|
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 |
$302.58
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.58
|
| 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 |
$302.58
|
| 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
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$168.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity 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 |
$124.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.00
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$519.75
|
|
|
Service Code
|
NDC 68084073801
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$467.78 |
| Rate for Payer: Aetna American Axle |
$337.84
|
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.84
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cofinity Commercial |
$363.82
|
| Rate for Payer: Cofinity Commercial |
$446.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.80
|
| Rate for Payer: Healthscope Commercial |
$467.78
|
| 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 |
$228.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.81
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.93 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna American Axle |
$280.96
|
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Medicare |
$216.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.96
|
| Rate for Payer: BCBS Complete |
$172.90
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$302.58
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.58
|
| 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 |
$302.58
|
| 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 |
$159.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
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
|
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
|
IP
|
$336.00
|
|
|
Service Code
|
NDC 00904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna American Axle |
$218.40
|
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity 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 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 09900000027
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 00990000171
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna American Axle |
$3.36
|
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.36
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 09900000027
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$516.25
|
|
|
Service Code
|
NDC 00054355563
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$464.62 |
| Rate for Payer: Aetna American Axle |
$335.56
|
| Rate for Payer: Aetna Commercial |
$438.81
|
| Rate for Payer: Aetna Medicare |
$258.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.56
|
| Rate for Payer: BCBS Complete |
$206.50
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cofinity Commercial |
$361.38
|
| Rate for Payer: Cofinity Commercial |
$443.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.00
|
| Rate for Payer: Healthscope Commercial |
$464.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.81
|
| Rate for Payer: PHP Commercial |
$438.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.56
|
| Rate for Payer: Priority Health SBD |
$325.24
|
| Rate for Payer: UMR Bronson Commercial |
$191.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.19
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 09900000026
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna American Axle |
$0.07
|
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.04
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cofinity Commercial |
$0.08
|
| Rate for Payer: Cofinity Commercial |
$0.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.07
|
| Rate for Payer: Priority Health SBD |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.08
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 00990000171
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna American Axle |
$3.36
|
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.36
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$2.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
NDC 68094003159
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$516.25
|
|
|
Service Code
|
NDC 00054355563
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.15 |
| Max. Negotiated Rate |
$464.62 |
| Rate for Payer: Aetna American Axle |
$335.56
|
| Rate for Payer: Aetna Commercial |
$438.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.56
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cofinity Commercial |
$361.38
|
| Rate for Payer: Cofinity Commercial |
$443.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.00
|
| Rate for Payer: Healthscope Commercial |
$464.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.81
|
| Rate for Payer: PHP Commercial |
$438.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.56
|
| Rate for Payer: Priority Health SBD |
$325.24
|
| Rate for Payer: UMR Bronson Commercial |
$227.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.19
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$40.08
|
|
|
Service Code
|
NDC 60687081886
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna American Axle |
$26.05
|
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$20.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: BCBS Complete |
$16.03
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health SBD |
$25.25
|
| Rate for Payer: UMR Bronson Commercial |
$14.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.06
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$40.08
|
|
|
Service Code
|
NDC 60687081840
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna American Axle |
$26.05
|
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$20.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: BCBS Complete |
$16.03
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health SBD |
$25.25
|
| Rate for Payer: UMR Bronson Commercial |
$14.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.06
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 00990000101
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.08
|
|
|
Service Code
|
NDC 60687081840
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna American Axle |
$26.05
|
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health SBD |
$25.25
|
| Rate for Payer: UMR Bronson Commercial |
$17.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.06
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
NDC 68094003162
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 00990000101
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
NDC 68094003162
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.08
|
|
|
Service Code
|
NDC 60687081886
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna American Axle |
$26.05
|
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health SBD |
$25.25
|
| Rate for Payer: UMR Bronson Commercial |
$17.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.06
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 09900000026
|
| Hospital Charge Code |
4952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna American Axle |
$0.07
|
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.07
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cofinity Commercial |
$0.08
|
| Rate for Payer: Cofinity Commercial |
$0.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.07
|
| Rate for Payer: Priority Health SBD |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$0.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.08
|
|
