|
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 Commercial |
$413.63
|
| Rate for Payer: Cofinity Commercial |
$508.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.63
|
| 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: PHP Commercial |
$502.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.08
|
| Rate for Payer: Priority Health SBD |
$372.27
|
| Rate for Payer: UMR Bronson Commercial |
$218.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$443.18
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna American Axle |
$214.60
|
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$165.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
| Rate for Payer: UMR Bronson Commercial |
$122.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna American Axle |
$214.60
|
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
| Rate for Payer: UMR Bronson Commercial |
$145.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$330.15
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna American Axle |
$214.60
|
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Medicare |
$165.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: BCBS Complete |
$132.06
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
| Rate for Payer: UMR Bronson Commercial |
$122.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
NDC 00517037401
|
| Hospital Charge Code |
180747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$297.13 |
| Rate for Payer: Aetna American Axle |
$214.60
|
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$297.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.60
|
| Rate for Payer: Priority Health SBD |
$207.99
|
| Rate for Payer: UMR Bronson Commercial |
$145.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Aetna American Axle |
$44.25
|
| Rate for Payer: Aetna American Axle |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.87
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Medicare |
$34.04
|
| Rate for Payer: Aetna Medicare |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: BCBS Complete |
$35.37
|
| Rate for Payer: BCBS Complete |
$27.23
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$58.55
|
| Rate for Payer: Cofinity Commercial |
$47.66
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$57.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health SBD |
$55.71
|
| Rate for Payer: Priority Health SBD |
$42.89
|
| Rate for Payer: UMR Bronson Commercial |
$25.19
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.06
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Aetna American Axle |
$44.25
|
| Rate for Payer: Aetna American Axle |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.87
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$47.66
|
| Rate for Payer: Cofinity Commercial |
$58.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$57.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health SBD |
$42.89
|
| Rate for Payer: Priority Health SBD |
$55.71
|
| Rate for Payer: UMR Bronson Commercial |
$29.96
|
| Rate for Payer: UMR Bronson Commercial |
$38.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$540.04
|
|
|
Service Code
|
NDC 16571073521
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.62 |
| Max. Negotiated Rate |
$486.04 |
| Rate for Payer: Aetna American Axle |
$351.03
|
| Rate for Payer: Aetna Commercial |
$459.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.03
|
| Rate for Payer: Cash Price |
$432.03
|
| Rate for Payer: Cofinity Commercial |
$378.03
|
| Rate for Payer: Cofinity Commercial |
$464.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$378.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.03
|
| Rate for Payer: Healthscope Commercial |
$486.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$378.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.03
|
| Rate for Payer: PHP Commercial |
$459.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.03
|
| Rate for Payer: Priority Health SBD |
$340.23
|
| Rate for Payer: UMR Bronson Commercial |
$237.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.03
|
|
|
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 Commercial |
$1,112.83
|
| Rate for Payer: Cofinity Commercial |
$1,367.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.83
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1,351.29
|
| Rate for Payer: PHP Commercial |
$1,351.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.34
|
| Rate for Payer: Priority Health SBD |
$1,001.54
|
| 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
|
$1,174.62
|
|
|
Service Code
|
NDC 16571073528
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.83 |
| Max. Negotiated Rate |
$1,057.16 |
| Rate for Payer: Aetna American Axle |
$763.50
|
| Rate for Payer: Aetna Commercial |
$998.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.50
|
| Rate for Payer: Cash Price |
$939.70
|
| Rate for Payer: Cofinity Commercial |
$1,010.17
|
| Rate for Payer: Cofinity Commercial |
$822.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.70
|
| Rate for Payer: Healthscope Commercial |
$1,057.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.43
|
| Rate for Payer: PHP Commercial |
$998.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.50
|
| Rate for Payer: Priority Health SBD |
$740.01
|
| Rate for Payer: UMR Bronson Commercial |
$516.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.97
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$540.04
|
|
|
Service Code
|
NDC 16571073521
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$486.04 |
| Rate for Payer: Aetna American Axle |
$351.03
|
| Rate for Payer: Aetna Commercial |
$459.03
|
| Rate for Payer: Aetna Medicare |
$270.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.03
|
| Rate for Payer: BCBS Complete |
$216.02
|
| Rate for Payer: Cash Price |
$432.03
|
| Rate for Payer: Cofinity Commercial |
$378.03
|
| Rate for Payer: Cofinity Commercial |
$464.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$378.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.03
|
| Rate for Payer: Healthscope Commercial |
$486.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$378.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.03
|
| Rate for Payer: PHP Commercial |
$459.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.03
|
| Rate for Payer: Priority Health SBD |
$340.23
|
| Rate for Payer: UMR Bronson Commercial |
$199.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.03
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$579.11
|
|
|
Service Code
|
NDC 70010078612
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.27 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Aetna American Axle |
$376.42
|
| Rate for Payer: Aetna Commercial |
$492.24
|
| Rate for Payer: Aetna Medicare |
$289.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.42
|
| Rate for Payer: BCBS Complete |
$231.64
|
| Rate for Payer: Cash Price |
$463.29
|
| Rate for Payer: Cofinity Commercial |
$405.38
|
| Rate for Payer: Cofinity Commercial |
$498.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.29
|
| Rate for Payer: Healthscope Commercial |
$521.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.24
|
| Rate for Payer: PHP Commercial |
$492.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.42
|
| Rate for Payer: Priority Health SBD |
$364.84
|
| Rate for Payer: UMR Bronson Commercial |
$214.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.33
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$579.11
|
|
|
Service Code
|
NDC 70010078612
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.81 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Aetna American Axle |
$376.42
|
| Rate for Payer: Aetna Commercial |
$492.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.42
|
| Rate for Payer: Cash Price |
$463.29
|
| Rate for Payer: Cofinity Commercial |
$405.38
|
| Rate for Payer: Cofinity Commercial |
$498.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.29
|
| Rate for Payer: Healthscope Commercial |
$521.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.24
|
| Rate for Payer: PHP Commercial |
$492.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.42
|
| Rate for Payer: Priority Health SBD |
$364.84
|
| Rate for Payer: UMR Bronson Commercial |
$254.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.33
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
IP
|
$1,589.75
|
|
|
Service Code
|
NDC 69238160508
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$699.49 |
| Max. Negotiated Rate |
$1,430.78 |
| Rate for Payer: Aetna American Axle |
$1,033.34
|
| Rate for Payer: Aetna Commercial |
$1,351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.34
|
| Rate for Payer: Cash Price |
$1,271.80
|
| Rate for Payer: Cofinity Commercial |
$1,112.83
|
| Rate for Payer: Cofinity Commercial |
$1,367.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.83
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1,351.29
|
| Rate for Payer: PHP Commercial |
$1,351.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.34
|
| Rate for Payer: Priority Health SBD |
$1,001.54
|
| Rate for Payer: UMR Bronson Commercial |
$699.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET
|
Facility
|
OP
|
$1,174.62
|
|
|
Service Code
|
NDC 16571073528
|
| Hospital Charge Code |
10572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.61 |
| Max. Negotiated Rate |
$1,057.16 |
| Rate for Payer: Aetna American Axle |
$763.50
|
| Rate for Payer: Aetna Commercial |
$998.43
|
| Rate for Payer: Aetna Medicare |
$587.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.50
|
| Rate for Payer: BCBS Complete |
$469.85
|
| Rate for Payer: Cash Price |
$939.70
|
| Rate for Payer: Cofinity Commercial |
$1,010.17
|
| Rate for Payer: Cofinity Commercial |
$822.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.70
|
| Rate for Payer: Healthscope Commercial |
$1,057.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$822.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.43
|
| Rate for Payer: PHP Commercial |
$998.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.50
|
| Rate for Payer: Priority Health SBD |
$740.01
|
| Rate for Payer: UMR Bronson Commercial |
$434.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.97
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna American Axle |
$344.01
|
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health SBD |
$333.42
|
| Rate for Payer: UMR Bronson Commercial |
$232.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.82 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna American Axle |
$344.01
|
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna Medicare |
$264.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health SBD |
$333.42
|
| Rate for Payer: UMR Bronson Commercial |
$195.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
159006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna American Axle |
$344.01
|
| Rate for Payer: Aetna American Axle |
$344.03
|
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna Commercial |
$449.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.03
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cofinity Commercial |
$455.17
|
| Rate for Payer: Cofinity Commercial |
$370.49
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Healthscope Commercial |
$476.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: PHP Commercial |
$449.88
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.03
|
| Rate for Payer: Priority Health SBD |
$333.42
|
| Rate for Payer: Priority Health SBD |
$333.44
|
| Rate for Payer: UMR Bronson Commercial |
$232.87
|
| Rate for Payer: UMR Bronson Commercial |
$232.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.95
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
159006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.82 |
| Max. Negotiated Rate |
$476.32 |
| Rate for Payer: Aetna American Axle |
$344.01
|
| Rate for Payer: Aetna American Axle |
$344.03
|
| Rate for Payer: Aetna Commercial |
$449.85
|
| Rate for Payer: Aetna Commercial |
$449.88
|
| Rate for Payer: Aetna Medicare |
$264.62
|
| Rate for Payer: Aetna Medicare |
$264.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.03
|
| Rate for Payer: BCBS Complete |
$211.71
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Cofinity Commercial |
$370.49
|
| Rate for Payer: Cofinity Commercial |
$455.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.42
|
| Rate for Payer: Healthscope Commercial |
$476.34
|
| Rate for Payer: Healthscope Commercial |
$476.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.88
|
| Rate for Payer: PHP Commercial |
$449.88
|
| Rate for Payer: PHP Commercial |
$449.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.03
|
| Rate for Payer: Priority Health SBD |
$333.44
|
| Rate for Payer: Priority Health SBD |
$333.42
|
| Rate for Payer: UMR Bronson Commercial |
$195.82
|
| Rate for Payer: UMR Bronson Commercial |
$195.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.93
|
|
|
METHYLPARABEN (BULK) POWDER
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
NDC 38779143904
|
| Hospital Charge Code |
13296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna American Axle |
$70.20
|
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health SBD |
$68.04
|
| Rate for Payer: UMR Bronson Commercial |
$47.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
METHYLPARABEN (BULK) POWDER
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
NDC 38779143904
|
| Hospital Charge Code |
13296
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna American Axle |
$70.20
|
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health SBD |
$68.04
|
| Rate for Payer: UMR Bronson Commercial |
$39.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: BCBS Complete |
$182.70
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.89
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UMR Bronson Commercial |
$169.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
NDC 57664022988
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna Medicare |
$238.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: BCBS Complete |
$190.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.40
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UMR Bronson Commercial |
$176.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$456.75
|
|
|
Service Code
|
NDC 00406114401
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna American Axle |
$296.89
|
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.89
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$319.73
|
| Rate for Payer: Cofinity Commercial |
$392.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.40
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.24
|
| Rate for Payer: PHP Commercial |
$388.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.89
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: UMR Bronson Commercial |
$200.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
METHYLPHENIDATE 10 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 10702010101
|
| Hospital Charge Code |
4986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna American Axle |
$145.60
|
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: UMR Bronson Commercial |
$98.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
