|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$83.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 68084080511
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna American Axle |
$6.41
|
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.41
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cofinity Advantage |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.89
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: PHP Commercial |
$8.38
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: UMR Bronson Commercial |
$4.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$295.78
|
|
|
Service Code
|
NDC 68084080521
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.44 |
| Max. Negotiated Rate |
$266.20 |
| Rate for Payer: Aetna American Axle |
$192.26
|
| Rate for Payer: Aetna Commercial |
$251.41
|
| Rate for Payer: Aetna Medicare |
$147.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.26
|
| Rate for Payer: BCBS Complete |
$118.31
|
| Rate for Payer: Cash Price |
$236.62
|
| Rate for Payer: Cofinity Advantage |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$254.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.62
|
| Rate for Payer: Healthscope Commercial |
$266.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.84
|
| Rate for Payer: PHP Commercial |
$251.41
|
| Rate for Payer: Priority Health SBD |
$186.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.26
|
| Rate for Payer: UHC Core |
$154.10
|
| Rate for Payer: UHC Exchange |
$116.24
|
| Rate for Payer: UMR Bronson Commercial |
$109.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.84
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$320.25
|
|
|
Service Code
|
NDC 00406114201
|
| 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
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$320.25
|
|
|
Service Code
|
NDC 00406114201
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$288.23 |
| Rate for Payer: Aetna American Axle |
$208.16
|
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.16
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$140.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.85
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Exchange |
$74.28
|
| Rate for Payer: UMR Bronson Commercial |
$69.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 68084080511
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna American Axle |
$6.41
|
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.41
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cofinity Advantage |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.89
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: PHP Commercial |
$8.38
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$5.14
|
| Rate for Payer: UHC Exchange |
$3.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$295.78
|
|
|
Service Code
|
NDC 68084080521
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$266.20 |
| Rate for Payer: Aetna American Axle |
$192.26
|
| Rate for Payer: Aetna Commercial |
$251.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.26
|
| Rate for Payer: Cash Price |
$236.62
|
| Rate for Payer: Cofinity Advantage |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$254.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.62
|
| Rate for Payer: Healthscope Commercial |
$266.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.84
|
| Rate for Payer: PHP Commercial |
$251.41
|
| Rate for Payer: Priority Health SBD |
$186.34
|
| Rate for Payer: UMR Bronson Commercial |
$130.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.84
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$320.25
|
|
|
Service Code
|
NDC 31722017301
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$288.23 |
| Rate for Payer: Aetna American Axle |
$208.16
|
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.16
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$140.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$470.40
|
|
|
Service Code
|
NDC 13811070610
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.98 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna American Axle |
$305.76
|
| Rate for Payer: Aetna Commercial |
$399.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.76
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Advantage |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.32
|
| Rate for Payer: Healthscope Commercial |
$423.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.80
|
| Rate for Payer: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health SBD |
$296.35
|
| Rate for Payer: UMR Bronson Commercial |
$206.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.80
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,958.68
|
|
|
Service Code
|
NDC 50458058501
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,464.71 |
| Max. Negotiated Rate |
$3,562.81 |
| Rate for Payer: Aetna American Axle |
$2,573.14
|
| Rate for Payer: Aetna Commercial |
$3,364.88
|
| Rate for Payer: Aetna Medicare |
$1,979.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,573.14
|
| Rate for Payer: BCBS Complete |
$1,583.47
|
| Rate for Payer: Cash Price |
$3,166.94
|
| Rate for Payer: Cofinity Advantage |
$2,771.08
|
| Rate for Payer: Cofinity Commercial |
$3,404.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,166.94
|
| Rate for Payer: Healthscope Commercial |
$3,562.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,771.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,969.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,166.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,364.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,969.01
|
| Rate for Payer: PHP Commercial |
$3,364.88
|
| Rate for Payer: Priority Health SBD |
$2,493.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.14
|
| Rate for Payer: UHC Core |
$2,062.47
|
| Rate for Payer: UHC Exchange |
$1,555.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,464.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,969.01
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 60687053211
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna American Axle |
$9.84
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.84
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cofinity Advantage |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: PHP Commercial |
$12.87
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,958.68
|
|
|
Service Code
|
NDC 50458058501
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,741.82 |
| Max. Negotiated Rate |
$3,562.81 |
| Rate for Payer: Aetna American Axle |
$2,573.14
|
| Rate for Payer: Aetna Commercial |
$3,364.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,573.14
|
| Rate for Payer: Cash Price |
$3,166.94
|
| Rate for Payer: Cofinity Advantage |
$2,771.08
|
| Rate for Payer: Cofinity Commercial |
$3,404.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,166.94
|
| Rate for Payer: Healthscope Commercial |
$3,562.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,771.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,969.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,364.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,969.01
|
| Rate for Payer: PHP Commercial |
$3,364.88
|
| Rate for Payer: Priority Health SBD |
$2,493.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,741.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,969.01
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$454.20
|
|
|
Service Code
|
NDC 60687053221
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.05 |
| Max. Negotiated Rate |
$408.78 |
| Rate for Payer: Aetna American Axle |
$295.23
|
| Rate for Payer: Aetna Commercial |
$386.07
|
| Rate for Payer: Aetna Medicare |
$227.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.23
|
| Rate for Payer: BCBS Complete |
$181.68
|
| Rate for Payer: Cash Price |
$363.36
|
| Rate for Payer: Cofinity Advantage |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$390.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.36
|
| Rate for Payer: Healthscope Commercial |
$408.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.65
|
| Rate for Payer: PHP Commercial |
$386.07
|
| Rate for Payer: Priority Health SBD |
$286.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.23
|
| Rate for Payer: UHC Core |
$236.64
|
| Rate for Payer: UHC Exchange |
$178.50
|
| Rate for Payer: UMR Bronson Commercial |
$168.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.65
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$470.40
|
|
|
Service Code
|
NDC 13811070610
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.05 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna American Axle |
$305.76
|
| Rate for Payer: Aetna Commercial |
$399.84
|
| Rate for Payer: Aetna Medicare |
$235.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.76
|
| Rate for Payer: BCBS Complete |
$188.16
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Advantage |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.32
|
| Rate for Payer: Healthscope Commercial |
$423.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.80
|
| Rate for Payer: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health SBD |
$296.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.76
|
| Rate for Payer: UHC Core |
$245.08
|
| Rate for Payer: UHC Exchange |
$184.87
|
| Rate for Payer: UMR Bronson Commercial |
$174.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.80
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$15.14
|
|
|
Service Code
|
NDC 60687053211
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna American Axle |
$9.84
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.84
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cofinity Advantage |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: PHP Commercial |
$12.87
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.84
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: UHC Exchange |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$5.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$454.20
|
|
|
Service Code
|
NDC 60687053221
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.85 |
| Max. Negotiated Rate |
$408.78 |
| Rate for Payer: Aetna American Axle |
$295.23
|
| Rate for Payer: Aetna Commercial |
$386.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.23
|
| Rate for Payer: Cash Price |
$363.36
|
| Rate for Payer: Cofinity Advantage |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$390.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.36
|
| Rate for Payer: Healthscope Commercial |
$408.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.65
|
| Rate for Payer: PHP Commercial |
$386.07
|
| Rate for Payer: Priority Health SBD |
$286.15
|
| Rate for Payer: UMR Bronson Commercial |
$199.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.65
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
NDC 00406147301
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.13 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna American Axle |
$486.85
|
| Rate for Payer: Aetna Commercial |
$636.65
|
| Rate for Payer: Aetna Medicare |
$374.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.85
|
| Rate for Payer: BCBS Complete |
$299.60
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cofinity Advantage |
$524.30
|
| Rate for Payer: Cofinity Commercial |
$644.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.20
|
| Rate for Payer: Healthscope Commercial |
$674.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.75
|
| Rate for Payer: PHP Commercial |
$636.65
|
| Rate for Payer: Priority Health SBD |
$471.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.85
|
| Rate for Payer: UHC Core |
$390.23
|
| Rate for Payer: UHC Exchange |
$294.36
|
| Rate for Payer: UMR Bronson Commercial |
$277.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.75
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$929.25
|
|
|
Service Code
|
NDC 10702007601
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.82 |
| Max. Negotiated Rate |
$836.33 |
| Rate for Payer: Aetna American Axle |
$604.01
|
| Rate for Payer: Aetna Commercial |
$789.86
|
| Rate for Payer: Aetna Medicare |
$464.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.01
|
| Rate for Payer: BCBS Complete |
$371.70
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cofinity Advantage |
$650.48
|
| Rate for Payer: Cofinity Commercial |
$799.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.40
|
| Rate for Payer: Healthscope Commercial |
$836.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$743.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.94
|
| Rate for Payer: PHP Commercial |
$789.86
|
| Rate for Payer: Priority Health SBD |
$585.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.01
|
| Rate for Payer: UHC Core |
$484.14
|
| Rate for Payer: UHC Exchange |
$365.20
|
| Rate for Payer: UMR Bronson Commercial |
$343.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.94
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
NDC 00406147301
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.56 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna American Axle |
$486.85
|
| Rate for Payer: Aetna Commercial |
$636.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.85
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cofinity Advantage |
$524.30
|
| Rate for Payer: Cofinity Commercial |
$644.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.20
|
| Rate for Payer: Healthscope Commercial |
$674.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.75
|
| Rate for Payer: PHP Commercial |
$636.65
|
| Rate for Payer: Priority Health SBD |
$471.87
|
| Rate for Payer: UMR Bronson Commercial |
$329.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.75
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$929.25
|
|
|
Service Code
|
NDC 10702007601
|
| Hospital Charge Code |
4989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.87 |
| Max. Negotiated Rate |
$836.33 |
| Rate for Payer: Aetna American Axle |
$604.01
|
| Rate for Payer: Aetna Commercial |
$789.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.01
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cofinity Advantage |
$650.48
|
| Rate for Payer: Cofinity Commercial |
$799.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.40
|
| Rate for Payer: Healthscope Commercial |
$836.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$650.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.94
|
| Rate for Payer: PHP Commercial |
$789.86
|
| Rate for Payer: Priority Health SBD |
$585.43
|
| Rate for Payer: UMR Bronson Commercial |
$408.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.94
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,058.01
|
|
|
Service Code
|
NDC 50458058801
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,501.46 |
| Max. Negotiated Rate |
$3,652.21 |
| Rate for Payer: Aetna American Axle |
$2,637.71
|
| Rate for Payer: Aetna Commercial |
$3,449.31
|
| Rate for Payer: Aetna Medicare |
$2,029.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.71
|
| Rate for Payer: BCBS Complete |
$1,623.20
|
| Rate for Payer: Cash Price |
$3,246.41
|
| Rate for Payer: Cofinity Advantage |
$2,840.61
|
| Rate for Payer: Cofinity Commercial |
$3,489.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,246.41
|
| Rate for Payer: Healthscope Commercial |
$3,652.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,840.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,043.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,246.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,449.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,043.51
|
| Rate for Payer: PHP Commercial |
$3,449.31
|
| Rate for Payer: Priority Health SBD |
$2,556.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,637.71
|
| Rate for Payer: UHC Core |
$2,114.22
|
| Rate for Payer: UHC Exchange |
$1,594.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,501.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,043.51
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,058.01
|
|
|
Service Code
|
NDC 50458058801
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,785.52 |
| Max. Negotiated Rate |
$3,652.21 |
| Rate for Payer: Aetna American Axle |
$2,637.71
|
| Rate for Payer: Aetna Commercial |
$3,449.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.71
|
| Rate for Payer: Cash Price |
$3,246.41
|
| Rate for Payer: Cofinity Advantage |
$2,840.61
|
| Rate for Payer: Cofinity Commercial |
$3,489.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,246.41
|
| Rate for Payer: Healthscope Commercial |
$3,652.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,840.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,043.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,449.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,043.51
|
| Rate for Payer: PHP Commercial |
$3,449.31
|
| Rate for Payer: Priority Health SBD |
$2,556.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,785.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,043.51
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$529.20
|
|
|
Service Code
|
NDC 13811070710
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.85 |
| Max. Negotiated Rate |
$476.28 |
| Rate for Payer: Aetna American Axle |
$343.98
|
| Rate for Payer: Aetna Commercial |
$449.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.98
|
| Rate for Payer: Cash Price |
$423.36
|
| Rate for Payer: Cofinity Advantage |
$370.44
|
| Rate for Payer: Cofinity Commercial |
$455.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.36
|
| Rate for Payer: Healthscope Commercial |
$476.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.90
|
| Rate for Payer: PHP Commercial |
$449.82
|
| Rate for Payer: Priority Health SBD |
$333.40
|
| Rate for Payer: UMR Bronson Commercial |
$232.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.90
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$529.20
|
|
|
Service Code
|
NDC 13811070710
|
| Hospital Charge Code |
32654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$476.28 |
| Rate for Payer: Aetna American Axle |
$343.98
|
| Rate for Payer: Aetna Commercial |
$449.82
|
| Rate for Payer: Aetna Medicare |
$264.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.98
|
| Rate for Payer: BCBS Complete |
$211.68
|
| Rate for Payer: Cash Price |
$423.36
|
| Rate for Payer: Cofinity Advantage |
$370.44
|
| Rate for Payer: Cofinity Commercial |
$455.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.36
|
| Rate for Payer: Healthscope Commercial |
$476.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.90
|
| Rate for Payer: PHP Commercial |
$449.82
|
| Rate for Payer: Priority Health SBD |
$333.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.98
|
| Rate for Payer: UHC Core |
$275.71
|
| Rate for Payer: UHC Exchange |
$207.98
|
| Rate for Payer: UMR Bronson Commercial |
$195.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.90
|
|
