|
METHADONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
NDC 68094003159
|
| 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 TABLET
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 00406575523
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna American Axle |
$2.87
|
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.53
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.75
|
| Rate for Payer: PHP Commercial |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 00406575523
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna American Axle |
$2.87
|
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.53
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.75
|
| Rate for Payer: PHP Commercial |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.31
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna Medicare |
$220.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$163.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$606.72
|
|
|
Service Code
|
NDC 24208002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.96 |
| Max. Negotiated Rate |
$546.05 |
| Rate for Payer: Aetna American Axle |
$394.37
|
| Rate for Payer: Aetna Commercial |
$515.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.37
|
| Rate for Payer: Cash Price |
$485.38
|
| Rate for Payer: Cofinity Commercial |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$521.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$424.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.38
|
| Rate for Payer: Healthscope Commercial |
$546.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$424.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515.71
|
| Rate for Payer: PHP Commercial |
$515.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.37
|
| Rate for Payer: Priority Health SBD |
$382.23
|
| Rate for Payer: UMR Bronson Commercial |
$266.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.04
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$513.12
|
|
|
Service Code
|
NDC 68682002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.85 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna Medicare |
$256.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: BCBS Complete |
$205.25
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Commercial |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.15
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UMR Bronson Commercial |
$189.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$513.12
|
|
|
Service Code
|
NDC 68682002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.77 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Commercial |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.15
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UMR Bronson Commercial |
$225.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$711.36
|
|
|
Service Code
|
NDC 62559024001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$640.22 |
| Rate for Payer: Aetna American Axle |
$462.38
|
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.38
|
| Rate for Payer: Cash Price |
$569.09
|
| Rate for Payer: Cofinity Commercial |
$497.95
|
| Rate for Payer: Cofinity Commercial |
$611.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.09
|
| Rate for Payer: Healthscope Commercial |
$640.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$533.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.66
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.38
|
| Rate for Payer: Priority Health SBD |
$448.16
|
| Rate for Payer: UMR Bronson Commercial |
$313.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$533.52
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$711.36
|
|
|
Service Code
|
NDC 62559024001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$640.22 |
| Rate for Payer: Aetna American Axle |
$462.38
|
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Medicare |
$355.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.38
|
| Rate for Payer: BCBS Complete |
$284.54
|
| Rate for Payer: Cash Price |
$569.09
|
| Rate for Payer: Cofinity Commercial |
$497.95
|
| Rate for Payer: Cofinity Commercial |
$611.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.09
|
| Rate for Payer: Healthscope Commercial |
$640.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$533.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.66
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.38
|
| Rate for Payer: Priority Health SBD |
$448.16
|
| Rate for Payer: UMR Bronson Commercial |
$263.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$533.52
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$606.72
|
|
|
Service Code
|
NDC 24208002210
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.49 |
| Max. Negotiated Rate |
$546.05 |
| Rate for Payer: Aetna American Axle |
$394.37
|
| Rate for Payer: Aetna Commercial |
$515.71
|
| Rate for Payer: Aetna Medicare |
$303.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.37
|
| Rate for Payer: BCBS Complete |
$242.69
|
| Rate for Payer: Cash Price |
$485.38
|
| Rate for Payer: Cofinity Commercial |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$521.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$424.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.38
|
| Rate for Payer: Healthscope Commercial |
$546.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$424.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515.71
|
| Rate for Payer: PHP Commercial |
$515.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.37
|
| Rate for Payer: Priority Health SBD |
$382.23
|
| Rate for Payer: UMR Bronson Commercial |
$224.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.04
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
OP
|
$791.43
|
|
|
Service Code
|
NDC 00574079001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.83 |
| Max. Negotiated Rate |
$712.29 |
| Rate for Payer: Aetna American Axle |
$514.43
|
| Rate for Payer: Aetna Commercial |
$672.72
|
| Rate for Payer: Aetna Medicare |
$395.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.43
|
| Rate for Payer: BCBS Complete |
$316.57
|
| Rate for Payer: Cash Price |
$633.14
|
| Rate for Payer: Cofinity Commercial |
$554.00
|
| Rate for Payer: Cofinity Commercial |
$680.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.14
|
| Rate for Payer: Healthscope Commercial |
$712.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.72
|
| Rate for Payer: PHP Commercial |
$672.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.43
|
| Rate for Payer: Priority Health SBD |
$498.60
|
| Rate for Payer: UMR Bronson Commercial |
$292.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.57
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$791.43
|
|
|
Service Code
|
NDC 00574079001
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.23 |
| Max. Negotiated Rate |
$712.29 |
| Rate for Payer: Aetna American Axle |
$514.43
|
| Rate for Payer: Aetna Commercial |
$672.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.43
|
| Rate for Payer: Cash Price |
$633.14
|
| Rate for Payer: Cofinity Commercial |
$554.00
|
| Rate for Payer: Cofinity Commercial |
$680.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.14
|
| Rate for Payer: Healthscope Commercial |
$712.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.72
|
| Rate for Payer: PHP Commercial |
$672.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.43
|
| Rate for Payer: Priority Health SBD |
$498.60
|
| Rate for Payer: UMR Bronson Commercial |
$348.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.57
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$350.88
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.83 |
| Max. Negotiated Rate |
$315.79 |
| Rate for Payer: Aetna American Axle |
$228.07
|
| Rate for Payer: Aetna Commercial |
$298.25
|
| Rate for Payer: Aetna Medicare |
$175.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.07
|
| Rate for Payer: BCBS Complete |
$140.35
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$315.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.25
|
| Rate for Payer: PHP Commercial |
$298.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.07
|
| Rate for Payer: Priority Health SBD |
$221.05
|
| Rate for Payer: UMR Bronson Commercial |
$129.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.16
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$350.88
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$315.79 |
| Rate for Payer: Aetna American Axle |
$228.07
|
| Rate for Payer: Aetna Commercial |
$298.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.07
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$315.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.25
|
| Rate for Payer: PHP Commercial |
$298.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.07
|
| Rate for Payer: Priority Health SBD |
$221.05
|
| Rate for Payer: UMR Bronson Commercial |
$154.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.16
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$151.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.39 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$133.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.90 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna American Axle |
$222.92
|
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.92
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$308.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health SBD |
$216.06
|
| Rate for Payer: UMR Bronson Commercial |
$150.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$103.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna American Axle |
$1.60
|
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna Medicare |
$122.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: BCBS Complete |
$98.11
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UMR Bronson Commercial |
$90.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna American Axle |
$1.60
|
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna American Axle |
$222.92
|
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: Aetna Medicare |
$171.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.92
|
| Rate for Payer: BCBS Complete |
$137.18
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$308.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health SBD |
$216.06
|
| Rate for Payer: UMR Bronson Commercial |
$126.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna American Axle |
$159.43
|
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.43
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$171.70
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| Rate for Payer: Priority Health SBD |
$154.53
|
| Rate for Payer: UMR Bronson Commercial |
$107.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
