|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 60687037011
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 60687037001
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.18 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: BCBS Trust/PPO |
$204.92
|
| Rate for Payer: BCN Commercial |
$194.00
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: Nomi Health Commercial |
$205.85
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health HMO/PPO |
$218.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$78.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.73
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: BCBS MAPPO |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$235.70
|
| Rate for Payer: BCN Medicare Advantage |
$75.79
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.79
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: PACE Senior Care Partners |
$72.00
|
| Rate for Payer: PACE SWMI |
$75.79
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Medicare |
$76.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: Railroad Medicare Medicare |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.79
|
| Rate for Payer: UHC Exchange |
$75.79
|
| Rate for Payer: UHC Medicare Advantage |
$75.79
|
| Rate for Payer: VA VA |
$75.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.92 |
| Max. Negotiated Rate |
$308.65 |
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: BCBS Trust/PPO |
$279.95
|
| Rate for Payer: BCN Commercial |
$265.03
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$308.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: Nomi Health Commercial |
$281.22
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health HMO/PPO |
$298.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.80
|
| Rate for Payer: UHC Core |
$286.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.62
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: BCBS MAPPO |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.01
|
| Rate for Payer: BCN Commercial |
$160.79
|
| Rate for Payer: BCN Medicare Advantage |
$51.70
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PACE Senior Care Partners |
$49.12
|
| Rate for Payer: PACE SWMI |
$51.70
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Medicare |
$52.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.70
|
| Rate for Payer: UHC Exchange |
$51.70
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
| Rate for Payer: VA VA |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS MAPPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.86
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$2.81
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.86
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2.98
|
| Rate for Payer: Priority Health Medicare |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.86
|
| Rate for Payer: UHC Exchange |
$0.86
|
| Rate for Payer: UHC Medicare Advantage |
$0.86
|
| Rate for Payer: VA VA |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$168.81
|
| Rate for Payer: BCN Commercial |
$159.82
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$308.65 |
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: Aetna Medicare |
$89.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.17
|
| Rate for Payer: BCBS Complete |
$137.18
|
| Rate for Payer: BCBS MAPPO |
$85.74
|
| Rate for Payer: BCBS Trust/PPO |
$281.94
|
| Rate for Payer: BCN Commercial |
$266.64
|
| Rate for Payer: BCN Medicare Advantage |
$85.74
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.74
|
| Rate for Payer: Healthscope Commercial |
$308.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: Nomi Health Commercial |
$281.22
|
| Rate for Payer: PACE Senior Care Partners |
$81.45
|
| Rate for Payer: PACE SWMI |
$85.74
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: PHP Medicare Advantage |
$85.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health HMO/PPO |
$298.37
|
| Rate for Payer: Priority Health Medicare |
$86.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.78
|
| Rate for Payer: Railroad Medicare Medicare |
$85.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.80
|
| Rate for Payer: UHC Core |
$286.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.74
|
| Rate for Payer: UHC Exchange |
$85.74
|
| Rate for Payer: UHC Medicare Advantage |
$85.74
|
| Rate for Payer: VA VA |
$85.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| Rate for Payer: BCN Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.28
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.64
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1.79
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.38
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$374.07
|
| Rate for Payer: BCN Commercial |
$354.14
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.56
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.12
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.54
|
| Rate for Payer: BCN Medicare Advantage |
$51.30
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PACE Senior Care Partners |
$48.73
|
| Rate for Payer: PACE SWMI |
$51.30
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Medicare |
$51.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.30
|
| Rate for Payer: UHC Exchange |
$51.30
|
| Rate for Payer: UHC Medicare Advantage |
$51.30
|
| Rate for Payer: VA VA |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$179.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.71
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.24 |
| 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 |
$101.46
|
| Rate for Payer: BCBS MAPPO |
$63.41
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$197.21
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| 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 Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Medicare |
$64.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.95
|
| 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 Dual Complete DSNP |
$63.41
|
| Rate for Payer: UHC Exchange |
$63.41
|
| Rate for Payer: UHC Medicare Advantage |
$63.41
|
| Rate for Payer: VA VA |
$63.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.87 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$207.05
|
| Rate for Payer: BCN Commercial |
$196.02
|
| 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: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health HMO/PPO |
$220.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.95
|
| 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
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$166.80
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Medicare |
$2.39
|
| Rate for Payer: Aetna Medicare |
$43.37
|
| Rate for Payer: Aetna Medicare |
$47.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.87
|
| Rate for Payer: BCBS Complete |
$73.41
|
| Rate for Payer: BCBS Complete |
$66.72
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$2.29
|
| Rate for Payer: BCBS MAPPO |
$41.70
|
| Rate for Payer: BCBS MAPPO |
$45.88
|
| Rate for Payer: BCBS Trust/PPO |
$150.87
|
| Rate for Payer: BCBS Trust/PPO |
$137.13
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$142.69
|
| Rate for Payer: BCN Commercial |
$7.14
|
| Rate for Payer: BCN Commercial |
$129.69
|
| Rate for Payer: BCN Medicare Advantage |
$41.70
|
| Rate for Payer: BCN Medicare Advantage |
$45.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.29
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Commercial |
$143.45
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| 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 |
$133.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$150.12
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.78
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Nomi Health Commercial |
$136.78
|
| Rate for Payer: Nomi Health Commercial |
$150.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.18
|
| Rate for Payer: PACE Senior Care Partners |
$39.62
|
| Rate for Payer: PACE Senior Care Partners |
$43.59
|
| Rate for Payer: PACE SWMI |
$45.88
|
| Rate for Payer: PACE SWMI |
$41.70
|
| Rate for Payer: PACE SWMI |
$2.29
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: PHP Commercial |
$141.78
|
| Rate for Payer: PHP Medicare Advantage |
$45.88
|
| Rate for Payer: PHP Medicare Advantage |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$41.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health HMO/PPO |
$145.12
|
| Rate for Payer: Priority Health HMO/PPO |
$159.66
|
| Rate for Payer: Priority Health Medicare |
$42.12
|
| Rate for Payer: Priority Health Medicare |
$2.32
|
| Rate for Payer: Priority Health Medicare |
$46.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.76
|
| Rate for Payer: Railroad Medicare Medicare |
$45.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.29
|
| Rate for Payer: Railroad Medicare Medicare |
$41.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.78
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: UHC Core |
$153.24
|
| Rate for Payer: UHC Core |
$139.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.88
|
| Rate for Payer: UHC Exchange |
$45.88
|
| Rate for Payer: UHC Exchange |
$41.70
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$41.70
|
| Rate for Payer: UHC Medicare Advantage |
$45.88
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
| Rate for Payer: VA VA |
$45.88
|
| Rate for Payer: VA VA |
$2.29
|
| Rate for Payer: VA VA |
$41.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.64
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$166.80
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.81
|
| Rate for Payer: BCBS Trust/PPO |
$136.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.49
|
| Rate for Payer: BCN Commercial |
$141.82
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| Rate for Payer: Cofinity Commercial |
$143.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$150.12
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$136.78
|
| Rate for Payer: Nomi Health Commercial |
$150.49
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: PHP Commercial |
$141.78
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health HMO/PPO |
$159.66
|
| Rate for Payer: Priority Health HMO/PPO |
$145.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.78
|
| Rate for Payer: UHC Core |
$139.28
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: UHC Core |
$153.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.64
|
|
|
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 |
$17.59 |
| 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 |
$29.63
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$60.90
|
| Rate for Payer: BCN Commercial |
$57.60
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.97
|
| Rate for Payer: Nomi Health Commercial |
$60.75
|
| 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 Cigna Priority Health |
$48.15
|
| Rate for Payer: Priority Health HMO/PPO |
$64.45
|
| Rate for Payer: Priority Health Medicare |
$18.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.63
|
| 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 Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| 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
|
IP
|
$74.08
|
|
|
Service Code
|
NDC 17478050401
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: BCBS Trust/PPO |
$60.47
|
| Rate for Payer: BCN Commercial |
$57.25
|
| 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: PHP Commercial |
$62.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.15
|
| Rate for Payer: Priority Health HMO/PPO |
$64.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.63
|
| 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
|
|
