|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.72
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Medicare |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: BCBS Complete |
$9.09
|
| Rate for Payer: BCBS Trust/PPO |
$11.38
|
| Rate for Payer: BCN Commercial |
$11.38
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health SBD |
$14.31
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
NDC 69584061150
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$562.59 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Advantage |
$625.10
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: Priority Health SBD |
$562.59
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.73
|
| Rate for Payer: UHC Core |
$116.81
|
| Rate for Payer: UHC Exchange |
$88.11
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.25 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$204.25
|
|
|
Service Code
|
NDC 63739099110
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.27 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna Medicare |
$102.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: BCBS Complete |
$81.70
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.76
|
| Rate for Payer: UHC Core |
$106.41
|
| Rate for Payer: UHC Exchange |
$80.27
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$129.68
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$110.23
|
| Rate for Payer: Aetna Medicare |
$64.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.29
|
| Rate for Payer: BCBS Complete |
$51.87
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cofinity Advantage |
$90.78
|
| Rate for Payer: Cofinity Commercial |
$111.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.74
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.26
|
| Rate for Payer: PHP Commercial |
$110.23
|
| Rate for Payer: Priority Health SBD |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.29
|
| Rate for Payer: UHC Core |
$67.56
|
| Rate for Payer: UHC Exchange |
$50.96
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 63739099110
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.68 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$129.68
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.70 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$110.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.29
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cofinity Advantage |
$90.78
|
| Rate for Payer: Cofinity Commercial |
$111.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.74
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.26
|
| Rate for Payer: PHP Commercial |
$110.23
|
| Rate for Payer: Priority Health SBD |
$81.70
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
NDC 69584061150
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.95 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna Medicare |
$446.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Advantage |
$625.10
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: Priority Health SBD |
$562.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.45
|
| Rate for Payer: UHC Core |
$465.25
|
| Rate for Payer: UHC Exchange |
$350.95
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.69
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.02
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.96 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.54
|
| Rate for Payer: UHC Core |
$145.52
|
| Rate for Payer: UHC Exchange |
$109.76
|
|
|
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 Advantage |
$91.89
|
| Rate for Payer: Cofinity Commercial |
$112.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.02
|
| Rate for Payer: Healthscope Commercial |
$118.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.45
|
| Rate for Payer: PHP Commercial |
$111.58
|
| Rate for Payer: Priority Health SBD |
$82.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.64
|
| Rate for Payer: UHC Core |
$65.64
|
| Rate for Payer: UHC Exchange |
$65.64
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna Commercial |
$4.38
|
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Medicare |
$83.14
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.08
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS Complete |
$73.14
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: BCBS Complete |
$66.51
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$133.02
|
| Rate for Payer: Cash Price |
$133.02
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Advantage |
$3.60
|
| Rate for Payer: Cofinity Advantage |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$116.40
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Cofinity Commercial |
$143.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
| Rate for Payer: Healthscope Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Healthscope Commercial |
$149.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.86
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: PHP Commercial |
$141.34
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Commercial |
$4.38
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: Priority Health SBD |
$3.24
|
| Rate for Payer: Priority Health SBD |
$5.76
|
| Rate for Payer: Priority Health SBD |
$115.20
|
| Rate for Payer: Priority Health SBD |
$104.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$182.86
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Commercial |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.35
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cash Price |
$133.02
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cofinity Advantage |
$116.40
|
| Rate for Payer: Cofinity Advantage |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$3.60
|
| Rate for Payer: Cofinity Advantage |
$180.10
|
| Rate for Payer: Cofinity Advantage |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$143.00
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$149.65
|
| Rate for Payer: Healthscope Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.71
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Commercial |
$4.38
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: PHP Commercial |
$141.34
|
| Rate for Payer: Priority Health SBD |
$115.20
|
| Rate for Payer: Priority Health SBD |
$5.76
|
| Rate for Payer: Priority Health SBD |
$3.24
|
| Rate for Payer: Priority Health SBD |
$104.76
|
| Rate for Payer: Priority Health SBD |
$162.09
|
|
|
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 |
$4.26 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Commercial |
$58.38
|
| Rate for Payer: Aetna Commercial |
$51.09
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Medicare |
$69.08
|
| Rate for Payer: Aetna Medicare |
$30.05
|
| Rate for Payer: Aetna Medicare |
$34.34
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: BCBS Complete |
$24.04
|
| Rate for Payer: BCBS Complete |
$27.47
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: BCBS Complete |
$34.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Advantage |
$61.15
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Advantage |
$42.07
|
| Rate for Payer: Cofinity Advantage |
$96.72
|
| Rate for Payer: Cofinity Advantage |
$48.08
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$51.69
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.08
|
| Rate for Payer: Healthscope Commercial |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$61.81
|
| Rate for Payer: Healthscope Commercial |
$124.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: PHP Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$51.09
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health SBD |
$43.27
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: Priority Health SBD |
$37.86
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$68.68
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$61.81 |
| Rate for Payer: Aetna Commercial |
$58.38
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Commercial |
$51.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Advantage |
$48.08
|
| Rate for Payer: Cofinity Advantage |
$96.72
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Advantage |
$42.07
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$51.69
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$61.81
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$124.35
|
| Rate for Payer: Healthscope Commercial |
$54.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.08
|
| Rate for Payer: PHP Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$51.09
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health SBD |
$37.86
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: Priority Health SBD |
$43.27
|
| Rate for Payer: Priority Health SBD |
$87.05
|
|
|
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 Advantage |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| 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: Opus (Opus Packaging Group) HMA |
$55.56
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health SBD |
$46.67
|
|
|
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 Advantage |
$413.63
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| 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: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health SBD |
$372.27
|
|
|
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 |
$29.11 |
| 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 Advantage |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$66.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.56
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health SBD |
$46.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.15
|
| Rate for Payer: UHC Core |
$38.60
|
| Rate for Payer: UHC Exchange |
$29.11
|
|
|
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 |
$232.22 |
| 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 Advantage |
$413.63
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.72
|
| Rate for Payer: Healthscope Commercial |
$531.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$472.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health SBD |
$372.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.08
|
| Rate for Payer: UHC Core |
$307.86
|
| Rate for Payer: UHC Exchange |
$232.22
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.54
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.18 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$145.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: BCBS Complete |
$116.22
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.85
|
| Rate for Payer: UHC Core |
$151.37
|
| Rate for Payer: UHC Exchange |
$114.18
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.54
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
|
