|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
NDC 50268055111
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 51224010750
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.59
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$180.50
|
|
|
Service Code
|
NDC 50268055115
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna American Axle |
$117.33
|
| Rate for Payer: Aetna Commercial |
$153.43
|
| Rate for Payer: Aetna Medicare |
$90.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.33
|
| Rate for Payer: BCBS Complete |
$72.20
|
| Rate for Payer: Cash Price |
$144.40
|
| Rate for Payer: Cofinity Commercial |
$126.35
|
| Rate for Payer: Cofinity Commercial |
$155.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.40
|
| Rate for Payer: Healthscope Commercial |
$162.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.43
|
| Rate for Payer: PHP Commercial |
$153.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.33
|
| Rate for Payer: Priority Health SBD |
$113.72
|
| Rate for Payer: UMR Bronson Commercial |
$66.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.38
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 67877041401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 51224010750
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.06 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.59
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 49483062401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.18
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 49483062401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.18
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
NDC 50268055111
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$285.61
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Aetna American Axle |
$185.65
|
| Rate for Payer: Aetna Commercial |
$242.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.65
|
| Rate for Payer: Cash Price |
$228.49
|
| Rate for Payer: Cofinity Commercial |
$199.93
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.49
|
| Rate for Payer: Healthscope Commercial |
$257.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.77
|
| Rate for Payer: PHP Commercial |
$242.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.65
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: UMR Bronson Commercial |
$125.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.21
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$285.61
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Aetna American Axle |
$185.65
|
| Rate for Payer: Aetna Commercial |
$242.77
|
| Rate for Payer: Aetna Medicare |
$142.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.65
|
| Rate for Payer: BCBS Complete |
$114.24
|
| Rate for Payer: Cash Price |
$228.49
|
| Rate for Payer: Cofinity Commercial |
$199.93
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.49
|
| Rate for Payer: Healthscope Commercial |
$257.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.77
|
| Rate for Payer: PHP Commercial |
$242.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.65
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: UMR Bronson Commercial |
$105.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.21
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,427.80
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$628.23 |
| Max. Negotiated Rate |
$1,285.02 |
| Rate for Payer: Aetna American Axle |
$928.07
|
| Rate for Payer: Aetna American Axle |
$1,292.13
|
| Rate for Payer: Aetna Commercial |
$1,213.63
|
| Rate for Payer: Aetna Commercial |
$1,689.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.13
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cash Price |
$1,590.32
|
| Rate for Payer: Cofinity Commercial |
$1,709.59
|
| Rate for Payer: Cofinity Commercial |
$1,391.53
|
| Rate for Payer: Cofinity Commercial |
$1,227.91
|
| Rate for Payer: Cofinity Commercial |
$999.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$999.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,391.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.32
|
| Rate for Payer: Healthscope Commercial |
$1,285.02
|
| Rate for Payer: Healthscope Commercial |
$1,789.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,391.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,213.63
|
| Rate for Payer: PHP Commercial |
$1,689.71
|
| Rate for Payer: PHP Commercial |
$1,213.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.13
|
| Rate for Payer: Priority Health SBD |
$899.51
|
| Rate for Payer: Priority Health SBD |
$1,252.38
|
| Rate for Payer: UMR Bronson Commercial |
$628.23
|
| Rate for Payer: UMR Bronson Commercial |
$874.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,490.92
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,427.80
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$528.29 |
| Max. Negotiated Rate |
$1,285.02 |
| Rate for Payer: Aetna American Axle |
$928.07
|
| Rate for Payer: Aetna American Axle |
$1,292.13
|
| Rate for Payer: Aetna Commercial |
$1,213.63
|
| Rate for Payer: Aetna Commercial |
$1,689.71
|
| Rate for Payer: Aetna Medicare |
$713.90
|
| Rate for Payer: Aetna Medicare |
$993.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.13
|
| Rate for Payer: BCBS Complete |
$795.16
|
| Rate for Payer: BCBS Complete |
$571.12
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cash Price |
$1,590.32
|
| Rate for Payer: Cofinity Commercial |
$999.46
|
| Rate for Payer: Cofinity Commercial |
$1,227.91
|
| Rate for Payer: Cofinity Commercial |
$1,391.53
|
| Rate for Payer: Cofinity Commercial |
$1,709.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,391.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$999.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.32
|
| Rate for Payer: Healthscope Commercial |
$1,789.11
|
| Rate for Payer: Healthscope Commercial |
$1,285.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,391.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,213.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.71
|
| Rate for Payer: PHP Commercial |
$1,689.71
|
| Rate for Payer: PHP Commercial |
$1,213.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.13
|
| Rate for Payer: Priority Health SBD |
$1,252.38
|
| Rate for Payer: Priority Health SBD |
$899.51
|
| Rate for Payer: UMR Bronson Commercial |
$528.29
|
| Rate for Payer: UMR Bronson Commercial |
$735.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,490.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.85
|
|
|
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 Commercial |
$575.75
|
| Rate for Payer: Cofinity Commercial |
$707.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.75
|
| 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: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.62
|
| 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
|
IP
|
$1,172.50
|
|
|
Service Code
|
NDC 00406052710
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$515.90 |
| Max. Negotiated Rate |
$1,055.25 |
| Rate for Payer: Aetna American Axle |
$762.12
|
| Rate for Payer: Aetna Commercial |
$996.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.12
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: Cofinity Commercial |
$1,008.35
|
| Rate for Payer: Cofinity Commercial |
$820.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$820.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$938.00
|
| Rate for Payer: Healthscope Commercial |
$1,055.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.62
|
| Rate for Payer: PHP Commercial |
$996.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$762.12
|
| Rate for Payer: Priority Health SBD |
$738.67
|
| Rate for Payer: UMR Bronson Commercial |
$515.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.38
|
|
|
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 Commercial |
$575.75
|
| Rate for Payer: Cofinity Commercial |
$707.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$575.75
|
| 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: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.62
|
| Rate for Payer: Priority Health SBD |
$518.17
|
| 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
|
$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 Commercial |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$118.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: PHP Commercial |
$112.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: Priority Health SBD |
$83.22
|
| Rate for Payer: UMR Bronson Commercial |
$58.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.07
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 09900001004
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.16
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health SBD |
$1.04
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
|
METHADONE 10 MG/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 Commercial |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.16
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.07
|
| Rate for Payer: Priority Health SBD |
$1.04
|
| 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
|
$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 Commercial |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$118.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: PHP Commercial |
$112.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.86
|
| Rate for Payer: Priority Health SBD |
$83.22
|
| 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
|
$1,172.50
|
|
|
Service Code
|
NDC 00406052710
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.82 |
| Max. Negotiated Rate |
$1,055.25 |
| Rate for Payer: Aetna American Axle |
$762.12
|
| Rate for Payer: Aetna Commercial |
$996.62
|
| Rate for Payer: Aetna Medicare |
$586.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.12
|
| Rate for Payer: BCBS Complete |
$469.00
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: Cofinity Commercial |
$1,008.35
|
| Rate for Payer: Cofinity Commercial |
$820.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$820.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$938.00
|
| Rate for Payer: Healthscope Commercial |
$1,055.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.62
|
| Rate for Payer: PHP Commercial |
$996.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$762.12
|
| Rate for Payer: Priority Health SBD |
$738.67
|
| Rate for Payer: UMR Bronson Commercial |
$433.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.38
|
|
|
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 Commercial |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.64
|
| 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: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.38
|
| 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
|
$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 Commercial |
$363.82
|
| Rate for Payer: Cofinity Commercial |
$446.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.82
|
| 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: PHP Commercial |
$441.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.84
|
| Rate for Payer: Priority Health SBD |
$327.44
|
| Rate for Payer: UMR Bronson Commercial |
$192.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.81
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
NDC 00904741761
|
| 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 Commercial |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$288.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.20
|
| 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: PHP Commercial |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| 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 Commercial |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.64
|
| 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: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.38
|
| Rate for Payer: Priority Health SBD |
$3.28
|
| 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
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna American Axle |
$280.96
|
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.96
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$302.57
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.96
|
| Rate for Payer: Priority Health SBD |
$272.32
|
| Rate for Payer: UMR Bronson Commercial |
$190.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
