|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
NDC 57664022988
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.40
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UMR Bronson Commercial |
$209.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
NDC 57664022988
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna Medicare |
$238.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: BCBS Complete |
$190.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.40
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UMR Bronson Commercial |
$176.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$411.08 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: BCBS Complete |
$182.70
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.89
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UMR Bronson Commercial |
$169.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$411.08 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.89
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UMR Bronson Commercial |
$200.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 10702010101
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna American Axle |
$145.60
|
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: UMR Bronson Commercial |
$98.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$621.38
|
|
|
Service Code
|
NDC 68968555303
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$559.24 |
| Rate for Payer: Aetna American Axle |
$403.90
|
| Rate for Payer: Aetna Commercial |
$528.17
|
| Rate for Payer: Aetna Medicare |
$310.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.90
|
| Rate for Payer: BCBS Complete |
$248.55
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$434.97
|
| Rate for Payer: Cofinity Commercial |
$534.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.10
|
| Rate for Payer: Healthscope Commercial |
$559.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.17
|
| Rate for Payer: PHP Commercial |
$528.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.90
|
| Rate for Payer: Priority Health SBD |
$391.47
|
| Rate for Payer: UMR Bronson Commercial |
$229.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.04
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$208.68
|
|
|
Service Code
|
NDC 54092055201
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna American Axle |
$135.64
|
| Rate for Payer: Aetna Commercial |
$177.38
|
| Rate for Payer: Aetna Medicare |
$104.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.64
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cofinity Commercial |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.94
|
| Rate for Payer: Healthscope Commercial |
$187.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.38
|
| Rate for Payer: PHP Commercial |
$177.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.64
|
| Rate for Payer: Priority Health SBD |
$131.47
|
| Rate for Payer: UMR Bronson Commercial |
$77.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.51
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$621.38
|
|
|
Service Code
|
NDC 68968555303
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.41 |
| Max. Negotiated Rate |
$559.24 |
| Rate for Payer: Aetna American Axle |
$403.90
|
| Rate for Payer: Aetna Commercial |
$528.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.90
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$434.97
|
| Rate for Payer: Cofinity Commercial |
$534.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.10
|
| Rate for Payer: Healthscope Commercial |
$559.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.17
|
| Rate for Payer: PHP Commercial |
$528.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.90
|
| Rate for Payer: Priority Health SBD |
$391.47
|
| Rate for Payer: UMR Bronson Commercial |
$273.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.04
|
|
|
METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$208.68
|
|
|
Service Code
|
NDC 54092055201
|
| Hospital Charge Code |
76394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna American Axle |
$135.64
|
| Rate for Payer: Aetna Commercial |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.64
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cofinity Commercial |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.94
|
| Rate for Payer: Healthscope Commercial |
$187.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.38
|
| Rate for Payer: PHP Commercial |
$177.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.64
|
| Rate for Payer: Priority Health SBD |
$131.47
|
| Rate for Payer: UMR Bronson Commercial |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.51
|
|
|
METHYLPHENIDATE 2.5 MG CUSTOM TAB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
NDC 09900000012
|
| Hospital Charge Code |
150703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna American Axle |
$63.70
|
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: UMR Bronson Commercial |
$43.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
METHYLPHENIDATE 2.5 MG CUSTOM TAB
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
NDC 09900000012
|
| Hospital Charge Code |
150703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna American Axle |
$63.70
|
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
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 |
$288.22 |
| 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 Commercial |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| 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: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| 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
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 68084080511
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna American Axle |
$8.55
|
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
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 |
$288.22 |
| 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 Commercial |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| 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: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| 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
|
$320.25
|
|
|
Service Code
|
NDC 00406114201
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.49 |
| Max. Negotiated Rate |
$288.22 |
| 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 Commercial |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| 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: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| Rate for Payer: Priority Health SBD |
$201.76
|
| Rate for Payer: UMR Bronson Commercial |
$118.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UMR Bronson Commercial |
$62.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$394.59
|
|
|
Service Code
|
NDC 68084080521
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$355.13 |
| Rate for Payer: Aetna American Axle |
$256.48
|
| Rate for Payer: Aetna Commercial |
$335.40
|
| Rate for Payer: Aetna Medicare |
$197.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.48
|
| Rate for Payer: BCBS Complete |
$157.84
|
| Rate for Payer: Cash Price |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$276.21
|
| Rate for Payer: Cofinity Commercial |
$339.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.67
|
| Rate for Payer: Healthscope Commercial |
$355.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.40
|
| Rate for Payer: PHP Commercial |
$335.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.48
|
| Rate for Payer: Priority Health SBD |
$248.59
|
| Rate for Payer: UMR Bronson Commercial |
$146.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.94
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$394.59
|
|
|
Service Code
|
NDC 68084080521
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.62 |
| Max. Negotiated Rate |
$355.13 |
| Rate for Payer: Aetna American Axle |
$256.48
|
| Rate for Payer: Aetna Commercial |
$335.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.48
|
| Rate for Payer: Cash Price |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$276.21
|
| Rate for Payer: Cofinity Commercial |
$339.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.67
|
| Rate for Payer: Healthscope Commercial |
$355.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.40
|
| Rate for Payer: PHP Commercial |
$335.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.48
|
| Rate for Payer: Priority Health SBD |
$248.59
|
| Rate for Payer: UMR Bronson Commercial |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.94
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 68084080511
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna American Axle |
$8.55
|
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.55
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health SBD |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UMR Bronson Commercial |
$73.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$320.25
|
|
|
Service Code
|
NDC 31722017301
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.49 |
| Max. Negotiated Rate |
$288.22 |
| 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 Commercial |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| 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: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| Rate for Payer: Priority Health SBD |
$201.76
|
| Rate for Payer: UMR Bronson Commercial |
$118.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$444.37
|
|
|
Service Code
|
NDC 60687053221
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.42 |
| Max. Negotiated Rate |
$399.93 |
| Rate for Payer: Aetna American Axle |
$288.84
|
| Rate for Payer: Aetna Commercial |
$377.71
|
| Rate for Payer: Aetna Medicare |
$222.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.84
|
| Rate for Payer: BCBS Complete |
$177.75
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cofinity Commercial |
$311.06
|
| Rate for Payer: Cofinity Commercial |
$382.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.50
|
| Rate for Payer: Healthscope Commercial |
$399.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.71
|
| Rate for Payer: PHP Commercial |
$377.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.84
|
| Rate for Payer: Priority Health SBD |
$279.95
|
| Rate for Payer: UMR Bronson Commercial |
$164.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.28
|
|
|
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 Commercial |
$2,771.08
|
| Rate for Payer: Cofinity Commercial |
$3,404.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,771.08
|
| 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: PHP Commercial |
$3,364.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,573.14
|
| 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
|
$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 Commercial |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.28
|
| 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: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.76
|
| Rate for Payer: Priority Health SBD |
$296.35
|
| 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
|
$14.82
|
|
|
Service Code
|
NDC 60687053211
|
| Hospital Charge Code |
28750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.37
|
| Rate for Payer: Aetna American Axle |
$9.63
|
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.63
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Healthscope Commercial |
$13.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.60
|
| Rate for Payer: PHP Commercial |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.63
|
| Rate for Payer: Priority Health SBD |
$9.34
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.12
|
|
