|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$579.11
|
|
|
Service Code
|
NDC 70010078612
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.81 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Aetna American Axle |
$376.42
|
| Rate for Payer: Aetna Commercial |
$492.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.42
|
| Rate for Payer: Cash Price |
$463.29
|
| Rate for Payer: Cofinity Advantage |
$405.38
|
| Rate for Payer: Cofinity Commercial |
$498.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.29
|
| Rate for Payer: Healthscope Commercial |
$521.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.33
|
| Rate for Payer: PHP Commercial |
$492.24
|
| Rate for Payer: Priority Health SBD |
$364.84
|
| Rate for Payer: UMR Bronson Commercial |
$254.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.33
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$3,595.15
|
|
|
Service Code
|
NDC 00904728210
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,330.21 |
| Max. Negotiated Rate |
$3,235.64 |
| Rate for Payer: Aetna American Axle |
$2,336.85
|
| Rate for Payer: Aetna Commercial |
$3,055.88
|
| Rate for Payer: Aetna Medicare |
$1,797.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,336.85
|
| Rate for Payer: BCBS Complete |
$1,438.06
|
| Rate for Payer: Cash Price |
$2,876.12
|
| Rate for Payer: Cofinity Advantage |
$2,516.61
|
| Rate for Payer: Cofinity Commercial |
$3,091.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,876.12
|
| Rate for Payer: Healthscope Commercial |
$3,235.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,516.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,696.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,876.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,055.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,696.36
|
| Rate for Payer: PHP Commercial |
$3,055.88
|
| Rate for Payer: Priority Health SBD |
$2,264.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,336.85
|
| Rate for Payer: UHC Core |
$1,873.07
|
| Rate for Payer: UHC Exchange |
$1,412.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,330.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,696.36
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$549.19
|
|
|
Service Code
|
NDC 16571073521
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$494.27 |
| Rate for Payer: Aetna American Axle |
$356.97
|
| Rate for Payer: Aetna Commercial |
$466.81
|
| Rate for Payer: Aetna Medicare |
$274.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.97
|
| Rate for Payer: BCBS Complete |
$219.68
|
| Rate for Payer: Cash Price |
$439.35
|
| Rate for Payer: Cofinity Advantage |
$384.43
|
| Rate for Payer: Cofinity Commercial |
$472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.35
|
| Rate for Payer: Healthscope Commercial |
$494.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.89
|
| Rate for Payer: PHP Commercial |
$466.81
|
| Rate for Payer: Priority Health SBD |
$345.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.97
|
| Rate for Payer: UHC Core |
$286.13
|
| Rate for Payer: UHC Exchange |
$215.83
|
| Rate for Payer: UMR Bronson Commercial |
$203.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.89
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$1,589.75
|
|
|
Service Code
|
NDC 69238160508
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$699.49 |
| Max. Negotiated Rate |
$1,430.78 |
| Rate for Payer: Aetna American Axle |
$1,033.34
|
| Rate for Payer: Aetna Commercial |
$1,351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.34
|
| Rate for Payer: Cash Price |
$1,271.80
|
| Rate for Payer: Cofinity Advantage |
$1,112.83
|
| Rate for Payer: Cofinity Commercial |
$1,367.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.80
|
| Rate for Payer: Healthscope Commercial |
$1,430.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,112.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,192.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,192.31
|
| Rate for Payer: PHP Commercial |
$1,351.29
|
| Rate for Payer: Priority Health SBD |
$1,001.54
|
| Rate for Payer: UMR Bronson Commercial |
$699.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$579.11
|
|
|
Service Code
|
NDC 70010078612
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.27 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Aetna American Axle |
$376.42
|
| Rate for Payer: Aetna Commercial |
$492.24
|
| Rate for Payer: Aetna Medicare |
$289.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.42
|
| Rate for Payer: BCBS Complete |
$231.64
|
| Rate for Payer: Cash Price |
$463.29
|
| Rate for Payer: Cofinity Advantage |
$405.38
|
| Rate for Payer: Cofinity Commercial |
$498.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.29
|
| Rate for Payer: Healthscope Commercial |
$521.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$463.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.33
|
| Rate for Payer: PHP Commercial |
$492.24
|
| Rate for Payer: Priority Health SBD |
$364.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.42
|
| Rate for Payer: UHC Core |
$301.72
|
| Rate for Payer: UHC Exchange |
$227.59
|
| Rate for Payer: UMR Bronson Commercial |
$214.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.33
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$1,177.73
|
|
|
Service Code
|
NDC 16571073528
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.76 |
| Max. Negotiated Rate |
$1,059.96 |
| Rate for Payer: Aetna American Axle |
$765.52
|
| Rate for Payer: Aetna Commercial |
$1,001.07
|
| Rate for Payer: Aetna Medicare |
$588.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.52
|
| Rate for Payer: BCBS Complete |
$471.09
|
| Rate for Payer: Cash Price |
$942.18
|
| Rate for Payer: Cofinity Advantage |
$824.41
|
| Rate for Payer: Cofinity Commercial |
$1,012.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.18
|
| Rate for Payer: Healthscope Commercial |
$1,059.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$824.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$942.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$883.30
|
| Rate for Payer: PHP Commercial |
$1,001.07
|
| Rate for Payer: Priority Health SBD |
$741.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.52
|
| Rate for Payer: UHC Core |
$613.60
|
| Rate for Payer: UHC Exchange |
$462.85
|
| Rate for Payer: UMR Bronson Commercial |
$435.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.30
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$616.53
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$271.27 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna American Axle |
$400.74
|
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.74
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cofinity Advantage |
$431.57
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: Priority Health SBD |
$388.41
|
| Rate for Payer: UMR Bronson Commercial |
$271.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$616.53
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna American Axle |
$400.74
|
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: Aetna Medicare |
$308.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.74
|
| Rate for Payer: BCBS Complete |
$246.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.47
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cofinity Advantage |
$431.57
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.65
|
| Rate for Payer: Priority Health SBD |
$388.41
|
| Rate for Payer: Priority Health Tiered Network |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.47
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$228.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$616.56
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
159006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$554.90 |
| Rate for Payer: Aetna American Axle |
$400.76
|
| Rate for Payer: Aetna American Axle |
$400.74
|
| Rate for Payer: Aetna Commercial |
$524.08
|
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: Aetna Medicare |
$308.28
|
| Rate for Payer: Aetna Medicare |
$308.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.76
|
| Rate for Payer: BCBS Complete |
$246.62
|
| Rate for Payer: BCBS Complete |
$246.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.47
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$493.25
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cash Price |
$493.25
|
| Rate for Payer: Cofinity Advantage |
$431.59
|
| Rate for Payer: Cofinity Advantage |
$431.57
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Cofinity Commercial |
$530.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Healthscope Commercial |
$554.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: PHP Commercial |
$524.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.65
|
| Rate for Payer: Priority Health SBD |
$388.43
|
| Rate for Payer: Priority Health SBD |
$388.41
|
| Rate for Payer: Priority Health Tiered Network |
$1.32
|
| Rate for Payer: Priority Health Tiered Network |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.47
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$228.12
|
| Rate for Payer: UMR Bronson Commercial |
$228.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.42
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$616.53
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
159006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$271.27 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna American Axle |
$400.74
|
| Rate for Payer: Aetna American Axle |
$400.76
|
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: Aetna Commercial |
$524.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.76
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cash Price |
$493.25
|
| Rate for Payer: Cofinity Advantage |
$431.59
|
| Rate for Payer: Cofinity Advantage |
$431.57
|
| Rate for Payer: Cofinity Commercial |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.25
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Healthscope Commercial |
$554.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.42
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: PHP Commercial |
$524.08
|
| Rate for Payer: Priority Health SBD |
$388.43
|
| Rate for Payer: Priority Health SBD |
$388.41
|
| Rate for Payer: UMR Bronson Commercial |
$271.27
|
| Rate for Payer: UMR Bronson Commercial |
$271.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.42
|
|
|
METHYLPARABEN (BULK) POWDER
|
Facility
|
OP
|
$124.20
|
|
|
Service Code
|
NDC 38779143904
|
| Hospital Charge Code |
13296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$62.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: BCBS Complete |
$49.68
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Advantage |
$86.94
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.15
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.73
|
| Rate for Payer: UHC Core |
$64.71
|
| Rate for Payer: UHC Exchange |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$45.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
METHYLPARABEN (BULK) POWDER
|
Facility
|
IP
|
$124.20
|
|
|
Service Code
|
NDC 38779143904
|
| Hospital Charge Code |
13296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Aetna American Axle |
$80.73
|
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.73
|
| Rate for Payer: Cash Price |
$99.36
|
| Rate for Payer: Cofinity Advantage |
$86.94
|
| Rate for Payer: Cofinity Commercial |
$106.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$111.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.15
|
| Rate for Payer: PHP Commercial |
$105.57
|
| Rate for Payer: Priority Health SBD |
$78.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.15
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$281.75
|
|
|
Service Code
|
NDC 10702010101
|
| Hospital Charge Code |
4986
|
|
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
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
NDC 57664022988
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna Medicare |
$238.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: BCBS Complete |
$190.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Advantage |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$380.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.00
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.40
|
| Rate for Payer: UHC Core |
$248.00
|
| Rate for Payer: UHC Exchange |
$187.07
|
| Rate for Payer: UMR Bronson Commercial |
$176.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$281.75
|
|
|
Service Code
|
NDC 10702010101
|
| Hospital Charge Code |
4986
|
|
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
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: BCBS Complete |
$182.70
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Advantage |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.89
|
| Rate for Payer: UHC Core |
$237.97
|
| Rate for Payer: UHC Exchange |
$179.50
|
| Rate for Payer: UMR Bronson Commercial |
$169.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$411.07 |
| 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 Advantage |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PHP Commercial |
$388.24
|
| 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
|
$476.00
|
|
|
Service Code
|
NDC 57664022988
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Advantage |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.00
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UMR Bronson Commercial |
$209.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$208.68
|
|
|
Service Code
|
NDC 54092055201
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna American Axle |
$135.64
|
| Rate for Payer: Aetna Commercial |
$177.38
|
| Rate for Payer: Aetna Medicare |
$104.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.64
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cofinity Advantage |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.46
|
| 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: MI Amish Medical Board Commercial |
$166.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.51
|
| Rate for Payer: PHP Commercial |
$177.38
|
| Rate for Payer: Priority Health SBD |
$131.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.64
|
| Rate for Payer: UHC Core |
$108.72
|
| Rate for Payer: UHC Exchange |
$82.01
|
| Rate for Payer: UMR Bronson Commercial |
$77.21
|
| 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 68968555303
|
| 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 Advantage |
$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 Commercial |
$528.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.04
|
| Rate for Payer: PHP Commercial |
$528.17
|
| 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 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$621.38
|
|
|
Service Code
|
NDC 68968555303
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$559.24 |
| Rate for Payer: Aetna American Axle |
$403.90
|
| Rate for Payer: Aetna Commercial |
$528.17
|
| Rate for Payer: Aetna Medicare |
$310.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.90
|
| Rate for Payer: BCBS Complete |
$248.55
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$497.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.04
|
| Rate for Payer: PHP Commercial |
$528.17
|
| Rate for Payer: Priority Health SBD |
$391.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.90
|
| Rate for Payer: UHC Core |
$323.74
|
| Rate for Payer: UHC Exchange |
$244.20
|
| Rate for Payer: UMR Bronson Commercial |
$229.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.04
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$208.68
|
|
|
Service Code
|
NDC 54092055201
|
| 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 Advantage |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.46
|
| 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 Commercial |
$177.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.51
|
| Rate for Payer: PHP Commercial |
$177.38
|
| 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 2.5 MG CUSTOM TAB
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
NDC 09900000012
|
| Hospital Charge Code |
150703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna American Axle |
$63.70
|
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$78.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.50
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.70
|
| Rate for Payer: UHC Core |
$51.06
|
| Rate for Payer: UHC Exchange |
$38.51
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
METHYLPHENIDATE 2.5 MG CUSTOM TAB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
NDC 09900000012
|
| 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 Advantage |
$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 Commercial |
$83.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.50
|
| Rate for Payer: PHP Commercial |
$83.30
|
| 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
|
OP
|
$320.25
|
|
|
Service Code
|
NDC 31722017301
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.49 |
| Max. Negotiated Rate |
$288.23 |
| Rate for Payer: Aetna American Axle |
$208.16
|
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: Aetna Medicare |
$160.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.16
|
| Rate for Payer: BCBS Complete |
$128.10
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity Advantage |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.19
|
| Rate for Payer: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health SBD |
$201.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.16
|
| Rate for Payer: UHC Core |
$166.85
|
| Rate for Payer: UHC Exchange |
$125.86
|
| Rate for Payer: UMR Bronson Commercial |
$118.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
