|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$30.62
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Aetna American Axle |
$19.90
|
| Rate for Payer: Aetna American Axle |
$23.41
|
| Rate for Payer: Aetna American Axle |
$19.91
|
| Rate for Payer: Aetna Commercial |
$30.61
|
| Rate for Payer: Aetna Commercial |
$26.03
|
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.91
|
| Rate for Payer: BCBS Complete |
$12.25
|
| Rate for Payer: BCBS Complete |
$12.25
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$20.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.74
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$26.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Healthscope Commercial |
$27.56
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Healthscope Commercial |
$32.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.61
|
| Rate for Payer: PHP Commercial |
$26.03
|
| Rate for Payer: PHP Commercial |
$30.61
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.21
|
| Rate for Payer: Priority Health SBD |
$19.29
|
| Rate for Payer: Priority Health SBD |
$19.30
|
| Rate for Payer: Priority Health SBD |
$22.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$13.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.01
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna American Axle |
$23.41
|
| Rate for Payer: Aetna American Axle |
$19.91
|
| Rate for Payer: Aetna American Axle |
$19.90
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Commercial |
$26.03
|
| Rate for Payer: Aetna Commercial |
$30.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.90
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cash Price |
$28.81
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$27.56
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$32.41
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.61
|
| Rate for Payer: PHP Commercial |
$30.61
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$26.03
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.21
|
| Rate for Payer: Priority Health SBD |
$16.23
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$19.30
|
| Rate for Payer: Priority Health SBD |
$22.69
|
| Rate for Payer: Priority Health SBD |
$19.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$13.48
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$15.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$35.20
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna American Axle |
$22.88
|
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna American Axle |
$22.87
|
| Rate for Payer: Aetna American Axle |
$38.13
|
| Rate for Payer: Aetna American Axle |
$38.12
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: Aetna Commercial |
$29.90
|
| Rate for Payer: Aetna Commercial |
$29.92
|
| Rate for Payer: Aetna Commercial |
$49.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.13
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$46.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$28.16
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Cofinity Commercial |
$50.45
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.16
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Healthscope Commercial |
$31.68
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$52.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$29.92
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: PHP Commercial |
$29.90
|
| Rate for Payer: PHP Commercial |
$49.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.63
|
| Rate for Payer: Priority Health SBD |
$36.96
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health SBD |
$22.18
|
| Rate for Payer: Priority Health SBD |
$36.95
|
| Rate for Payer: UMR Bronson Commercial |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: UMR Bronson Commercial |
$25.81
|
| Rate for Payer: UMR Bronson Commercial |
$15.49
|
| Rate for Payer: UMR Bronson Commercial |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.99
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$141.60
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$127.44 |
| Rate for Payer: Aetna American Axle |
$92.04
|
| Rate for Payer: Aetna American Axle |
$118.16
|
| Rate for Payer: Aetna Commercial |
$154.52
|
| Rate for Payer: Aetna Commercial |
$120.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.16
|
| Rate for Payer: BCBS Complete |
$72.72
|
| Rate for Payer: BCBS Complete |
$56.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$113.28
|
| Rate for Payer: Cash Price |
$113.28
|
| Rate for Payer: Cash Price |
$145.43
|
| Rate for Payer: Cash Price |
$145.43
|
| Rate for Payer: Cofinity Commercial |
$121.78
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Commercial |
$127.25
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.43
|
| Rate for Payer: Healthscope Commercial |
$163.61
|
| Rate for Payer: Healthscope Commercial |
$127.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.52
|
| Rate for Payer: PHP Commercial |
$154.52
|
| Rate for Payer: PHP Commercial |
$120.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.12
|
| Rate for Payer: Priority Health SBD |
$114.53
|
| Rate for Payer: Priority Health SBD |
$89.21
|
| Rate for Payer: UMR Bronson Commercial |
$52.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.34
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$181.79
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna American Axle |
$118.16
|
| Rate for Payer: Aetna American Axle |
$92.04
|
| Rate for Payer: Aetna Commercial |
$120.36
|
| Rate for Payer: Aetna Commercial |
$154.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.16
|
| Rate for Payer: Cash Price |
$113.28
|
| Rate for Payer: Cash Price |
$145.43
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Commercial |
$121.78
|
| Rate for Payer: Cofinity Commercial |
$127.25
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.28
|
| Rate for Payer: Healthscope Commercial |
$127.44
|
| Rate for Payer: Healthscope Commercial |
$163.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.36
|
| Rate for Payer: PHP Commercial |
$120.36
|
| Rate for Payer: PHP Commercial |
$154.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.25
|
| Rate for Payer: Priority Health SBD |
$89.21
|
| Rate for Payer: Priority Health SBD |
$114.53
|
| Rate for Payer: UMR Bronson Commercial |
$62.30
|
| Rate for Payer: UMR Bronson Commercial |
$79.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$21.53
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$19.38 |
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna Commercial |
$18.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$19.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.30
|
| Rate for Payer: PHP Commercial |
$18.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.15
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$17.37
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna American Axle |
$11.29
|
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna Commercial |
$14.76
|
| Rate for Payer: Aetna Commercial |
$18.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Cofinity Commercial |
$12.16
|
| Rate for Payer: Cofinity Commercial |
$14.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$19.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.76
|
| Rate for Payer: PHP Commercial |
$18.30
|
| Rate for Payer: PHP Commercial |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.07
|
| Rate for Payer: Priority Health SBD |
$10.94
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: UMR Bronson Commercial |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.15
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$320.14
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.09
|
| Rate for Payer: Aetna Commercial |
$272.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.09
|
| Rate for Payer: Cash Price |
$256.11
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.11
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.12
|
| Rate for Payer: PHP Commercial |
$272.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.10
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$16.70
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna American Axle |
$10.86
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: BCBS Complete |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$11.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: UMR Bronson Commercial |
$6.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$16.70
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna American Axle |
$10.86
|
| Rate for Payer: Aetna American Axle |
$16.33
|
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.33
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.10
|
| Rate for Payer: Healthscope Commercial |
$22.62
|
| Rate for Payer: Healthscope Commercial |
$15.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.36
|
| Rate for Payer: PHP Commercial |
$14.20
|
| Rate for Payer: PHP Commercial |
$21.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: Priority Health SBD |
$10.52
|
| Rate for Payer: Priority Health SBD |
$15.83
|
| Rate for Payer: UMR Bronson Commercial |
$11.06
|
| Rate for Payer: UMR Bronson Commercial |
$7.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.85
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$100.26
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$90.23 |
| Rate for Payer: Aetna American Axle |
$65.17
|
| Rate for Payer: Aetna American Axle |
$40.18
|
| Rate for Payer: Aetna Commercial |
$85.22
|
| Rate for Payer: Aetna Commercial |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.17
|
| Rate for Payer: Cash Price |
$49.46
|
| Rate for Payer: Cash Price |
$80.21
|
| Rate for Payer: Cofinity Commercial |
$53.17
|
| Rate for Payer: Cofinity Commercial |
$43.27
|
| Rate for Payer: Cofinity Commercial |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.21
|
| Rate for Payer: Healthscope Commercial |
$55.64
|
| Rate for Payer: Healthscope Commercial |
$90.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.22
|
| Rate for Payer: PHP Commercial |
$85.22
|
| Rate for Payer: PHP Commercial |
$52.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.18
|
| Rate for Payer: Priority Health SBD |
$38.95
|
| Rate for Payer: Priority Health SBD |
$63.16
|
| Rate for Payer: UMR Bronson Commercial |
$44.11
|
| Rate for Payer: UMR Bronson Commercial |
$27.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.36
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$100.26
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$90.23 |
| Rate for Payer: Aetna American Axle |
$65.17
|
| Rate for Payer: Aetna Commercial |
$85.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.17
|
| Rate for Payer: BCBS Complete |
$40.10
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$80.21
|
| Rate for Payer: Cash Price |
$80.21
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$86.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.21
|
| Rate for Payer: Healthscope Commercial |
$90.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.22
|
| Rate for Payer: PHP Commercial |
$85.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.18
|
| Rate for Payer: Priority Health SBD |
$63.16
|
| Rate for Payer: UMR Bronson Commercial |
$37.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.20
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOL (CODE)
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
163731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna American Axle |
$20.64
|
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.99
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.22
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
119451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna American Axle |
$20.64
|
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: BCBS Complete |
$12.70
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$22.22
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.99
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.22
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
119451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna American Axle |
$20.64
|
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.99
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.22
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$19.95
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.96
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$7.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.96
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$19.95
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
119450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.96
|
| Rate for Payer: PHP Commercial |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.96
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$16.28
|
|
|
Service Code
|
NDC 76420-999-01
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Aetna American Axle |
$10.58
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Commercial |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.84
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: UMR Bronson Commercial |
$7.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
76971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 49884-689-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.04
|
| Rate for Payer: Aetna Commercial |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.42
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 0093-2203-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna American Axle |
$48.88
|
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 68084-676-11
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
METOCLOPRAMIDE 10 MG TABLET
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
NDC 68084-676-01
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
