|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$1,530.47
|
|
|
Service Code
|
NDC 0456-3210-60
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,071.33 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: ASR ASR |
$1,484.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.57
|
| Rate for Payer: BCN Commercial |
$1,186.57
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.38
|
| Rate for Payer: Healthscope Commercial |
$1,530.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.56
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 0591-3875-45
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: ASR ASR |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.85
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Healthscope Whirlpool |
$2.31
|
| Rate for Payer: Mclaren Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.09
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
NDC 0456-3210-11
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 0591-3875-44
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$184.87
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$378.18
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$264.73 |
| Max. Negotiated Rate |
$378.18 |
| Rate for Payer: Aetna Commercial |
$340.36
|
| Rate for Payer: ASR ASR |
$366.83
|
| Rate for Payer: BCBS Trust/PPO |
$293.20
|
| Rate for Payer: BCN Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$302.54
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.54
|
| Rate for Payer: Healthscope Commercial |
$378.18
|
| Rate for Payer: Healthscope Whirlpool |
$366.83
|
| Rate for Payer: Mclaren Commercial |
$340.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.80
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$12,780.94
|
|
|
Service Code
|
MS-DRG 760
|
| Min. Negotiated Rate |
$9,602.97 |
| Max. Negotiated Rate |
$12,780.94 |
| Rate for Payer: Aetna Medicare |
$10,108.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,635.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,635.49
|
| Rate for Payer: BCBS MAPPO |
$10,108.39
|
| Rate for Payer: BCN Medicare Advantage |
$10,108.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,108.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,108.39
|
| Rate for Payer: Mclaren Medicare |
$10,108.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,613.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,624.65
|
| Rate for Payer: PACE Medicare |
$9,602.97
|
| Rate for Payer: PACE SWMI |
$10,108.39
|
| Rate for Payer: PHP Commercial |
$11,119.23
|
| Rate for Payer: PHP Medicare Advantage |
$10,108.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,780.94
|
| Rate for Payer: Priority Health Medicare |
$10,108.39
|
| Rate for Payer: Priority Health Narrow Network |
$10,224.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10,108.39
|
| Rate for Payer: UHC Medicare Advantage |
$10,411.64
|
| Rate for Payer: VA VA |
$10,108.39
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,510.22
|
|
|
Service Code
|
MS-DRG 761
|
| Min. Negotiated Rate |
$6,220.72 |
| Max. Negotiated Rate |
$8,510.22 |
| Rate for Payer: Aetna Medicare |
$6,808.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,510.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,510.22
|
| Rate for Payer: BCBS MAPPO |
$6,808.18
|
| Rate for Payer: BCN Medicare Advantage |
$6,808.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,808.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,808.18
|
| Rate for Payer: Mclaren Medicare |
$6,808.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,148.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,829.41
|
| Rate for Payer: PACE Medicare |
$6,467.77
|
| Rate for Payer: PACE SWMI |
$6,808.18
|
| Rate for Payer: PHP Commercial |
$7,489.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,808.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,775.90
|
| Rate for Payer: Priority Health Medicare |
$6,808.18
|
| Rate for Payer: Priority Health Narrow Network |
$6,220.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6,808.18
|
| Rate for Payer: UHC Medicare Advantage |
$7,012.43
|
| Rate for Payer: VA VA |
$6,808.18
|
|
|
MENTHOL 5 % TOPICAL GEL
|
Facility
|
IP
|
$30.96
|
|
|
Service Code
|
NDC 58980-618-40
|
| Hospital Charge Code |
152031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$24.00
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$9,590.96
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,713.67 |
| Max. Negotiated Rate |
$9,590.96 |
| Rate for Payer: Aetna Commercial |
$8,631.86
|
| Rate for Payer: ASR ASR |
$9,303.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,435.87
|
| Rate for Payer: BCN Commercial |
$7,435.87
|
| Rate for Payer: Cash Price |
$7,672.77
|
| Rate for Payer: Cofinity Commercial |
$9,015.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,672.77
|
| Rate for Payer: Healthscope Commercial |
$9,590.96
|
| Rate for Payer: Healthscope Whirlpool |
$9,303.23
|
| Rate for Payer: Mclaren Commercial |
$8,631.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,152.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,713.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,440.04
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,673.02
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
176478
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,371.11 |
| Max. Negotiated Rate |
$7,673.02 |
| Rate for Payer: Aetna Commercial |
$6,905.72
|
| Rate for Payer: ASR ASR |
$7,442.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,948.89
|
| Rate for Payer: BCN Commercial |
$5,948.89
|
| Rate for Payer: Cash Price |
$6,138.41
|
| Rate for Payer: Cofinity Commercial |
$7,212.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,138.42
|
| Rate for Payer: Healthscope Commercial |
$7,673.02
|
| Rate for Payer: Healthscope Whirlpool |
$7,442.83
|
| Rate for Payer: Mclaren Commercial |
$6,905.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,522.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,371.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,752.26
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.75
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$21.38
|
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: ASR ASR |
$27.69
|
| Rate for Payer: ASR ASR |
$23.04
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$19.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.48
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$22.13
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$23.75
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Commercial |
$28.55
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$23.04
|
| Rate for Payer: Healthscope Whirlpool |
$27.69
|
| Rate for Payer: Mclaren Commercial |
$25.70
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$21.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.89
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: ASR ASR |
$19.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.42
|
| Rate for Payer: BCN Commercial |
$15.42
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$19.89
|
| Rate for Payer: Healthscope Whirlpool |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$17.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.50
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 60687-155-11
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
METFORMIN 500 MG TABLET
|
Facility
|
IP
|
$256.15
|
|
|
Service Code
|
NDC 60687-155-01
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$256.15 |
| Rate for Payer: Aetna Commercial |
$230.54
|
| Rate for Payer: ASR ASR |
$248.47
|
| Rate for Payer: BCBS Trust/PPO |
$198.59
|
| Rate for Payer: BCN Commercial |
$198.59
|
| Rate for Payer: Cash Price |
$204.92
|
| Rate for Payer: Cofinity Commercial |
$240.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.92
|
| Rate for Payer: Healthscope Commercial |
$256.15
|
| Rate for Payer: Healthscope Whirlpool |
$248.47
|
| Rate for Payer: Mclaren Commercial |
$230.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.41
|
|
|
METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION
|
Facility
|
IP
|
$170.19
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
180308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$170.19 |
| Rate for Payer: Aetna Commercial |
$153.17
|
| Rate for Payer: ASR ASR |
$165.08
|
| Rate for Payer: BCBS Trust/PPO |
$131.95
|
| Rate for Payer: BCN Commercial |
$131.95
|
| Rate for Payer: Cash Price |
$136.15
|
| Rate for Payer: Cofinity Commercial |
$159.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.15
|
| Rate for Payer: Healthscope Commercial |
$170.19
|
| Rate for Payer: Healthscope Whirlpool |
$165.08
|
| Rate for Payer: Mclaren Commercial |
$153.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.77
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: ASR ASR |
$277.03
|
| Rate for Payer: BCBS Trust/PPO |
$221.43
|
| Rate for Payer: BCN Commercial |
$221.43
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Healthscope Commercial |
$285.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.03
|
| Rate for Payer: Mclaren Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.33
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 0406-4123-03
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.46 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$102.41
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 0054-3553-44
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.46 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$102.41
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.67
|
| Rate for Payer: Healthscope Commercial |
$132.09
|
| Rate for Payer: Healthscope Whirlpool |
$128.13
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$332.50
|
|
|
Service Code
|
NDC 0904-6530-61
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$299.25
|
| Rate for Payer: ASR ASR |
$322.52
|
| Rate for Payer: BCBS Trust/PPO |
$257.79
|
| Rate for Payer: BCN Commercial |
$257.79
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.00
|
| Rate for Payer: Healthscope Commercial |
$332.50
|
| Rate for Payer: Healthscope Whirlpool |
$322.52
|
| Rate for Payer: Mclaren Commercial |
$299.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.60
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$500.50
|
|
|
Service Code
|
NDC 0054-0709-20
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.35 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: ASR ASR |
$485.48
|
| Rate for Payer: BCBS Trust/PPO |
$388.04
|
| Rate for Payer: BCN Commercial |
$388.04
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cofinity Commercial |
$470.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.40
|
| Rate for Payer: Healthscope Commercial |
$500.50
|
| Rate for Payer: Healthscope Whirlpool |
$485.48
|
| Rate for Payer: Mclaren Commercial |
$450.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.44
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 23155-070-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: ASR ASR |
$145.89
|
| Rate for Payer: BCBS Trust/PPO |
$116.61
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Healthscope Whirlpool |
$145.89
|
| Rate for Payer: Mclaren Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.35
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687-357-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.06 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna Commercial |
$308.66
|
| Rate for Payer: ASR ASR |
$332.66
|
| Rate for Payer: BCBS Trust/PPO |
$265.89
|
| Rate for Payer: BCN Commercial |
$265.89
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$322.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$342.95
|
| Rate for Payer: Healthscope Whirlpool |
$332.66
|
| Rate for Payer: Mclaren Commercial |
$308.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.80
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687-357-11
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: ASR ASR |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Healthscope Whirlpool |
$3.33
|
| Rate for Payer: Mclaren Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.02
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 70010-754-05
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.30 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$255.07
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 0904-7057-61
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.55 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: ASR ASR |
$433.10
|
| Rate for Payer: BCBS Trust/PPO |
$346.17
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.10
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
