|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: BCBS Trust/PPO |
$204.00
|
| Rate for Payer: BCN Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$58.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.06
|
| Rate for Payer: BCBS Complete |
$41.50
|
| Rate for Payer: BCBS MAPPO |
$56.05
|
| Rate for Payer: BCBS Trust/PPO |
$184.31
|
| Rate for Payer: BCN Commercial |
$184.31
|
| Rate for Payer: BCN Medicare Advantage |
$56.05
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.05
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Mclaren Medicaid |
$39.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.85
|
| Rate for Payer: Meridian Medicaid |
$41.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Nomi Health Commercial |
$183.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PACE Senior Care Partners |
$53.25
|
| Rate for Payer: PACE SWMI |
$56.05
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: PHP Medicare Advantage |
$56.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.05
|
| Rate for Payer: Priority Health Medicare |
$56.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.04
|
| Rate for Payer: Railroad Medicare Medicare |
$56.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.30
|
| Rate for Payer: UHC Core |
$187.21
|
| Rate for Payer: UHC Exchange |
$56.05
|
| Rate for Payer: UHC Medicaid |
$39.53
|
| Rate for Payer: UHC Medicare Advantage |
$56.05
|
| Rate for Payer: UHCCP Medicaid |
$39.53
|
| Rate for Payer: VA VA |
$56.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.04 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: BCBS Trust/PPO |
$185.17
|
| Rate for Payer: BCN Commercial |
$185.17
|
| Rate for Payer: Cash Price |
$179.36
|
| 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: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Nomi Health Commercial |
$183.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.30
|
| Rate for Payer: UHC Core |
$187.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| Rate for Payer: BCN Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$64.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.19
|
| Rate for Payer: BCBS Complete |
$45.72
|
| Rate for Payer: BCBS MAPPO |
$61.75
|
| Rate for Payer: BCBS Trust/PPO |
$203.06
|
| Rate for Payer: BCN Commercial |
$203.06
|
| Rate for Payer: BCN Medicare Advantage |
$61.75
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Mclaren Medicaid |
$43.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.84
|
| Rate for Payer: Meridian Medicaid |
$45.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PACE Senior Care Partners |
$58.66
|
| Rate for Payer: PACE SWMI |
$61.75
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Medicare Advantage |
$61.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.89
|
| Rate for Payer: Priority Health Medicare |
$62.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.91
|
| Rate for Payer: Railroad Medicare Medicare |
$61.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.25
|
| Rate for Payer: UHC Exchange |
$61.75
|
| Rate for Payer: UHC Medicaid |
$43.55
|
| Rate for Payer: UHC Medicare Advantage |
$61.75
|
| Rate for Payer: UHCCP Medicaid |
$43.55
|
| Rate for Payer: VA VA |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$2.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.62
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.62
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Mclaren Medicaid |
$0.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: Meridian Medicaid |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.62
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: Railroad Medicare Medicare |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UHC Medicaid |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: UHCCP Medicaid |
$0.44
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$230.67
|
| Rate for Payer: BCN Commercial |
$230.67
|
| Rate for Payer: Cash Price |
$223.44
|
| 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: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$209.49
|
| Rate for Payer: BCN Commercial |
$209.49
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.24
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.21
|
| Rate for Payer: UHC Core |
$211.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$65.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.27
|
| Rate for Payer: BCBS Complete |
$46.95
|
| Rate for Payer: BCBS MAPPO |
$63.41
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$208.53
|
| Rate for Payer: BCN Medicare Advantage |
$63.41
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Mclaren Medicaid |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.58
|
| Rate for Payer: Meridian Medicaid |
$46.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.24
|
| Rate for Payer: PACE Senior Care Partners |
$60.24
|
| Rate for Payer: PACE SWMI |
$63.41
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: PHP Medicare Advantage |
$63.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Medicare |
$64.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.54
|
| Rate for Payer: Railroad Medicare Medicare |
$63.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.21
|
| Rate for Payer: UHC Core |
$211.80
|
| Rate for Payer: UHC Exchange |
$63.41
|
| Rate for Payer: UHC Medicaid |
$44.72
|
| Rate for Payer: UHC Medicare Advantage |
$63.41
|
| Rate for Payer: UHCCP Medicaid |
$44.72
|
| Rate for Payer: VA VA |
$63.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.28
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCBS Trust/PPO |
$229.61
|
| Rate for Payer: BCN Commercial |
$229.61
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Mclaren Medicaid |
$49.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Meridian Medicaid |
$51.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PACE Senior Care Partners |
$66.33
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Medicare |
$70.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.39
|
| Rate for Payer: Railroad Medicare Medicare |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: UHC Exchange |
$69.83
|
| Rate for Payer: UHC Medicaid |
$49.24
|
| Rate for Payer: UHC Medicare Advantage |
$69.83
|
| Rate for Payer: UHCCP Medicaid |
$49.24
|
| Rate for Payer: VA VA |
$69.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$166.28
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$149.65 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna Medicare |
$43.23
|
| Rate for Payer: Aetna Medicare |
$47.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.86
|
| Rate for Payer: BCBS Complete |
$33.85
|
| Rate for Payer: BCBS Complete |
$30.78
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$2.29
|
| Rate for Payer: BCBS MAPPO |
$41.57
|
| Rate for Payer: BCBS MAPPO |
$45.72
|
| Rate for Payer: BCBS Trust/PPO |
$136.70
|
| Rate for Payer: BCBS Trust/PPO |
$150.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.52
|
| Rate for Payer: BCN Commercial |
$150.33
|
| Rate for Payer: BCN Commercial |
$7.52
|
| Rate for Payer: BCN Commercial |
$136.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.29
|
| Rate for Payer: BCN Medicare Advantage |
$45.72
|
| Rate for Payer: BCN Medicare Advantage |
$41.57
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$133.02
|
| Rate for Payer: Cofinity Commercial |
$143.00
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.57
|
| Rate for Payer: Healthscope Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$149.65
|
| Rate for Payer: Healthscope Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.15
|
| Rate for Payer: Mclaren Medicaid |
$29.32
|
| Rate for Payer: Mclaren Medicaid |
$1.61
|
| Rate for Payer: Mclaren Medicaid |
$32.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.40
|
| Rate for Payer: Meridian Medicaid |
$1.69
|
| Rate for Payer: Meridian Medicaid |
$30.78
|
| Rate for Payer: Meridian Medicaid |
$33.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.73
|
| 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 |
$155.43
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: Nomi Health Commercial |
$136.35
|
| 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: PACE Senior Care Partners |
$43.43
|
| Rate for Payer: PACE Senior Care Partners |
$39.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.17
|
| Rate for Payer: PACE SWMI |
$2.29
|
| Rate for Payer: PACE SWMI |
$45.72
|
| Rate for Payer: PACE SWMI |
$41.57
|
| Rate for Payer: PHP Commercial |
$141.34
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: PHP Medicare Advantage |
$45.72
|
| Rate for Payer: PHP Medicare Advantage |
$41.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Medicare |
$2.31
|
| Rate for Payer: Priority Health Medicare |
$46.17
|
| Rate for Payer: Priority Health Medicare |
$41.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.73
|
| Rate for Payer: Railroad Medicare Medicare |
$45.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2.29
|
| Rate for Payer: Railroad Medicare Medicare |
$41.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.33
|
| Rate for Payer: UHC Core |
$138.84
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: UHC Core |
$152.69
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Exchange |
$45.72
|
| Rate for Payer: UHC Exchange |
$41.57
|
| Rate for Payer: UHC Medicaid |
$29.32
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHC Medicaid |
$32.24
|
| Rate for Payer: UHC Medicare Advantage |
$45.72
|
| Rate for Payer: UHC Medicare Advantage |
$41.57
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
| Rate for Payer: UHCCP Medicaid |
$32.24
|
| Rate for Payer: UHCCP Medicaid |
$29.32
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: VA VA |
$41.57
|
| Rate for Payer: VA VA |
$2.29
|
| Rate for Payer: VA VA |
$45.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$166.28
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.73 |
| Max. Negotiated Rate |
$149.65 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$151.02
|
| Rate for Payer: BCBS Trust/PPO |
$137.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.56
|
| Rate for Payer: BCN Commercial |
$151.02
|
| Rate for Payer: BCN Commercial |
$137.33
|
| Rate for Payer: BCN Commercial |
$7.56
|
| Rate for Payer: Cash Price |
$133.02
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cofinity Commercial |
$7.87
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$143.00
|
| 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: Lakeland Regional Health Systems Commercial |
$6.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.78
|
| Rate for Payer: Nomi Health Commercial |
$136.35
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| 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 |
$6.86
|
| Rate for Payer: PHP Commercial |
$141.34
|
| Rate for Payer: PHP Commercial |
$7.78
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.33
|
| Rate for Payer: UHC Core |
$138.84
|
| Rate for Payer: UHC Core |
$7.64
|
| Rate for Payer: UHC Core |
$152.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.15
|
|
|
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 |
$51.56 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: BCBS Trust/PPO |
$61.18
|
| Rate for Payer: BCN Commercial |
$61.18
|
| Rate for Payer: Cash Price |
$59.26
|
| 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: Lakeland Regional Health Systems Commercial |
$55.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: Nomi Health Commercial |
$60.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.56
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.19
|
| Rate for Payer: UHC Core |
$61.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.56
|
|
|
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 |
$411.27 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: BCBS Trust/PPO |
$488.02
|
| Rate for Payer: BCN Commercial |
$488.02
|
| Rate for Payer: Cash Price |
$472.72
|
| 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: Lakeland Regional Health Systems Commercial |
$443.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: Nomi Health Commercial |
$484.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$514.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.99
|
| Rate for Payer: UHC Core |
$493.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.18
|
|
|
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 |
$13.06 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$13.71
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$60.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$66.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.56
|
| Rate for Payer: Mclaren Medicaid |
$13.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$13.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: Nomi Health Commercial |
$60.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.56
|
| Rate for Payer: PACE Senior Care Partners |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$62.97
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.45
|
| Rate for Payer: Priority Health Medicare |
$18.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.56
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.19
|
| Rate for Payer: UHC Core |
$61.86
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicaid |
$13.06
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$13.06
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.56
|
|
|
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 |
$104.18 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: Aetna Medicare |
$153.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.66
|
| Rate for Payer: BCBS Complete |
$109.38
|
| Rate for Payer: BCBS MAPPO |
$147.72
|
| Rate for Payer: BCBS Trust/PPO |
$485.78
|
| Rate for Payer: BCN Commercial |
$485.78
|
| Rate for Payer: BCN Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$472.72
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.72
|
| Rate for Payer: Healthscope Commercial |
$531.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$443.18
|
| Rate for Payer: Mclaren Medicaid |
$104.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.11
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: Nomi Health Commercial |
$484.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PACE Senior Care Partners |
$140.34
|
| Rate for Payer: PACE SWMI |
$147.72
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: PHP Medicare Advantage |
$147.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$514.08
|
| Rate for Payer: Priority Health Medicare |
$149.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.27
|
| Rate for Payer: Railroad Medicare Medicare |
$147.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.99
|
| Rate for Payer: UHC Core |
$493.40
|
| Rate for Payer: UHC Exchange |
$147.72
|
| Rate for Payer: UHC Medicaid |
$104.18
|
| Rate for Payer: UHC Medicare Advantage |
$147.72
|
| Rate for Payer: UHCCP Medicaid |
$104.18
|
| Rate for Payer: VA VA |
$147.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.18
|
|
|
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 |
$202.22 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.96
|
| Rate for Payer: BCN Commercial |
$239.96
|
| Rate for Payer: Cash Price |
$232.43
|
| 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: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Nomi Health Commercial |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.68
|
| Rate for Payer: UHC Core |
$242.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
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 |
$51.22 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$75.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.79
|
| Rate for Payer: BCBS Complete |
$53.78
|
| Rate for Payer: BCBS MAPPO |
$72.64
|
| Rate for Payer: BCBS Trust/PPO |
$238.85
|
| Rate for Payer: BCN Commercial |
$238.85
|
| Rate for Payer: BCN Medicare Advantage |
$72.64
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.64
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Mclaren Medicaid |
$51.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.27
|
| Rate for Payer: Meridian Medicaid |
$53.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Nomi Health Commercial |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PACE Senior Care Partners |
$69.00
|
| Rate for Payer: PACE SWMI |
$72.64
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: PHP Medicare Advantage |
$72.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.77
|
| Rate for Payer: Priority Health Medicare |
$73.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.22
|
| Rate for Payer: Railroad Medicare Medicare |
$72.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.68
|
| Rate for Payer: UHC Core |
$242.60
|
| Rate for Payer: UHC Exchange |
$72.64
|
| Rate for Payer: UHC Medicaid |
$51.22
|
| Rate for Payer: UHC Medicare Advantage |
$72.64
|
| Rate for Payer: UHCCP Medicaid |
$51.22
|
| Rate for Payer: VA VA |
$72.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.54
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$75.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.79
|
| Rate for Payer: BCBS Complete |
$53.78
|
| Rate for Payer: BCBS MAPPO |
$72.64
|
| Rate for Payer: BCBS Trust/PPO |
$238.85
|
| Rate for Payer: BCN Commercial |
$238.85
|
| Rate for Payer: BCN Medicare Advantage |
$72.64
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.64
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Mclaren Medicaid |
$51.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.27
|
| Rate for Payer: Meridian Medicaid |
$53.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Nomi Health Commercial |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PACE Senior Care Partners |
$69.00
|
| Rate for Payer: PACE SWMI |
$72.64
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: PHP Medicare Advantage |
$72.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.77
|
| Rate for Payer: Priority Health Medicare |
$73.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.22
|
| Rate for Payer: Railroad Medicare Medicare |
$72.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.68
|
| Rate for Payer: UHC Core |
$242.60
|
| Rate for Payer: UHC Exchange |
$72.64
|
| Rate for Payer: UHC Medicaid |
$51.22
|
| Rate for Payer: UHC Medicare Advantage |
$72.64
|
| Rate for Payer: UHCCP Medicaid |
$51.22
|
| Rate for Payer: VA VA |
$72.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.54
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$202.22 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.96
|
| Rate for Payer: BCN Commercial |
$239.96
|
| Rate for Payer: Cash Price |
$232.43
|
| 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: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Nomi Health Commercial |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.68
|
| Rate for Payer: UHC Core |
$242.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$30.53
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: BCBS Trust/PPO |
$25.21
|
| Rate for Payer: BCBS Trust/PPO |
$55.10
|
| Rate for Payer: BCN Commercial |
$25.21
|
| Rate for Payer: BCN Commercial |
$55.10
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: Nomi Health Commercial |
$54.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: PHP Commercial |
$25.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Core |
$55.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.04
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$30.53
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna Medicare |
$17.35
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.85
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: BCBS Complete |
$12.35
|
| Rate for Payer: BCBS MAPPO |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$25.10
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$54.85
|
| Rate for Payer: BCN Commercial |
$25.10
|
| Rate for Payer: BCN Medicare Advantage |
$16.68
|
| Rate for Payer: BCN Medicare Advantage |
$7.63
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.63
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.04
|
| Rate for Payer: Mclaren Medicaid |
$11.76
|
| Rate for Payer: Mclaren Medicaid |
$5.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.01
|
| Rate for Payer: Meridian Medicaid |
$5.65
|
| Rate for Payer: Meridian Medicaid |
$12.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.95
|
| Rate for Payer: Nomi Health Commercial |
$54.71
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: PACE Senior Care Partners |
$15.85
|
| Rate for Payer: PACE Senior Care Partners |
$7.25
|
| Rate for Payer: PACE SWMI |
$16.68
|
| Rate for Payer: PACE SWMI |
$7.63
|
| Rate for Payer: PHP Commercial |
$25.95
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$16.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.56
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Medicare |
$7.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.44
|
| Rate for Payer: Railroad Medicare Medicare |
$7.63
|
| Rate for Payer: Railroad Medicare Medicare |
$16.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$55.71
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Exchange |
$16.68
|
| Rate for Payer: UHC Exchange |
$7.63
|
| Rate for Payer: UHC Medicaid |
$11.76
|
| Rate for Payer: UHC Medicaid |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$7.63
|
| Rate for Payer: UHC Medicare Advantage |
$16.68
|
| Rate for Payer: UHCCP Medicaid |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$11.76
|
| Rate for Payer: VA VA |
$7.63
|
| Rate for Payer: VA VA |
$16.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.90
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$616.53
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: Aetna Medicare |
$160.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.67
|
| Rate for Payer: BCBS Complete |
$114.12
|
| Rate for Payer: BCBS MAPPO |
$154.13
|
| Rate for Payer: BCBS Trust/PPO |
$506.85
|
| Rate for Payer: BCN Commercial |
$506.85
|
| Rate for Payer: BCN Medicare Advantage |
$154.13
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.13
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: Mclaren Medicaid |
$108.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.84
|
| Rate for Payer: Meridian Medicaid |
$114.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Nomi Health Commercial |
$505.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: PACE Senior Care Partners |
$146.43
|
| Rate for Payer: PACE SWMI |
$154.13
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: PHP Medicare Advantage |
$154.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$536.38
|
| Rate for Payer: Priority Health Medicare |
$155.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.10
|
| Rate for Payer: Railroad Medicare Medicare |
$154.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.55
|
| Rate for Payer: UHC Core |
$514.80
|
| Rate for Payer: UHC Exchange |
$154.13
|
| Rate for Payer: UHC Medicaid |
$108.69
|
| Rate for Payer: UHC Medicare Advantage |
$154.13
|
| Rate for Payer: UHCCP Medicaid |
$108.69
|
| Rate for Payer: VA VA |
$154.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$616.53
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$524.05
|
| Rate for Payer: BCBS Trust/PPO |
$509.19
|
| Rate for Payer: BCN Commercial |
$509.19
|
| Rate for Payer: Cash Price |
$493.22
|
| Rate for Payer: Cofinity Commercial |
$530.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.22
|
| Rate for Payer: Healthscope Commercial |
$554.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.05
|
| Rate for Payer: Nomi Health Commercial |
$505.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$462.40
|
| Rate for Payer: PHP Commercial |
$524.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$536.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.55
|
| Rate for Payer: UHC Core |
$514.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.40
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$156.10
|
| Rate for Payer: BCN Commercial |
$156.10
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
