METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
Service Code
|
NDC 60687-568-01
|
Hospital Charge Code |
4972
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$108.68 |
Max. Negotiated Rate |
$222.30 |
Rate for Payer: Aetna American Axle |
$160.55
|
Rate for Payer: Aetna Commercial |
$209.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
Rate for Payer: Cash Price |
$197.60
|
Rate for Payer: Cofinity Commercial |
$172.90
|
Rate for Payer: Cofinity Commercial |
$212.42
|
Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
Rate for Payer: Healthscope Commercial |
$222.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.95
|
Rate for Payer: PHP Commercial |
$209.95
|
Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
Rate for Payer: Priority Health SBD |
$155.61
|
Rate for Payer: UMR Bronson Commercial |
$108.68
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
Service Code
|
NDC 63739-992-10
|
Hospital Charge Code |
4972
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$102.41 |
Max. Negotiated Rate |
$209.48 |
Rate for Payer: Aetna American Axle |
$151.29
|
Rate for Payer: Aetna Commercial |
$197.84
|
Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
Rate for Payer: Cash Price |
$186.20
|
Rate for Payer: Cofinity Commercial |
$162.92
|
Rate for Payer: Cofinity Commercial |
$200.16
|
Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
Rate for Payer: Healthscope Commercial |
$209.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
Rate for Payer: PHP Commercial |
$197.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
Rate for Payer: Priority Health SBD |
$146.63
|
Rate for Payer: UMR Bronson Commercial |
$102.41
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
METHOHEXITAL 500 MG SOLUTION FOR AVM PROVACATIVE TESTING
|
Facility
|
IP
|
$378.49
|
|
Service Code
|
NDC 42023-105-01
|
Hospital Charge Code |
180402
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$166.54 |
Max. Negotiated Rate |
$340.64 |
Rate for Payer: Aetna American Axle |
$246.02
|
Rate for Payer: Aetna Commercial |
$321.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$246.02
|
Rate for Payer: Cash Price |
$302.79
|
Rate for Payer: Cofinity Commercial |
$264.94
|
Rate for Payer: Cofinity Commercial |
$325.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$302.79
|
Rate for Payer: Healthscope Commercial |
$340.64
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.94
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.87
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.72
|
Rate for Payer: PHP Commercial |
$321.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$264.94
|
Rate for Payer: Priority Health SBD |
$238.45
|
Rate for Payer: UMR Bronson Commercial |
$166.54
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.87
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$378.49
|
|
Service Code
|
NDC 42023-105-01
|
Hospital Charge Code |
70545
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$166.54 |
Max. Negotiated Rate |
$340.64 |
Rate for Payer: Aetna American Axle |
$246.02
|
Rate for Payer: Aetna Commercial |
$321.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$246.02
|
Rate for Payer: Cash Price |
$302.79
|
Rate for Payer: Cofinity Commercial |
$264.94
|
Rate for Payer: Cofinity Commercial |
$325.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$302.79
|
Rate for Payer: Healthscope Commercial |
$340.64
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.94
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.87
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.72
|
Rate for Payer: PHP Commercial |
$321.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$264.94
|
Rate for Payer: Priority Health SBD |
$238.45
|
Rate for Payer: UMR Bronson Commercial |
$166.54
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.87
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
Service Code
|
HCPCS J8610
|
Hospital Charge Code |
4973
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$120.38 |
Max. Negotiated Rate |
$246.24 |
Rate for Payer: Aetna American Axle |
$177.84
|
Rate for Payer: Aetna American Axle |
$99.81
|
Rate for Payer: Aetna American Axle |
$197.60
|
Rate for Payer: Aetna American Axle |
$118.86
|
Rate for Payer: Aetna Commercial |
$232.56
|
Rate for Payer: Aetna Commercial |
$130.53
|
Rate for Payer: Aetna Commercial |
$155.43
|
Rate for Payer: Aetna Commercial |
$258.40
|
Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
Rate for Payer: Aetna New Business (MI Preferred) |
$99.81
|
Rate for Payer: Aetna New Business (MI Preferred) |
$118.86
|
Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
Rate for Payer: Cash Price |
$243.20
|
Rate for Payer: Cash Price |
$146.29
|
Rate for Payer: Cash Price |
$122.85
|
Rate for Payer: Cash Price |
$218.88
|
Rate for Payer: Cofinity Commercial |
$128.00
|
Rate for Payer: Cofinity Commercial |
$157.26
|
Rate for Payer: Cofinity Commercial |
$212.80
|
Rate for Payer: Cofinity Commercial |
$107.49
|
Rate for Payer: Cofinity Commercial |
$235.30
|
Rate for Payer: Cofinity Commercial |
$191.52
|
Rate for Payer: Cofinity Commercial |
$132.06
|
Rate for Payer: Cofinity Commercial |
$261.44
|
Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$122.85
|
Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
Rate for Payer: Healthscope Commercial |
$273.60
|
Rate for Payer: Healthscope Commercial |
$164.57
|
Rate for Payer: Healthscope Commercial |
$138.20
|
Rate for Payer: Healthscope Commercial |
$246.24
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.49
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.14
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.17
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.43
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.53
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.40
|
Rate for Payer: PHP Commercial |
$232.56
|
Rate for Payer: PHP Commercial |
$130.53
|
Rate for Payer: PHP Commercial |
$155.43
|
Rate for Payer: PHP Commercial |
$258.40
|
Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
Rate for Payer: Priority Health Cigna Priority Health |
$128.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$107.49
|
Rate for Payer: Priority Health SBD |
$115.20
|
Rate for Payer: Priority Health SBD |
$191.52
|
Rate for Payer: Priority Health SBD |
$96.74
|
Rate for Payer: Priority Health SBD |
$172.37
|
Rate for Payer: UMR Bronson Commercial |
$120.38
|
Rate for Payer: UMR Bronson Commercial |
$67.57
|
Rate for Payer: UMR Bronson Commercial |
$133.76
|
Rate for Payer: UMR Bronson Commercial |
$80.46
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.14
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.17
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$541.59
|
|
Service Code
|
HCPCS J9260
|
Hospital Charge Code |
4975
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$238.30 |
Max. Negotiated Rate |
$487.43 |
Rate for Payer: Aetna American Axle |
$352.03
|
Rate for Payer: Aetna American Axle |
$270.37
|
Rate for Payer: Aetna Commercial |
$353.56
|
Rate for Payer: Aetna Commercial |
$460.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
Rate for Payer: Aetna New Business (MI Preferred) |
$352.03
|
Rate for Payer: Cash Price |
$433.27
|
Rate for Payer: Cash Price |
$332.76
|
Rate for Payer: Cofinity Commercial |
$291.16
|
Rate for Payer: Cofinity Commercial |
$465.77
|
Rate for Payer: Cofinity Commercial |
$379.11
|
Rate for Payer: Cofinity Commercial |
$357.72
|
Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
Rate for Payer: Encore Health Key Benefits Commercial |
$433.27
|
Rate for Payer: Healthscope Commercial |
$374.36
|
Rate for Payer: Healthscope Commercial |
$487.43
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.11
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.16
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.19
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.35
|
Rate for Payer: PHP Commercial |
$353.56
|
Rate for Payer: PHP Commercial |
$460.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$379.11
|
Rate for Payer: Priority Health Cigna Priority Health |
$291.16
|
Rate for Payer: Priority Health SBD |
$341.20
|
Rate for Payer: Priority Health SBD |
$262.05
|
Rate for Payer: UMR Bronson Commercial |
$183.02
|
Rate for Payer: UMR Bronson Commercial |
$238.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.19
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$175.69
|
|
Service Code
|
HCPCS J9255
|
Hospital Charge Code |
96981
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$77.30 |
Max. Negotiated Rate |
$158.12 |
Rate for Payer: Aetna American Axle |
$114.20
|
Rate for Payer: Aetna Commercial |
$149.34
|
Rate for Payer: Aetna New Business (MI Preferred) |
$114.20
|
Rate for Payer: Cash Price |
$140.55
|
Rate for Payer: Cofinity Commercial |
$122.98
|
Rate for Payer: Cofinity Commercial |
$151.09
|
Rate for Payer: Encore Health Key Benefits Commercial |
$140.55
|
Rate for Payer: Healthscope Commercial |
$158.12
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.98
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.77
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.34
|
Rate for Payer: PHP Commercial |
$149.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$122.98
|
Rate for Payer: Priority Health SBD |
$110.68
|
Rate for Payer: UMR Bronson Commercial |
$77.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.77
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$229.60
|
|
Service Code
|
HCPCS J9260
|
Hospital Charge Code |
96981
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$101.02 |
Max. Negotiated Rate |
$206.64 |
Rate for Payer: Aetna American Axle |
$149.24
|
Rate for Payer: Aetna American Axle |
$89.81
|
Rate for Payer: Aetna American Axle |
$77.71
|
Rate for Payer: Aetna American Axle |
$183.95
|
Rate for Payer: Aetna American Axle |
$55.80
|
Rate for Payer: Aetna Commercial |
$101.63
|
Rate for Payer: Aetna Commercial |
$240.55
|
Rate for Payer: Aetna Commercial |
$195.16
|
Rate for Payer: Aetna Commercial |
$72.97
|
Rate for Payer: Aetna Commercial |
$117.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$77.71
|
Rate for Payer: Aetna New Business (MI Preferred) |
$183.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$149.24
|
Rate for Payer: Cash Price |
$110.54
|
Rate for Payer: Cash Price |
$95.65
|
Rate for Payer: Cash Price |
$68.68
|
Rate for Payer: Cash Price |
$183.68
|
Rate for Payer: Cash Price |
$226.40
|
Rate for Payer: Cofinity Commercial |
$73.83
|
Rate for Payer: Cofinity Commercial |
$102.82
|
Rate for Payer: Cofinity Commercial |
$83.69
|
Rate for Payer: Cofinity Commercial |
$118.83
|
Rate for Payer: Cofinity Commercial |
$96.72
|
Rate for Payer: Cofinity Commercial |
$60.10
|
Rate for Payer: Cofinity Commercial |
$160.72
|
Rate for Payer: Cofinity Commercial |
$197.46
|
Rate for Payer: Cofinity Commercial |
$198.10
|
Rate for Payer: Cofinity Commercial |
$243.38
|
Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
Rate for Payer: Encore Health Key Benefits Commercial |
$226.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$183.68
|
Rate for Payer: Encore Health Key Benefits Commercial |
$95.65
|
Rate for Payer: Healthscope Commercial |
$206.64
|
Rate for Payer: Healthscope Commercial |
$77.26
|
Rate for Payer: Healthscope Commercial |
$107.60
|
Rate for Payer: Healthscope Commercial |
$254.70
|
Rate for Payer: Healthscope Commercial |
$124.35
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.72
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.72
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.69
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.25
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.97
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.63
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.16
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.55
|
Rate for Payer: PHP Commercial |
$72.97
|
Rate for Payer: PHP Commercial |
$101.63
|
Rate for Payer: PHP Commercial |
$117.44
|
Rate for Payer: PHP Commercial |
$195.16
|
Rate for Payer: PHP Commercial |
$240.55
|
Rate for Payer: Priority Health Cigna Priority Health |
$198.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$96.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$160.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$83.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$60.10
|
Rate for Payer: Priority Health SBD |
$178.29
|
Rate for Payer: Priority Health SBD |
$75.32
|
Rate for Payer: Priority Health SBD |
$54.09
|
Rate for Payer: Priority Health SBD |
$144.65
|
Rate for Payer: Priority Health SBD |
$87.05
|
Rate for Payer: UMR Bronson Commercial |
$124.52
|
Rate for Payer: UMR Bronson Commercial |
$101.02
|
Rate for Payer: UMR Bronson Commercial |
$60.79
|
Rate for Payer: UMR Bronson Commercial |
$52.61
|
Rate for Payer: UMR Bronson Commercial |
$37.77
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.20
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.67
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$138.17
|
|
Service Code
|
HCPCS J9260
|
Hospital Charge Code |
96981
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$9.80 |
Max. Negotiated Rate |
$124.35 |
Rate for Payer: Aetna American Axle |
$89.81
|
Rate for Payer: Aetna American Axle |
$183.95
|
Rate for Payer: Aetna American Axle |
$77.71
|
Rate for Payer: Aetna American Axle |
$149.24
|
Rate for Payer: Aetna American Axle |
$55.80
|
Rate for Payer: Aetna Commercial |
$72.97
|
Rate for Payer: Aetna Commercial |
$195.16
|
Rate for Payer: Aetna Commercial |
$240.55
|
Rate for Payer: Aetna Commercial |
$101.63
|
Rate for Payer: Aetna Commercial |
$117.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$77.71
|
Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$183.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$149.24
|
Rate for Payer: BCBS Complete |
$55.27
|
Rate for Payer: BCBS Complete |
$34.34
|
Rate for Payer: BCBS Complete |
$47.82
|
Rate for Payer: BCBS Complete |
$113.20
|
Rate for Payer: BCBS Complete |
$91.84
|
Rate for Payer: BCBS Trust/PPO |
$9.80
|
Rate for Payer: BCBS Trust/PPO |
$9.80
|
Rate for Payer: BCBS Trust/PPO |
$9.80
|
Rate for Payer: BCBS Trust/PPO |
$9.80
|
Rate for Payer: BCBS Trust/PPO |
$9.80
|
Rate for Payer: Cash Price |
$68.68
|
Rate for Payer: Cash Price |
$183.68
|
Rate for Payer: Cash Price |
$226.40
|
Rate for Payer: Cash Price |
$68.68
|
Rate for Payer: Cash Price |
$110.54
|
Rate for Payer: Cash Price |
$183.68
|
Rate for Payer: Cash Price |
$95.65
|
Rate for Payer: Cash Price |
$226.40
|
Rate for Payer: Cash Price |
$110.54
|
Rate for Payer: Cash Price |
$95.65
|
Rate for Payer: Cofinity Commercial |
$198.10
|
Rate for Payer: Cofinity Commercial |
$118.83
|
Rate for Payer: Cofinity Commercial |
$73.83
|
Rate for Payer: Cofinity Commercial |
$60.10
|
Rate for Payer: Cofinity Commercial |
$160.72
|
Rate for Payer: Cofinity Commercial |
$197.46
|
Rate for Payer: Cofinity Commercial |
$102.82
|
Rate for Payer: Cofinity Commercial |
$83.69
|
Rate for Payer: Cofinity Commercial |
$96.72
|
Rate for Payer: Cofinity Commercial |
$243.38
|
Rate for Payer: Encore Health Key Benefits Commercial |
$226.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$183.68
|
Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
Rate for Payer: Encore Health Key Benefits Commercial |
$95.65
|
Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
Rate for Payer: Healthscope Commercial |
$254.70
|
Rate for Payer: Healthscope Commercial |
$77.26
|
Rate for Payer: Healthscope Commercial |
$124.35
|
Rate for Payer: Healthscope Commercial |
$107.60
|
Rate for Payer: Healthscope Commercial |
$206.64
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.72
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.69
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.72
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.10
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.16
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.63
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.55
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.97
|
Rate for Payer: PHP Commercial |
$195.16
|
Rate for Payer: PHP Commercial |
$117.44
|
Rate for Payer: PHP Commercial |
$240.55
|
Rate for Payer: PHP Commercial |
$72.97
|
Rate for Payer: PHP Commercial |
$101.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$160.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$83.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$96.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$198.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$60.10
|
Rate for Payer: Priority Health SBD |
$75.32
|
Rate for Payer: Priority Health SBD |
$178.29
|
Rate for Payer: Priority Health SBD |
$144.65
|
Rate for Payer: Priority Health SBD |
$87.05
|
Rate for Payer: Priority Health SBD |
$54.09
|
Rate for Payer: UMR Bronson Commercial |
$31.76
|
Rate for Payer: UMR Bronson Commercial |
$104.71
|
Rate for Payer: UMR Bronson Commercial |
$84.95
|
Rate for Payer: UMR Bronson Commercial |
$44.24
|
Rate for Payer: UMR Bronson Commercial |
$51.12
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.20
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.67
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$175.69
|
|
Service Code
|
HCPCS J9255
|
Hospital Charge Code |
96981
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$158.12 |
Rate for Payer: Aetna American Axle |
$114.20
|
Rate for Payer: Aetna American Axle |
$71.34
|
Rate for Payer: Aetna Commercial |
$93.30
|
Rate for Payer: Aetna Commercial |
$149.34
|
Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
Rate for Payer: Aetna New Business (MI Preferred) |
$114.20
|
Rate for Payer: BCBS Complete |
$70.28
|
Rate for Payer: BCBS Complete |
$43.90
|
Rate for Payer: BCBS Trust/PPO |
$0.03
|
Rate for Payer: BCBS Trust/PPO |
$0.03
|
Rate for Payer: Cash Price |
$140.55
|
Rate for Payer: Cash Price |
$87.81
|
Rate for Payer: Cash Price |
$87.81
|
Rate for Payer: Cash Price |
$140.55
|
Rate for Payer: Cofinity Commercial |
$151.09
|
Rate for Payer: Cofinity Commercial |
$76.83
|
Rate for Payer: Cofinity Commercial |
$94.39
|
Rate for Payer: Cofinity Commercial |
$122.98
|
Rate for Payer: Encore Health Key Benefits Commercial |
$140.55
|
Rate for Payer: Encore Health Key Benefits Commercial |
$87.81
|
Rate for Payer: Healthscope Commercial |
$98.78
|
Rate for Payer: Healthscope Commercial |
$158.12
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.83
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.98
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.77
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.32
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.30
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.34
|
Rate for Payer: PHP Commercial |
$149.34
|
Rate for Payer: PHP Commercial |
$93.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$76.83
|
Rate for Payer: Priority Health Cigna Priority Health |
$122.98
|
Rate for Payer: Priority Health SBD |
$69.15
|
Rate for Payer: Priority Health SBD |
$110.68
|
Rate for Payer: UMR Bronson Commercial |
$65.01
|
Rate for Payer: UMR Bronson Commercial |
$40.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.77
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.32
|
|
METHYLCELLULOSE (BULK) 1 % GEL
|
Facility
|
IP
|
$66.50
|
|
Service Code
|
NDC 3877930608
|
Hospital Charge Code |
82599
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$29.26 |
Max. Negotiated Rate |
$59.85 |
Rate for Payer: Aetna American Axle |
$43.22
|
Rate for Payer: Aetna Commercial |
$56.52
|
Rate for Payer: Aetna New Business (MI Preferred) |
$43.22
|
Rate for Payer: Cash Price |
$53.20
|
Rate for Payer: Cofinity Commercial |
$46.55
|
Rate for Payer: Cofinity Commercial |
$57.19
|
Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
Rate for Payer: Healthscope Commercial |
$59.85
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.52
|
Rate for Payer: PHP Commercial |
$56.52
|
Rate for Payer: Priority Health Cigna Priority Health |
$46.55
|
Rate for Payer: Priority Health SBD |
$41.90
|
Rate for Payer: UMR Bronson Commercial |
$29.26
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
METHYLDOPA 250 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
Service Code
|
NDC 51079-200-01
|
Hospital Charge Code |
4982
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.61 |
Max. Negotiated Rate |
$3.30 |
Rate for Payer: Aetna American Axle |
$2.39
|
Rate for Payer: Aetna Commercial |
$3.12
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
Rate for Payer: Cash Price |
$2.94
|
Rate for Payer: Cofinity Commercial |
$2.57
|
Rate for Payer: Cofinity Commercial |
$3.16
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
Rate for Payer: Healthscope Commercial |
$3.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.57
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.12
|
Rate for Payer: PHP Commercial |
$3.12
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
Rate for Payer: Priority Health SBD |
$2.31
|
Rate for Payer: UMR Bronson Commercial |
$1.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
METHYLDOPA 250 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
Service Code
|
NDC 16729-030-01
|
Hospital Charge Code |
4982
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$109.60 |
Max. Negotiated Rate |
$224.19 |
Rate for Payer: Aetna American Axle |
$161.92
|
Rate for Payer: Aetna Commercial |
$211.74
|
Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
Rate for Payer: Cash Price |
$199.28
|
Rate for Payer: Cofinity Commercial |
$174.37
|
Rate for Payer: Cofinity Commercial |
$214.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
Rate for Payer: Healthscope Commercial |
$224.19
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
Rate for Payer: PHP Commercial |
$211.74
|
Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
Rate for Payer: Priority Health SBD |
$156.93
|
Rate for Payer: UMR Bronson Commercial |
$109.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$590.90
|
|
Service Code
|
NDC 17478-504-10
|
Hospital Charge Code |
4985
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$531.81 |
Rate for Payer: Aetna American Axle |
$384.08
|
Rate for Payer: Aetna Commercial |
$502.26
|
Rate for Payer: Aetna New Business (MI Preferred) |
$384.08
|
Rate for Payer: Cash Price |
$472.72
|
Rate for Payer: Cofinity Commercial |
$413.63
|
Rate for Payer: Cofinity Commercial |
$508.17
|
Rate for Payer: Encore Health Key Benefits Commercial |
$472.72
|
Rate for Payer: Healthscope Commercial |
$531.81
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.63
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$443.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$502.26
|
Rate for Payer: PHP Commercial |
$502.26
|
Rate for Payer: Priority Health Cigna Priority Health |
$413.63
|
Rate for Payer: Priority Health SBD |
$372.27
|
Rate for Payer: UMR Bronson Commercial |
$260.00
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.18
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$662.29
|
|
Service Code
|
NDC 0517-0374-05
|
Hospital Charge Code |
180747
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$291.41 |
Max. Negotiated Rate |
$596.06 |
Rate for Payer: Aetna American Axle |
$430.49
|
Rate for Payer: Aetna Commercial |
$562.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$430.49
|
Rate for Payer: Cash Price |
$529.83
|
Rate for Payer: Cofinity Commercial |
$463.60
|
Rate for Payer: Cofinity Commercial |
$569.57
|
Rate for Payer: Encore Health Key Benefits Commercial |
$529.83
|
Rate for Payer: Healthscope Commercial |
$596.06
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.72
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$562.95
|
Rate for Payer: PHP Commercial |
$562.95
|
Rate for Payer: Priority Health Cigna Priority Health |
$463.60
|
Rate for Payer: Priority Health SBD |
$417.24
|
Rate for Payer: UMR Bronson Commercial |
$291.41
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.72
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$662.29
|
|
Service Code
|
NDC 0517-0374-01
|
Hospital Charge Code |
180747
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$291.41 |
Max. Negotiated Rate |
$596.06 |
Rate for Payer: Aetna American Axle |
$430.49
|
Rate for Payer: Aetna Commercial |
$562.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$430.49
|
Rate for Payer: Cash Price |
$529.83
|
Rate for Payer: Cofinity Commercial |
$463.60
|
Rate for Payer: Cofinity Commercial |
$569.57
|
Rate for Payer: Encore Health Key Benefits Commercial |
$529.83
|
Rate for Payer: Healthscope Commercial |
$596.06
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.72
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$562.95
|
Rate for Payer: PHP Commercial |
$562.95
|
Rate for Payer: Priority Health Cigna Priority Health |
$463.60
|
Rate for Payer: Priority Health SBD |
$417.24
|
Rate for Payer: UMR Bronson Commercial |
$291.41
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.72
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$88.43
|
|
Service Code
|
HCPCS J2210
|
Hospital Charge Code |
10571
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$38.91 |
Max. Negotiated Rate |
$79.59 |
Rate for Payer: Aetna American Axle |
$57.48
|
Rate for Payer: Aetna American Axle |
$44.25
|
Rate for Payer: Aetna Commercial |
$57.87
|
Rate for Payer: Aetna Commercial |
$75.17
|
Rate for Payer: Aetna New Business (MI Preferred) |
$44.25
|
Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
Rate for Payer: Cash Price |
$54.46
|
Rate for Payer: Cash Price |
$70.74
|
Rate for Payer: Cofinity Commercial |
$76.05
|
Rate for Payer: Cofinity Commercial |
$47.66
|
Rate for Payer: Cofinity Commercial |
$58.55
|
Rate for Payer: Cofinity Commercial |
$61.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
Rate for Payer: Healthscope Commercial |
$79.59
|
Rate for Payer: Healthscope Commercial |
$61.27
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.90
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.66
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.87
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
Rate for Payer: PHP Commercial |
$75.17
|
Rate for Payer: PHP Commercial |
$57.87
|
Rate for Payer: Priority Health Cigna Priority Health |
$47.66
|
Rate for Payer: Priority Health Cigna Priority Health |
$61.90
|
Rate for Payer: Priority Health SBD |
$42.89
|
Rate for Payer: Priority Health SBD |
$55.71
|
Rate for Payer: UMR Bronson Commercial |
$38.91
|
Rate for Payer: UMR Bronson Commercial |
$29.96
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.06
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$1,589.75
|
|
Service Code
|
NDC 69238-1605-8
|
Hospital Charge Code |
10572
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$699.49 |
Max. Negotiated Rate |
$1,430.78 |
Rate for Payer: Aetna American Axle |
$1,033.34
|
Rate for Payer: Aetna Commercial |
$1,351.29
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.34
|
Rate for Payer: Cash Price |
$1,271.80
|
Rate for Payer: Cofinity Commercial |
$1,112.82
|
Rate for Payer: Cofinity Commercial |
$1,367.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.80
|
Rate for Payer: Healthscope Commercial |
$1,430.78
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,112.82
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,192.31
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,351.29
|
Rate for Payer: PHP Commercial |
$1,351.29
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,112.82
|
Rate for Payer: Priority Health SBD |
$1,001.54
|
Rate for Payer: UMR Bronson Commercial |
$699.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.31
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$487.21
|
|
Service Code
|
NDC 16571-735-21
|
Hospital Charge Code |
10572
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$214.37 |
Max. Negotiated Rate |
$438.49 |
Rate for Payer: Aetna American Axle |
$316.69
|
Rate for Payer: Aetna Commercial |
$414.13
|
Rate for Payer: Aetna New Business (MI Preferred) |
$316.69
|
Rate for Payer: Cash Price |
$389.77
|
Rate for Payer: Cofinity Commercial |
$341.05
|
Rate for Payer: Cofinity Commercial |
$419.00
|
Rate for Payer: Encore Health Key Benefits Commercial |
$389.77
|
Rate for Payer: Healthscope Commercial |
$438.49
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.05
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.41
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.13
|
Rate for Payer: PHP Commercial |
$414.13
|
Rate for Payer: Priority Health Cigna Priority Health |
$341.05
|
Rate for Payer: Priority Health SBD |
$306.94
|
Rate for Payer: UMR Bronson Commercial |
$214.37
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.41
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$6,014.19
|
|
Service Code
|
NDC 27437-050-56
|
Hospital Charge Code |
10572
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2,646.24 |
Max. Negotiated Rate |
$5,412.77 |
Rate for Payer: Aetna American Axle |
$3,909.22
|
Rate for Payer: Aetna Commercial |
$5,112.06
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3,909.22
|
Rate for Payer: Cash Price |
$4,811.35
|
Rate for Payer: Cofinity Commercial |
$4,209.93
|
Rate for Payer: Cofinity Commercial |
$5,172.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$4,811.35
|
Rate for Payer: Healthscope Commercial |
$5,412.77
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,209.93
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,510.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,112.06
|
Rate for Payer: PHP Commercial |
$5,112.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,209.93
|
Rate for Payer: Priority Health SBD |
$3,788.94
|
Rate for Payer: UMR Bronson Commercial |
$2,646.24
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,510.64
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$5,196.17
|
|
Service Code
|
NDC 43386-140-28
|
Hospital Charge Code |
10572
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2,286.31 |
Max. Negotiated Rate |
$4,676.55 |
Rate for Payer: Aetna American Axle |
$3,377.51
|
Rate for Payer: Aetna Commercial |
$4,416.74
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3,377.51
|
Rate for Payer: Cash Price |
$4,156.94
|
Rate for Payer: Cofinity Commercial |
$3,637.32
|
Rate for Payer: Cofinity Commercial |
$4,468.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$4,156.94
|
Rate for Payer: Healthscope Commercial |
$4,676.55
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,637.32
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,897.13
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,416.74
|
Rate for Payer: PHP Commercial |
$4,416.74
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,637.32
|
Rate for Payer: Priority Health SBD |
$3,273.59
|
Rate for Payer: UMR Bronson Commercial |
$2,286.31
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,897.13
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$1,383.17
|
|
Service Code
|
NDC 16571-735-28
|
Hospital Charge Code |
10572
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$608.59 |
Max. Negotiated Rate |
$1,244.85 |
Rate for Payer: Aetna American Axle |
$899.06
|
Rate for Payer: Aetna Commercial |
$1,175.69
|
Rate for Payer: Aetna New Business (MI Preferred) |
$899.06
|
Rate for Payer: Cash Price |
$1,106.54
|
Rate for Payer: Cofinity Commercial |
$1,189.53
|
Rate for Payer: Cofinity Commercial |
$968.22
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.54
|
Rate for Payer: Healthscope Commercial |
$1,244.85
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$968.22
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,037.38
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.69
|
Rate for Payer: PHP Commercial |
$1,175.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$968.22
|
Rate for Payer: Priority Health SBD |
$871.40
|
Rate for Payer: UMR Bronson Commercial |
$608.59
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,037.38
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$507.90
|
|
Service Code
|
HCPCS J2212
|
Hospital Charge Code |
91651
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$223.48 |
Max. Negotiated Rate |
$457.11 |
Rate for Payer: Aetna American Axle |
$330.14
|
Rate for Payer: Aetna Commercial |
$431.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$330.14
|
Rate for Payer: Cash Price |
$406.32
|
Rate for Payer: Cofinity Commercial |
$355.53
|
Rate for Payer: Cofinity Commercial |
$436.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$406.32
|
Rate for Payer: Healthscope Commercial |
$457.11
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.53
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.92
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.72
|
Rate for Payer: PHP Commercial |
$431.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$355.53
|
Rate for Payer: Priority Health SBD |
$319.98
|
Rate for Payer: UMR Bronson Commercial |
$223.48
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.92
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$507.93
|
|
Service Code
|
HCPCS J2212
|
Hospital Charge Code |
159006
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$223.49 |
Max. Negotiated Rate |
$457.14 |
Rate for Payer: Aetna American Axle |
$330.15
|
Rate for Payer: Aetna American Axle |
$330.14
|
Rate for Payer: Aetna Commercial |
$431.72
|
Rate for Payer: Aetna Commercial |
$431.74
|
Rate for Payer: Aetna New Business (MI Preferred) |
$330.14
|
Rate for Payer: Aetna New Business (MI Preferred) |
$330.15
|
Rate for Payer: Cash Price |
$406.34
|
Rate for Payer: Cash Price |
$406.32
|
Rate for Payer: Cofinity Commercial |
$436.79
|
Rate for Payer: Cofinity Commercial |
$436.82
|
Rate for Payer: Cofinity Commercial |
$355.55
|
Rate for Payer: Cofinity Commercial |
$355.53
|
Rate for Payer: Encore Health Key Benefits Commercial |
$406.34
|
Rate for Payer: Encore Health Key Benefits Commercial |
$406.32
|
Rate for Payer: Healthscope Commercial |
$457.14
|
Rate for Payer: Healthscope Commercial |
$457.11
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.55
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.53
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.92
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.95
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.72
|
Rate for Payer: PHP Commercial |
$431.74
|
Rate for Payer: PHP Commercial |
$431.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
Rate for Payer: Priority Health Cigna Priority Health |
$355.53
|
Rate for Payer: Priority Health SBD |
$319.98
|
Rate for Payer: Priority Health SBD |
$320.00
|
Rate for Payer: UMR Bronson Commercial |
$223.48
|
Rate for Payer: UMR Bronson Commercial |
$223.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.95
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.92
|
|
METHYLPARABEN (BULK) POWDER
|
Facility
|
IP
|
$108.00
|
|
Service Code
|
NDC 3877914394
|
Hospital Charge Code |
13296
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$47.52 |
Max. Negotiated Rate |
$97.20 |
Rate for Payer: Aetna American Axle |
$70.20
|
Rate for Payer: Aetna Commercial |
$91.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
Rate for Payer: Cash Price |
$86.40
|
Rate for Payer: Cofinity Commercial |
$75.60
|
Rate for Payer: Cofinity Commercial |
$92.88
|
Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
Rate for Payer: Healthscope Commercial |
$97.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
Rate for Payer: PHP Commercial |
$91.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
Rate for Payer: Priority Health SBD |
$68.04
|
Rate for Payer: UMR Bronson Commercial |
$47.52
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|