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.72
|
| Rate for Payer: UHC Core |
$171.30
|
| Rate for Payer: UHC Exchange |
$129.22
|
| Rate for Payer: UMR Bronson Commercial |
$121.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.60
|
|
