|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
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 |
$2.30
|
| 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 |
$2.30
|
| 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 |
$2.30
|
| 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 |
$47.96
|
| 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 |
$2.30
|
| 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 |
$2.30
|
| 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 |
$2.30
|
| 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 |
$2.30
|
| 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 |
$2.30
|
| Rate for Payer: UHC Medicare Advantage |
$41.70
|
| Rate for Payer: UHC Medicare Advantage |
$45.88
|
| Rate for Payer: UHC Medicare Advantage |
$2.30
|
| Rate for Payer: VA VA |
$45.88
|
| Rate for Payer: VA VA |
$2.30
|
| 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
|
|
|
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 |
$140.34 |
| 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 |
$236.36
|
| Rate for Payer: BCBS MAPPO |
$147.72
|
| Rate for Payer: BCBS Trust/PPO |
$485.78
|
| Rate for Payer: BCN Commercial |
$459.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: Nomi Health Commercial |
$484.54
|
| 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 Cigna Priority Health |
$384.08
|
| Rate for Payer: Priority Health HMO/PPO |
$514.08
|
| Rate for Payer: Priority Health Medicare |
$149.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.90
|
| 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 Dual Complete DSNP |
$147.72
|
| Rate for Payer: UHC Exchange |
$147.72
|
| Rate for Payer: UHC Medicare Advantage |
$147.72
|
| Rate for Payer: VA VA |
$147.72
|
| 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 |
$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
|
|
|
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 |
$384.08 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: BCBS Trust/PPO |
$482.35
|
| Rate for Payer: BCN Commercial |
$456.65
|
| 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: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.08
|
| Rate for Payer: Priority Health HMO/PPO |
$514.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.90
|
| 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) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$85.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.17
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: BCBS MAPPO |
$82.54
|
| Rate for Payer: BCBS Trust/PPO |
$271.42
|
| Rate for Payer: BCN Commercial |
$256.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.54
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$297.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: Nomi Health Commercial |
$270.72
|
| Rate for Payer: PACE Senior Care Partners |
$78.41
|
| Rate for Payer: PACE SWMI |
$82.54
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: PHP Medicare Advantage |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health HMO/PPO |
$287.23
|
| Rate for Payer: Priority Health Medicare |
$83.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.20
|
| Rate for Payer: Railroad Medicare Medicare |
$82.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.53
|
| Rate for Payer: UHC Core |
$275.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.54
|
| Rate for Payer: UHC Exchange |
$82.54
|
| Rate for Payer: UHC Medicare Advantage |
$82.54
|
| Rate for Payer: VA VA |
$82.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: BCBS Trust/PPO |
$269.50
|
| Rate for Payer: BCN Commercial |
$255.14
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: Nomi Health Commercial |
$270.72
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health HMO/PPO |
$287.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.53
|
| Rate for Payer: UHC Core |
$275.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: BCBS Trust/PPO |
$269.50
|
| Rate for Payer: BCN Commercial |
$255.14
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: Nomi Health Commercial |
$270.72
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health HMO/PPO |
$287.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.53
|
| Rate for Payer: UHC Core |
$275.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$85.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.17
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: BCBS MAPPO |
$82.54
|
| Rate for Payer: BCBS Trust/PPO |
$271.42
|
| Rate for Payer: BCN Commercial |
$256.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.54
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$297.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: Nomi Health Commercial |
$270.72
|
| Rate for Payer: PACE Senior Care Partners |
$78.41
|
| Rate for Payer: PACE SWMI |
$82.54
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: PHP Medicare Advantage |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health HMO/PPO |
$287.23
|
| Rate for Payer: Priority Health Medicare |
$83.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.20
|
| Rate for Payer: Railroad Medicare Medicare |
$82.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.53
|
| Rate for Payer: UHC Core |
$275.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.54
|
| Rate for Payer: UHC Exchange |
$82.54
|
| Rate for Payer: UHC Medicare Advantage |
$82.54
|
| Rate for Payer: VA VA |
$82.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Aetna Commercial |
$57.87
|
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.54
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS Complete |
$27.23
|
| Rate for Payer: BCBS MAPPO |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$55.97
|
| Rate for Payer: BCBS Trust/PPO |
$25.10
|
| Rate for Payer: BCN Commercial |
$52.93
|
| Rate for Payer: BCN Commercial |
$23.74
|
| Rate for Payer: BCN Medicare Advantage |
$17.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.63
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$58.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.02
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.95
|
| Rate for Payer: Nomi Health Commercial |
$55.83
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: PACE Senior Care Partners |
$16.17
|
| Rate for Payer: PACE Senior Care Partners |
$7.25
|
| Rate for Payer: PACE SWMI |
$17.02
|
| Rate for Payer: PACE SWMI |
$7.63
|
| Rate for Payer: PHP Commercial |
$57.87
|
| Rate for Payer: PHP Commercial |
$25.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$17.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.84
|
| Rate for Payer: Priority Health HMO/PPO |
$26.56
|
| Rate for Payer: Priority Health HMO/PPO |
$59.23
|
| Rate for Payer: Priority Health Medicare |
$17.19
|
| Rate for Payer: Priority Health Medicare |
$7.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.63
|
| Rate for Payer: Railroad Medicare Medicare |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.91
|
| Rate for Payer: UHC Core |
$56.85
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.63
|
| Rate for Payer: UHC Exchange |
$7.63
|
| Rate for Payer: UHC Exchange |
$17.02
|
| Rate for Payer: UHC Medicare Advantage |
$7.63
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: VA VA |
$7.63
|
| Rate for Payer: VA VA |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.90
|
|
|
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 |
$19.84 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Commercial |
$57.87
|
| Rate for Payer: BCBS Trust/PPO |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$55.57
|
| Rate for Payer: BCN Commercial |
$23.59
|
| Rate for Payer: BCN Commercial |
$52.61
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$58.55
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: Nomi Health Commercial |
$55.83
|
| Rate for Payer: PHP Commercial |
$25.95
|
| Rate for Payer: PHP Commercial |
$57.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.84
|
| Rate for Payer: Priority Health HMO/PPO |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO |
$26.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.91
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Core |
$56.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.06
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$344.01 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: BCBS Trust/PPO |
$432.02
|
| Rate for Payer: BCN Commercial |
$409.00
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: Nomi Health Commercial |
$433.98
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health HMO/PPO |
$460.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$354.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.73
|
| Rate for Payer: UHC Core |
$441.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.69 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna Medicare |
$137.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.39
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: BCBS MAPPO |
$132.31
|
| Rate for Payer: BCBS Trust/PPO |
$435.09
|
| Rate for Payer: BCN Commercial |
$411.48
|
| Rate for Payer: BCN Medicare Advantage |
$132.31
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.31
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: Nomi Health Commercial |
$433.98
|
| Rate for Payer: PACE Senior Care Partners |
$125.69
|
| Rate for Payer: PACE SWMI |
$132.31
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: PHP Medicare Advantage |
$132.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health HMO/PPO |
$460.44
|
| Rate for Payer: Priority Health Medicare |
$133.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$354.59
|
| Rate for Payer: Railroad Medicare Medicare |
$132.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.73
|
| Rate for Payer: UHC Core |
$441.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.31
|
| Rate for Payer: UHC Exchange |
$132.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.31
|
| Rate for Payer: VA VA |
$132.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$320.25
|
|
|
Service Code
|
NDC 00406114201
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.06 |
| Max. Negotiated Rate |
$288.22 |
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: Aetna Medicare |
$83.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.08
|
| Rate for Payer: BCBS Complete |
$128.10
|
| Rate for Payer: BCBS MAPPO |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$263.28
|
| Rate for Payer: BCN Commercial |
$248.99
|
| Rate for Payer: BCN Medicare Advantage |
$80.06
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.21
|
| Rate for Payer: Nomi Health Commercial |
$262.60
|
| Rate for Payer: PACE Senior Care Partners |
$76.06
|
| Rate for Payer: PACE SWMI |
$80.06
|
| Rate for Payer: PHP Commercial |
$272.21
|
| Rate for Payer: PHP Medicare Advantage |
$80.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| Rate for Payer: Priority Health HMO/PPO |
$278.62
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.57
|
| Rate for Payer: Railroad Medicare Medicare |
$80.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.82
|
| Rate for Payer: UHC Core |
$267.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.06
|
| Rate for Payer: UHC Exchange |
$80.06
|
| Rate for Payer: UHC Medicare Advantage |
$80.06
|
| Rate for Payer: VA VA |
$80.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 68084080511
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna Medicare |
$3.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.11
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS MAPPO |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.82
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: BCN Medicare Advantage |
$3.29
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: PACE Senior Care Partners |
$3.13
|
| Rate for Payer: PACE SWMI |
$3.29
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health HMO/PPO |
$11.45
|
| Rate for Payer: Priority Health Medicare |
$3.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.29
|
| Rate for Payer: UHC Exchange |
$3.29
|
| Rate for Payer: UHC Medicare Advantage |
$3.29
|
| Rate for Payer: VA VA |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.87
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$320.25
|
|
|
Service Code
|
NDC 00406114201
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.16 |
| Max. Negotiated Rate |
$288.22 |
| Rate for Payer: Aetna Commercial |
$272.21
|
| Rate for Payer: BCBS Trust/PPO |
$261.42
|
| Rate for Payer: BCN Commercial |
$247.49
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.20
|
| Rate for Payer: Healthscope Commercial |
$288.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.21
|
| Rate for Payer: Nomi Health Commercial |
$262.60
|
| Rate for Payer: PHP Commercial |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.16
|
| Rate for Payer: Priority Health HMO/PPO |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.82
|
| Rate for Payer: UHC Core |
$267.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.19
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$137.14
|
| Rate for Payer: BCN Commercial |
$129.83
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO |
$146.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.50
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$138.11
|
| Rate for Payer: BCN Commercial |
$130.62
|
| Rate for Payer: BCN Medicare Advantage |
$42.00
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Nomi Health Commercial |
$137.76
|
| Rate for Payer: PACE Senior Care Partners |
$39.90
|
| Rate for Payer: PACE SWMI |
$42.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: PHP Medicare Advantage |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO |
$146.16
|
| Rate for Payer: Priority Health Medicare |
$42.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.56
|
| Rate for Payer: Railroad Medicare Medicare |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.00
|
| Rate for Payer: UHC Exchange |
$42.00
|
| Rate for Payer: UHC Medicare Advantage |
$42.00
|
| Rate for Payer: VA VA |
$42.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
METHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$394.59
|
|
|
Service Code
|
NDC 68084080521
|
| Hospital Charge Code |
4988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$355.13 |
| Rate for Payer: Aetna Commercial |
$335.40
|
| Rate for Payer: Aetna Medicare |
$102.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.31
|
| Rate for Payer: BCBS Complete |
$157.84
|
| Rate for Payer: BCBS MAPPO |
$98.65
|
| Rate for Payer: BCBS Trust/PPO |
$324.39
|
| Rate for Payer: BCN Commercial |
$306.79
|
| Rate for Payer: BCN Medicare Advantage |
$98.65
|
| Rate for Payer: Cash Price |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$339.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$355.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.40
|
| Rate for Payer: Nomi Health Commercial |
$323.56
|
| Rate for Payer: PACE Senior Care Partners |
$93.72
|
| Rate for Payer: PACE SWMI |
$98.65
|
| Rate for Payer: PHP Commercial |
$335.40
|
| Rate for Payer: PHP Medicare Advantage |
$98.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.48
|
| Rate for Payer: Priority Health HMO/PPO |
$343.29
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.38
|
| Rate for Payer: Railroad Medicare Medicare |
$98.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.24
|
| Rate for Payer: UHC Core |
$329.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.65
|
| Rate for Payer: UHC Exchange |
$98.65
|
| Rate for Payer: UHC Medicare Advantage |
$98.65
|
| Rate for Payer: VA VA |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.94
|
|
