|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 76385012401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$103.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Advantage |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.42
|
| Rate for Payer: UHC Core |
$107.74
|
| Rate for Payer: UHC Exchange |
$81.27
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 31722053401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.54
|
| Rate for Payer: UHC Core |
$145.52
|
| Rate for Payer: UHC Exchange |
$109.76
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: BCBS Complete |
$101.46
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Advantage |
$177.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.24
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.87
|
| Rate for Payer: UHC Core |
$132.15
|
| Rate for Payer: UHC Exchange |
$99.68
|
| Rate for Payer: UMR Bronson Commercial |
$93.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687056811
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.45
|
| Rate for Payer: UHC Core |
$159.87
|
| Rate for Payer: UHC Exchange |
$120.59
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 31722053401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.59
|
| Rate for Payer: UHC Core |
$71.01
|
| Rate for Payer: UHC Exchange |
$53.57
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 60687056811
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Advantage |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.00
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
NDC 43547022650
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.52 |
| Max. Negotiated Rate |
$592.20 |
| Rate for Payer: Aetna American Axle |
$427.70
|
| Rate for Payer: Aetna Commercial |
$559.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.70
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cofinity Advantage |
$460.60
|
| Rate for Payer: Cofinity Commercial |
$565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.40
|
| Rate for Payer: Healthscope Commercial |
$592.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.50
|
| Rate for Payer: PHP Commercial |
$559.30
|
| Rate for Payer: Priority Health SBD |
$414.54
|
| Rate for Payer: UMR Bronson Commercial |
$289.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.50
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 76385012401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Advantage |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.10
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
NDC 43547022650
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.46 |
| Max. Negotiated Rate |
$592.20 |
| Rate for Payer: Aetna American Axle |
$427.70
|
| Rate for Payer: Aetna Commercial |
$559.30
|
| Rate for Payer: Aetna Medicare |
$329.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.70
|
| Rate for Payer: BCBS Complete |
$263.20
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cofinity Advantage |
$460.60
|
| Rate for Payer: Cofinity Commercial |
$565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.40
|
| Rate for Payer: Healthscope Commercial |
$592.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$526.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.50
|
| Rate for Payer: PHP Commercial |
$559.30
|
| Rate for Payer: Priority Health SBD |
$414.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.70
|
| Rate for Payer: UHC Core |
$342.82
|
| Rate for Payer: UHC Exchange |
$258.59
|
| Rate for Payer: UMR Bronson Commercial |
$243.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.50
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Advantage |
$177.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.24
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$111.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR AVM PROVACATIVE TESTING
|
Facility
|
IP
|
$457.09
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
180402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$411.38 |
| Rate for Payer: Aetna American Axle |
$297.11
|
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.11
|
| Rate for Payer: Cash Price |
$365.67
|
| Rate for Payer: Cofinity Advantage |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.67
|
| Rate for Payer: Healthscope Commercial |
$411.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.82
|
| Rate for Payer: PHP Commercial |
$388.53
|
| Rate for Payer: Priority Health SBD |
$287.97
|
| Rate for Payer: UMR Bronson Commercial |
$201.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.82
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR AVM PROVACATIVE TESTING
|
Facility
|
OP
|
$457.09
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
180402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$411.38 |
| Rate for Payer: Aetna American Axle |
$297.11
|
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: Aetna Medicare |
$228.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.11
|
| Rate for Payer: BCBS Complete |
$182.84
|
| Rate for Payer: Cash Price |
$365.67
|
| Rate for Payer: Cofinity Advantage |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.67
|
| Rate for Payer: Healthscope Commercial |
$411.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.82
|
| Rate for Payer: PHP Commercial |
$388.53
|
| Rate for Payer: Priority Health SBD |
$287.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.11
|
| Rate for Payer: UHC Core |
$238.14
|
| Rate for Payer: UHC Exchange |
$179.64
|
| Rate for Payer: UMR Bronson Commercial |
$169.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.82
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$457.09
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$411.38 |
| Rate for Payer: Aetna American Axle |
$297.11
|
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: Aetna Medicare |
$228.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.11
|
| Rate for Payer: BCBS Complete |
$182.84
|
| Rate for Payer: Cash Price |
$365.67
|
| Rate for Payer: Cofinity Advantage |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.67
|
| Rate for Payer: Healthscope Commercial |
$411.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.82
|
| Rate for Payer: PHP Commercial |
$388.53
|
| Rate for Payer: Priority Health SBD |
$287.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.11
|
| Rate for Payer: UHC Core |
$238.14
|
| Rate for Payer: UHC Exchange |
$179.64
|
| Rate for Payer: UMR Bronson Commercial |
$169.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.82
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$457.09
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$411.38 |
| Rate for Payer: Aetna American Axle |
$297.11
|
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.11
|
| Rate for Payer: Cash Price |
$365.67
|
| Rate for Payer: Cofinity Advantage |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.67
|
| Rate for Payer: Healthscope Commercial |
$411.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.82
|
| Rate for Payer: PHP Commercial |
$388.53
|
| Rate for Payer: Priority Health SBD |
$287.97
|
| Rate for Payer: UMR Bronson Commercial |
$201.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.82
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$672.56
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
4974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$605.30 |
| Rate for Payer: Aetna American Axle |
$437.16
|
| Rate for Payer: Aetna Commercial |
$571.68
|
| Rate for Payer: Aetna Medicare |
$336.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.16
|
| Rate for Payer: BCBS Complete |
$269.02
|
| Rate for Payer: Cash Price |
$538.05
|
| Rate for Payer: Cofinity Advantage |
$470.79
|
| Rate for Payer: Cofinity Commercial |
$578.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.05
|
| Rate for Payer: Healthscope Commercial |
$605.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$538.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.42
|
| Rate for Payer: PHP Commercial |
$571.68
|
| Rate for Payer: Priority Health SBD |
$423.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.28
|
| Rate for Payer: UHC Core |
$336.28
|
| Rate for Payer: UHC Exchange |
$336.28
|
| Rate for Payer: UMR Bronson Commercial |
$248.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.42
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$672.56
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
4974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$295.93 |
| Max. Negotiated Rate |
$605.30 |
| Rate for Payer: Aetna American Axle |
$437.16
|
| Rate for Payer: Aetna Commercial |
$571.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.16
|
| Rate for Payer: Cash Price |
$538.05
|
| Rate for Payer: Cofinity Advantage |
$470.79
|
| Rate for Payer: Cofinity Commercial |
$578.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.05
|
| Rate for Payer: Healthscope Commercial |
$605.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.42
|
| Rate for Payer: PHP Commercial |
$571.68
|
| Rate for Payer: Priority Health SBD |
$423.71
|
| Rate for Payer: UMR Bronson Commercial |
$295.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.42
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna American Axle |
$101.82
|
| Rate for Payer: Aetna American Axle |
$118.86
|
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Commercial |
$133.14
|
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Aetna Medicare |
$154.85
|
| Rate for Payer: Aetna Medicare |
$78.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: BCBS Complete |
$62.66
|
| Rate for Payer: BCBS Complete |
$73.14
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cash Price |
$125.31
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$125.31
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Advantage |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$134.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.31
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: PHP Commercial |
$133.14
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: Priority Health SBD |
$98.68
|
| Rate for Payer: Priority Health SBD |
$115.20
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$57.96
|
| Rate for Payer: UMR Bronson Commercial |
$67.66
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.07
|
| Rate for Payer: Aetna American Axle |
$118.86
|
| Rate for Payer: Aetna American Axle |
$201.31
|
| Rate for Payer: Aetna American Axle |
$101.82
|
| Rate for Payer: Aetna Commercial |
$263.25
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Commercial |
$133.14
|
| Rate for Payer: Aetna Commercial |
$155.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.82
|
| Rate for Payer: Cash Price |
$125.31
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cash Price |
$146.29
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$109.65
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Advantage |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$134.71
|
| Rate for Payer: Cofinity Commercial |
$157.26
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.29
|
| Rate for Payer: Healthscope Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$140.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.48
|
| Rate for Payer: PHP Commercial |
$133.14
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$155.43
|
| Rate for Payer: PHP Commercial |
$263.25
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: Priority Health SBD |
$98.68
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: Priority Health SBD |
$115.20
|
| Rate for Payer: UMR Bronson Commercial |
$80.46
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: UMR Bronson Commercial |
$68.92
|
| Rate for Payer: UMR Bronson Commercial |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
4975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.02 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna American Axle |
$270.37
|
| Rate for Payer: Aetna American Axle |
$352.03
|
| 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 |
$332.76
|
| Rate for Payer: Cash Price |
$433.27
|
| Rate for Payer: Cofinity Advantage |
$379.11
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$465.77
|
| 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 |
$291.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.19
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: PHP Commercial |
$460.35
|
| 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 |
$311.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.19
|
|
