|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$415.95
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
4975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.26 |
| 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 Medicare |
$207.97
|
| Rate for Payer: Aetna Medicare |
$270.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.03
|
| Rate for Payer: BCBS Complete |
$216.64
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cash Price |
$433.27
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cash Price |
$433.27
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Advantage |
$379.11
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Cofinity Commercial |
$465.77
|
| 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 |
$291.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.27
|
| 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 |
$406.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: PHP Commercial |
$460.35
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: Priority Health SBD |
$341.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UMR Bronson Commercial |
$153.90
|
| Rate for Payer: UMR Bronson Commercial |
$200.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.19
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$277.50
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$249.75 |
| Rate for Payer: Aetna American Axle |
$180.38
|
| Rate for Payer: Aetna American Axle |
$156.70
|
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna American Axle |
$89.81
|
| Rate for Payer: Aetna American Axle |
$77.71
|
| Rate for Payer: Aetna Commercial |
$101.63
|
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Aetna Commercial |
$235.88
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: Cash Price |
$192.86
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cofinity Advantage |
$83.69
|
| Rate for Payer: Cofinity Advantage |
$61.15
|
| Rate for Payer: Cofinity Advantage |
$96.72
|
| Rate for Payer: Cofinity Advantage |
$194.25
|
| Rate for Payer: Cofinity Advantage |
$168.76
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Cofinity Commercial |
$238.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Commercial |
$124.35
|
| Rate for Payer: Healthscope Commercial |
$216.97
|
| Rate for Payer: Healthscope Commercial |
$249.75
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.12
|
| Rate for Payer: PHP Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$101.63
|
| Rate for Payer: PHP Commercial |
$235.88
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: Priority Health SBD |
$174.82
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: Priority Health SBD |
$75.32
|
| Rate for Payer: Priority Health SBD |
$151.88
|
| Rate for Payer: UMR Bronson Commercial |
$60.79
|
| Rate for Payer: UMR Bronson Commercial |
$38.44
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: UMR Bronson Commercial |
$52.61
|
| Rate for Payer: UMR Bronson Commercial |
$122.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$109.76
|
|
|
Service Code
|
HCPCS J9255
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna American Axle |
$114.20
|
| Rate for Payer: Aetna Commercial |
$93.30
|
| Rate for Payer: Aetna Commercial |
$149.34
|
| Rate for Payer: Aetna Medicare |
$87.84
|
| Rate for Payer: Aetna Medicare |
$54.88
|
| 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 |
$43.90
|
| Rate for Payer: BCBS Complete |
$70.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$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 Advantage |
$122.98
|
| Rate for Payer: Cofinity Advantage |
$76.83
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$151.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.55
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Healthscope Commercial |
$158.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.77
|
| Rate for Payer: PHP Commercial |
$149.34
|
| Rate for Payer: PHP Commercial |
$93.30
|
| Rate for Payer: Priority Health SBD |
$110.68
|
| Rate for Payer: Priority Health SBD |
$69.15
|
| Rate for Payer: UMR Bronson Commercial |
$40.61
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.32
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$119.56
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna American Axle |
$77.71
|
| Rate for Payer: Aetna American Axle |
$180.38
|
| Rate for Payer: Aetna American Axle |
$156.70
|
| Rate for Payer: Aetna American Axle |
$89.81
|
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna Commercial |
$101.63
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Commercial |
$235.88
|
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna Medicare |
$69.08
|
| Rate for Payer: Aetna Medicare |
$59.78
|
| Rate for Payer: Aetna Medicare |
$120.54
|
| Rate for Payer: Aetna Medicare |
$138.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: BCBS Complete |
$111.00
|
| Rate for Payer: BCBS Complete |
$47.82
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: BCBS Complete |
$96.43
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cash Price |
$192.86
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cash Price |
$192.86
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Advantage |
$194.25
|
| Rate for Payer: Cofinity Advantage |
$96.72
|
| Rate for Payer: Cofinity Advantage |
$168.76
|
| Rate for Payer: Cofinity Advantage |
$61.15
|
| Rate for Payer: Cofinity Advantage |
$83.69
|
| Rate for Payer: Cofinity Commercial |
$238.65
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.00
|
| 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 |
$192.86
|
| Rate for Payer: Healthscope Commercial |
$216.97
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$249.75
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| 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 |
$61.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.52
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: PHP Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$235.88
|
| Rate for Payer: PHP Commercial |
$101.63
|
| Rate for Payer: Priority Health SBD |
$151.88
|
| Rate for Payer: Priority Health SBD |
$75.32
|
| Rate for Payer: Priority Health SBD |
$174.82
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.24
|
| Rate for Payer: UMR Bronson Commercial |
$102.67
|
| Rate for Payer: UMR Bronson Commercial |
$89.20
|
| Rate for Payer: UMR Bronson Commercial |
$32.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.67
|
|
|
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 Advantage |
$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 Commercial |
$149.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.77
|
| Rate for Payer: PHP Commercial |
$149.34
|
| 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
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL
|
Facility
|
IP
|
$85.75
|
|
|
Service Code
|
NDC 38779306008
|
| Hospital Charge Code |
82599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$77.17 |
| Rate for Payer: Aetna American Axle |
$55.74
|
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.74
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: Cofinity Advantage |
$60.02
|
| Rate for Payer: Cofinity Commercial |
$73.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.60
|
| Rate for Payer: Healthscope Commercial |
$77.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.31
|
| Rate for Payer: PHP Commercial |
$72.89
|
| Rate for Payer: Priority Health SBD |
$54.02
|
| Rate for Payer: UMR Bronson Commercial |
$37.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.31
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL
|
Facility
|
OP
|
$85.75
|
|
|
Service Code
|
NDC 38779306008
|
| Hospital Charge Code |
82599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$77.17 |
| Rate for Payer: Aetna American Axle |
$55.74
|
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna Medicare |
$42.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.74
|
| Rate for Payer: BCBS Complete |
$34.30
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: Cofinity Advantage |
$60.02
|
| Rate for Payer: Cofinity Commercial |
$73.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.60
|
| Rate for Payer: Healthscope Commercial |
$77.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.31
|
| Rate for Payer: PHP Commercial |
$72.89
|
| Rate for Payer: Priority Health SBD |
$54.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.74
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Exchange |
$33.70
|
| Rate for Payer: UMR Bronson Commercial |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.31
|
|
|
METHYLDOPA 250 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079020001
|
| 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 Advantage |
$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 Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| 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
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 51079020001
|
| Hospital Charge Code |
4982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$1.91
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$590.90
|
|
|
Service Code
|
NDC 17478050410
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$218.63 |
| Max. Negotiated Rate |
$531.81 |
| Rate for Payer: Aetna American Axle |
$384.08
|
| Rate for Payer: Aetna Commercial |
$502.26
|
| Rate for Payer: Aetna Medicare |
$295.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.08
|
| Rate for Payer: BCBS Complete |
$236.36
|
| Rate for Payer: Cash Price |
$472.72
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$472.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health SBD |
$372.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.08
|
| Rate for Payer: UHC Core |
$307.86
|
| Rate for Payer: UHC Exchange |
$232.22
|
| Rate for Payer: UMR Bronson Commercial |
$218.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.18
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$590.90
|
|
|
Service Code
|
NDC 17478050410
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 Advantage |
$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 Commercial |
$502.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.18
|
| Rate for Payer: PHP Commercial |
$502.26
|
| 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
|
OP
|
$290.54
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna American Axle |
$188.85
|
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$145.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: BCBS Complete |
$116.22
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.85
|
| Rate for Payer: UHC Core |
$151.37
|
| Rate for Payer: UHC Exchange |
$114.18
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$198.77
|
|
|
Service Code
|
NDC 70710183801
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$178.89 |
| Rate for Payer: Aetna American Axle |
$129.20
|
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna Medicare |
$99.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$79.51
|
| Rate for Payer: Cash Price |
$159.02
|
| Rate for Payer: Cofinity Advantage |
$139.14
|
| Rate for Payer: Cofinity Commercial |
$170.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.02
|
| Rate for Payer: Healthscope Commercial |
$178.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.08
|
| Rate for Payer: PHP Commercial |
$168.95
|
| Rate for Payer: Priority Health SBD |
$125.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.20
|
| Rate for Payer: UHC Core |
$103.56
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.08
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$198.77
|
|
|
Service Code
|
NDC 70710183805
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$178.89 |
| Rate for Payer: Aetna American Axle |
$129.20
|
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: Cash Price |
$159.02
|
| Rate for Payer: Cofinity Advantage |
$139.14
|
| Rate for Payer: Cofinity Commercial |
$170.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.02
|
| Rate for Payer: Healthscope Commercial |
$178.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.08
|
| Rate for Payer: PHP Commercial |
$168.95
|
| Rate for Payer: Priority Health SBD |
$125.23
|
| Rate for Payer: UMR Bronson Commercial |
$87.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.08
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.54
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna American Axle |
$188.85
|
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
| Rate for Payer: UMR Bronson Commercial |
$127.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.54
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna American Axle |
$188.85
|
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
| Rate for Payer: UMR Bronson Commercial |
$127.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.54
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$261.49 |
| Rate for Payer: Aetna American Axle |
$188.85
|
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$145.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.85
|
| Rate for Payer: BCBS Complete |
$116.22
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Cofinity Advantage |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$261.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.91
|
| Rate for Payer: PHP Commercial |
$246.96
|
| Rate for Payer: Priority Health SBD |
$183.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.85
|
| Rate for Payer: UHC Core |
$151.37
|
| Rate for Payer: UHC Exchange |
$114.18
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.91
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$198.77
|
|
|
Service Code
|
NDC 70710183801
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$178.89 |
| Rate for Payer: Aetna American Axle |
$129.20
|
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: Cash Price |
$159.02
|
| Rate for Payer: Cofinity Advantage |
$139.14
|
| Rate for Payer: Cofinity Commercial |
$170.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.02
|
| Rate for Payer: Healthscope Commercial |
$178.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.08
|
| Rate for Payer: PHP Commercial |
$168.95
|
| Rate for Payer: Priority Health SBD |
$125.23
|
| Rate for Payer: UMR Bronson Commercial |
$87.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.08
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$198.77
|
|
|
Service Code
|
NDC 70710183805
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$178.89 |
| Rate for Payer: Aetna American Axle |
$129.20
|
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna Medicare |
$99.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$79.51
|
| Rate for Payer: Cash Price |
$159.02
|
| Rate for Payer: Cofinity Advantage |
$139.14
|
| Rate for Payer: Cofinity Commercial |
$170.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.02
|
| Rate for Payer: Healthscope Commercial |
$178.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.08
|
| Rate for Payer: PHP Commercial |
$168.95
|
| Rate for Payer: Priority Health SBD |
$125.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.20
|
| Rate for Payer: UHC Core |
$103.56
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.08
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$66.72
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna American Axle |
$43.37
|
| Rate for Payer: Aetna American Axle |
$60.10
|
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna Commercial |
$78.59
|
| Rate for Payer: Aetna Medicare |
$33.36
|
| Rate for Payer: Aetna Medicare |
$46.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.10
|
| Rate for Payer: BCBS Complete |
$36.98
|
| Rate for Payer: BCBS Complete |
$26.69
|
| Rate for Payer: BCBS Trust/PPO |
$69.25
|
| Rate for Payer: BCBS Trust/PPO |
$69.25
|
| Rate for Payer: BCN Commercial |
$69.25
|
| Rate for Payer: BCN Commercial |
$69.25
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cash Price |
$73.97
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cash Price |
$73.97
|
| Rate for Payer: Cofinity Advantage |
$46.70
|
| Rate for Payer: Cofinity Advantage |
$64.72
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.97
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: Healthscope Commercial |
$83.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: PHP Commercial |
$78.59
|
| Rate for Payer: Priority Health SBD |
$42.03
|
| Rate for Payer: Priority Health SBD |
$58.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.24
|
| Rate for Payer: UHC Core |
$35.24
|
| Rate for Payer: UHC Core |
$35.24
|
| Rate for Payer: UHC Exchange |
$35.24
|
| Rate for Payer: UHC Exchange |
$35.24
|
| Rate for Payer: UMR Bronson Commercial |
$24.69
|
| Rate for Payer: UMR Bronson Commercial |
$34.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.34
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$66.72
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$60.05 |
| Rate for Payer: Aetna American Axle |
$43.37
|
| Rate for Payer: Aetna American Axle |
$60.10
|
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna Commercial |
$78.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.10
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cash Price |
$73.97
|
| Rate for Payer: Cofinity Advantage |
$64.72
|
| Rate for Payer: Cofinity Advantage |
$46.70
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.97
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: Healthscope Commercial |
$83.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.34
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: PHP Commercial |
$78.59
|
| Rate for Payer: Priority Health SBD |
$58.25
|
| Rate for Payer: Priority Health SBD |
$42.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.36
|
| Rate for Payer: UMR Bronson Commercial |
$40.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.34
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$1,589.75
|
|
|
Service Code
|
NDC 69238160508
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.21 |
| 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 Medicare |
$794.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.34
|
| Rate for Payer: BCBS Complete |
$635.90
|
| Rate for Payer: Cash Price |
$1,271.80
|
| Rate for Payer: Cofinity Advantage |
$1,112.83
|
| 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 |
$1,112.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,192.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,192.31
|
| Rate for Payer: PHP Commercial |
$1,351.29
|
| Rate for Payer: Priority Health SBD |
$1,001.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.34
|
| Rate for Payer: UHC Core |
$828.26
|
| Rate for Payer: UHC Exchange |
$624.77
|
| Rate for Payer: UMR Bronson Commercial |
$588.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$549.19
|
|
|
Service Code
|
NDC 16571073521
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.64 |
| Max. Negotiated Rate |
$494.27 |
| Rate for Payer: Aetna American Axle |
$356.97
|
| Rate for Payer: Aetna Commercial |
$466.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.97
|
| Rate for Payer: Cash Price |
$439.35
|
| Rate for Payer: Cofinity Advantage |
$384.43
|
| Rate for Payer: Cofinity Commercial |
$472.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.35
|
| Rate for Payer: Healthscope Commercial |
$494.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.89
|
| Rate for Payer: PHP Commercial |
$466.81
|
| Rate for Payer: Priority Health SBD |
$345.99
|
| Rate for Payer: UMR Bronson Commercial |
$241.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.89
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$3,595.15
|
|
|
Service Code
|
NDC 00904728210
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,581.87 |
| Max. Negotiated Rate |
$3,235.64 |
| Rate for Payer: Aetna American Axle |
$2,336.85
|
| Rate for Payer: Aetna Commercial |
$3,055.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,336.85
|
| Rate for Payer: Cash Price |
$2,876.12
|
| Rate for Payer: Cofinity Advantage |
$2,516.61
|
| Rate for Payer: Cofinity Commercial |
$3,091.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,876.12
|
| Rate for Payer: Healthscope Commercial |
$3,235.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,516.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,696.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,055.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,696.36
|
| Rate for Payer: PHP Commercial |
$3,055.88
|
| Rate for Payer: Priority Health SBD |
$2,264.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,581.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,696.36
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$1,177.73
|
|
|
Service Code
|
NDC 16571073528
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.20 |
| Max. Negotiated Rate |
$1,059.96 |
| Rate for Payer: Aetna American Axle |
$765.52
|
| Rate for Payer: Aetna Commercial |
$1,001.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.52
|
| Rate for Payer: Cash Price |
$942.18
|
| Rate for Payer: Cofinity Advantage |
$824.41
|
| Rate for Payer: Cofinity Commercial |
$1,012.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.18
|
| Rate for Payer: Healthscope Commercial |
$1,059.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$824.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$883.30
|
| Rate for Payer: PHP Commercial |
$1,001.07
|
| Rate for Payer: Priority Health SBD |
$741.97
|
| Rate for Payer: UMR Bronson Commercial |
$518.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.30
|
|
