|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$131.27
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
4974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$118.14 |
| Rate for Payer: Aetna Commercial |
$111.58
|
| Rate for Payer: Aetna Medicare |
$65.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.33
|
| Rate for Payer: BCBS Complete |
$52.51
|
| Rate for Payer: Cash Price |
$105.02
|
| Rate for Payer: Cofinity Commercial |
$112.89
|
| Rate for Payer: Cofinity Commercial |
$91.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.02
|
| Rate for Payer: Healthscope Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.58
|
| Rate for Payer: PHP Commercial |
$111.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.33
|
| Rate for Payer: Priority Health SBD |
$82.70
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$208.69
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna Medicare |
$122.76
|
| Rate for Payer: Aetna Medicare |
$91.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: BCBS Complete |
$73.41
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS Complete |
$98.21
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$196.42
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cofinity Commercial |
$211.15
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Commercial |
$128.46
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| Rate for Payer: Cofinity Commercial |
$171.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.42
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$220.97
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: PHP Commercial |
$208.69
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health SBD |
$115.62
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: Priority Health SBD |
$154.68
|
| Rate for Payer: Priority Health SBD |
$5.78
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Commercial |
$208.69
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$196.42
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Commercial |
$128.46
|
| Rate for Payer: Cofinity Commercial |
$171.86
|
| Rate for Payer: Cofinity Commercial |
$211.15
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.42
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$220.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: PHP Commercial |
$208.69
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.59
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: Priority Health SBD |
$115.62
|
| Rate for Payer: Priority Health SBD |
$154.68
|
| Rate for Payer: Priority Health SBD |
$5.78
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$87.36
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: Priority Health SBD |
$55.04
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$590.90
|
|
|
Service Code
|
NDC 17478050410
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$372.27 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.08
|
| Rate for Payer: Cash Price |
$472.72
|
| Rate for Payer: Cofinity Commercial |
$413.63
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.72
|
| Rate for Payer: Healthscope Commercial |
$531.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.08
|
| Rate for Payer: Priority Health SBD |
$372.27
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.08
|
|
|
Service Code
|
NDC 17478050401
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.15
|
| Rate for Payer: Cash Price |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$66.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.15
|
| Rate for Payer: Priority Health SBD |
$46.67
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.08
|
|
|
Service Code
|
NDC 17478050401
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: Aetna Medicare |
$37.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.15
|
| Rate for Payer: BCBS Complete |
$29.63
|
| Rate for Payer: Cash Price |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$66.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.15
|
| Rate for Payer: Priority Health SBD |
$46.67
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$590.90
|
|
|
Service Code
|
NDC 17478050410
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$236.36 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: Aetna Medicare |
$295.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.08
|
| Rate for Payer: BCBS Complete |
$236.36
|
| Rate for Payer: Cash Price |
$472.72
|
| Rate for Payer: Cofinity Commercial |
$413.63
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.72
|
| Rate for Payer: Healthscope Commercial |
$531.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.08
|
| Rate for Payer: Priority Health SBD |
$372.27
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$165.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$207.99 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$165.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$207.99 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health SBD |
$55.71
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.37 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Medicare |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: BCBS Complete |
$35.37
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health SBD |
$55.71
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$177.98
|
|
|
Service Code
|
NDC 60687041011
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$160.18 |
| Rate for Payer: Aetna Commercial |
$151.28
|
| Rate for Payer: Aetna Medicare |
$88.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.69
|
| Rate for Payer: BCBS Complete |
$71.19
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$124.59
|
| Rate for Payer: Cofinity Commercial |
$153.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.38
|
| Rate for Payer: Healthscope Commercial |
$160.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.28
|
| Rate for Payer: PHP Commercial |
$151.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.69
|
| Rate for Payer: Priority Health SBD |
$112.13
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$3,559.48
|
|
|
Service Code
|
NDC 60687041094
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,242.47 |
| Max. Negotiated Rate |
$3,203.53 |
| Rate for Payer: Aetna Commercial |
$3,025.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,313.66
|
| Rate for Payer: Cash Price |
$2,847.58
|
| Rate for Payer: Cofinity Commercial |
$2,491.64
|
| Rate for Payer: Cofinity Commercial |
$3,061.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,491.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,847.58
|
| Rate for Payer: Healthscope Commercial |
$3,203.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,025.56
|
| Rate for Payer: PHP Commercial |
$3,025.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,313.66
|
| Rate for Payer: Priority Health SBD |
$2,242.47
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$177.98
|
|
|
Service Code
|
NDC 60687041011
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.13 |
| Max. Negotiated Rate |
$160.18 |
| Rate for Payer: Aetna Commercial |
$151.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.69
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$124.59
|
| Rate for Payer: Cofinity Commercial |
$153.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.38
|
| Rate for Payer: Healthscope Commercial |
$160.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.28
|
| Rate for Payer: PHP Commercial |
$151.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.69
|
| Rate for Payer: Priority Health SBD |
$112.13
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$3,559.48
|
|
|
Service Code
|
NDC 60687041094
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,423.79 |
| Max. Negotiated Rate |
$3,203.53 |
| Rate for Payer: Aetna Commercial |
$3,025.56
|
| Rate for Payer: Aetna Medicare |
$1,779.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,313.66
|
| Rate for Payer: BCBS Complete |
$1,423.79
|
| Rate for Payer: Cash Price |
$2,847.58
|
| Rate for Payer: Cofinity Commercial |
$2,491.64
|
| Rate for Payer: Cofinity Commercial |
$3,061.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,491.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,847.58
|
| Rate for Payer: Healthscope Commercial |
$3,203.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,025.56
|
| Rate for Payer: PHP Commercial |
$3,025.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,313.66
|
| Rate for Payer: Priority Health SBD |
$2,242.47
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$681.32
|
|
|
Service Code
|
NDC 69238160502
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.23 |
| Max. Negotiated Rate |
$613.19 |
| Rate for Payer: Aetna Commercial |
$579.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.86
|
| Rate for Payer: Cash Price |
$545.06
|
| Rate for Payer: Cofinity Commercial |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$585.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$476.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.06
|
| Rate for Payer: Healthscope Commercial |
$613.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.12
|
| Rate for Payer: PHP Commercial |
$579.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.86
|
| Rate for Payer: Priority Health SBD |
$429.23
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$681.32
|
|
|
Service Code
|
NDC 69238160502
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.53 |
| Max. Negotiated Rate |
$613.19 |
| Rate for Payer: Aetna Commercial |
$579.12
|
| Rate for Payer: Aetna Medicare |
$340.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.86
|
| Rate for Payer: BCBS Complete |
$272.53
|
| Rate for Payer: Cash Price |
$545.06
|
| Rate for Payer: Cofinity Commercial |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$585.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$476.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.06
|
| Rate for Payer: Healthscope Commercial |
$613.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.12
|
| Rate for Payer: PHP Commercial |
$579.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.86
|
| Rate for Payer: Priority Health SBD |
$429.23
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.70 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna Medicare |
$264.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health SBD |
$333.42
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$333.42 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health SBD |
$333.42
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$425.25
|
|
|
Service Code
|
NDC 16729047901
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.91 |
| Max. Negotiated Rate |
$382.73 |
| Rate for Payer: Aetna Commercial |
$361.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.41
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cofinity Commercial |
$297.68
|
| Rate for Payer: Cofinity Commercial |
$365.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.20
|
| Rate for Payer: Healthscope Commercial |
$382.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.46
|
| Rate for Payer: PHP Commercial |
$361.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.41
|
| Rate for Payer: Priority Health SBD |
$267.91
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 31722017401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$411.07 |
| 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 |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| 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
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$411.07 |
| 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 |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| 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
|
|
