|
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 Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| 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: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 60687056811
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
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 Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| 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: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| 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
|
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 |
$126.82
|
| 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 Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| 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: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$93.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR AVM PROVACATIVE TESTING
|
Facility
|
IP
|
$397.42
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
180402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.86 |
| Max. Negotiated Rate |
$357.68 |
| Rate for Payer: Aetna American Axle |
$258.32
|
| Rate for Payer: Aetna Commercial |
$337.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.32
|
| Rate for Payer: Cash Price |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$278.19
|
| Rate for Payer: Cofinity Commercial |
$341.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.94
|
| Rate for Payer: Healthscope Commercial |
$357.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.81
|
| Rate for Payer: PHP Commercial |
$337.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.32
|
| Rate for Payer: Priority Health SBD |
$250.37
|
| Rate for Payer: UMR Bronson Commercial |
$174.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.06
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR AVM PROVACATIVE TESTING
|
Facility
|
OP
|
$397.42
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
180402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$357.68 |
| Rate for Payer: Aetna American Axle |
$258.32
|
| Rate for Payer: Aetna Commercial |
$337.81
|
| Rate for Payer: Aetna Medicare |
$198.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.32
|
| Rate for Payer: BCBS Complete |
$158.97
|
| Rate for Payer: Cash Price |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$278.19
|
| Rate for Payer: Cofinity Commercial |
$341.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.94
|
| Rate for Payer: Healthscope Commercial |
$357.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.81
|
| Rate for Payer: PHP Commercial |
$337.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.32
|
| Rate for Payer: Priority Health SBD |
$250.37
|
| Rate for Payer: UMR Bronson Commercial |
$147.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.06
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$397.42
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$357.68 |
| Rate for Payer: Aetna American Axle |
$258.32
|
| Rate for Payer: Aetna Commercial |
$337.81
|
| Rate for Payer: Aetna Medicare |
$198.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.32
|
| Rate for Payer: BCBS Complete |
$158.97
|
| Rate for Payer: Cash Price |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$278.19
|
| Rate for Payer: Cofinity Commercial |
$341.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.94
|
| Rate for Payer: Healthscope Commercial |
$357.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.81
|
| Rate for Payer: PHP Commercial |
$337.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.32
|
| Rate for Payer: Priority Health SBD |
$250.37
|
| Rate for Payer: UMR Bronson Commercial |
$147.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.06
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$397.42
|
|
|
Service Code
|
NDC 42023010501
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.86 |
| Max. Negotiated Rate |
$357.68 |
| Rate for Payer: Aetna American Axle |
$258.32
|
| Rate for Payer: Aetna Commercial |
$337.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.32
|
| Rate for Payer: Cash Price |
$317.94
|
| Rate for Payer: Cofinity Commercial |
$278.19
|
| Rate for Payer: Cofinity Commercial |
$341.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.94
|
| Rate for Payer: Healthscope Commercial |
$357.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.81
|
| Rate for Payer: PHP Commercial |
$337.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.32
|
| Rate for Payer: Priority Health SBD |
$250.37
|
| Rate for Payer: UMR Bronson Commercial |
$174.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.06
|
|
|
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 Commercial |
$470.79
|
| Rate for Payer: Cofinity Commercial |
$578.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.79
|
| 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: PHP Commercial |
$571.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.16
|
| 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 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 Commercial |
$470.79
|
| Rate for Payer: Cofinity Commercial |
$578.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.79
|
| 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: PHP Commercial |
$571.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.16
|
| Rate for Payer: Priority Health SBD |
$423.71
|
| Rate for Payer: UMR Bronson Commercial |
$248.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.42
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna American Axle |
$179.08
|
| Rate for Payer: Aetna American Axle |
$102.26
|
| Rate for Payer: Aetna American Axle |
$119.29
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Commercial |
$133.72
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna Medicare |
$91.76
|
| Rate for Payer: Aetna Medicare |
$78.66
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.29
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: BCBS Complete |
$62.93
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: BCBS Complete |
$73.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| Rate for Payer: Cofinity Commercial |
$110.12
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$128.46
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Healthscope Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.72
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: PHP Commercial |
$133.72
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health SBD |
$99.11
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: Priority Health SBD |
$115.62
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: UMR Bronson Commercial |
$67.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
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 |
$179.08
|
| Rate for Payer: Aetna American Axle |
$119.29
|
| Rate for Payer: Aetna American Axle |
$102.26
|
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Commercial |
$155.99
|
| Rate for Payer: Aetna Commercial |
$133.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: Cash Price |
$146.82
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$110.12
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$128.46
|
| Rate for Payer: Cofinity Commercial |
$157.83
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.82
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$133.72
|
| Rate for Payer: PHP Commercial |
$155.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.26
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: Priority Health SBD |
$99.11
|
| Rate for Payer: Priority Health SBD |
$115.62
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: UMR Bronson Commercial |
$80.75
|
| Rate for Payer: UMR Bronson Commercial |
$69.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
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 |
$7.33 |
| 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 |
$460.35
|
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna Medicare |
$207.98
|
| 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 |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$433.27
|
| Rate for Payer: Cash Price |
$433.27
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$465.77
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Cofinity Commercial |
$379.11
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$487.43
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.35
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: PHP Commercial |
$460.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.03
|
| Rate for Payer: Priority Health SBD |
$341.20
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| 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 |
$406.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
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 Commercial |
$465.77
|
| Rate for Payer: Cofinity Commercial |
$379.11
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.11
|
| 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 |
$291.16
|
| 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: Multiplan/Beech St/PHCS Commercial |
$460.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: PHP Commercial |
$460.35
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.03
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: Priority Health SBD |
$341.20
|
| 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
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna American Axle |
$77.71
|
| Rate for Payer: Aetna American Axle |
$89.81
|
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna American Axle |
$156.70
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Commercial |
$101.63
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$192.86
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$168.76
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.72
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Cofinity Commercial |
$83.69
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| 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 |
$69.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.86
|
| Rate for Payer: Healthscope Commercial |
$124.35
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$216.97
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| 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 |
$96.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.52
|
| 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: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.63
|
| Rate for Payer: PHP Commercial |
$101.63
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.71
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: Priority Health SBD |
$151.88
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: Priority Health SBD |
$75.32
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$52.61
|
| Rate for Payer: UMR Bronson Commercial |
$60.79
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: UMR Bronson Commercial |
$38.44
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$138.17
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$124.35 |
| Rate for Payer: Aetna American Axle |
$89.81
|
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna American Axle |
$156.70
|
| Rate for Payer: Aetna American Axle |
$77.71
|
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Commercial |
$101.63
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Commercial |
$204.92
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$120.54
|
| Rate for Payer: Aetna Medicare |
$137.50
|
| Rate for Payer: Aetna Medicare |
$69.08
|
| Rate for Payer: Aetna Medicare |
$59.78
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| 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) |
$156.70
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: BCBS Complete |
$47.82
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: BCBS Complete |
$96.43
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$192.86
|
| Rate for Payer: Cash Price |
$95.65
|
| 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 |
$69.89
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$207.33
|
| Rate for Payer: Cofinity Commercial |
$168.76
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$96.72
|
| Rate for Payer: Cofinity Commercial |
$83.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| 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 |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| 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 |
$78.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.81
|
| 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 |
$233.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.63
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: PHP Commercial |
$101.63
|
| Rate for Payer: PHP Commercial |
$204.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.81
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: Priority Health SBD |
$75.32
|
| Rate for Payer: Priority Health SBD |
$151.88
|
| Rate for Payer: UMR Bronson Commercial |
$44.24
|
| Rate for Payer: UMR Bronson Commercial |
$89.20
|
| Rate for Payer: UMR Bronson Commercial |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: UMR Bronson Commercial |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.81
|
| 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 Commercial |
$122.98
|
| Rate for Payer: Cofinity Commercial |
$151.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.98
|
| 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: PHP Commercial |
$149.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.20
|
| Rate for Payer: Priority Health SBD |
$110.68
|
| Rate for Payer: UMR Bronson Commercial |
$77.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.77
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$175.69
|
|
|
Service Code
|
HCPCS J9255
|
| Hospital Charge Code |
96981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$158.12 |
| Rate for Payer: Aetna American Axle |
$114.20
|
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna Commercial |
$93.30
|
| Rate for Payer: Aetna Commercial |
$149.34
|
| Rate for Payer: Aetna 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 |
$70.28
|
| Rate for Payer: BCBS Complete |
$43.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$87.81
|
| Rate for Payer: Cash Price |
$87.81
|
| Rate for Payer: Cash Price |
$140.55
|
| Rate for Payer: Cash Price |
$140.55
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$151.09
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.81
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Healthscope Commercial |
$158.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.30
|
| Rate for Payer: PHP Commercial |
$149.34
|
| Rate for Payer: PHP Commercial |
$93.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.20
|
| 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 |
$82.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.77
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
NDC 38779306008
|
| Hospital Charge Code |
82599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna American Axle |
$43.22
|
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.22
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$46.55
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$59.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.52
|
| Rate for Payer: PHP Commercial |
$56.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.22
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UMR Bronson Commercial |
$29.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL
|
Facility
|
OP
|
$66.50
|
|
|
Service Code
|
NDC 38779306008
|
| Hospital Charge Code |
82599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna American Axle |
$43.22
|
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna Medicare |
$33.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.22
|
| Rate for Payer: BCBS Complete |
$26.60
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$46.55
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$59.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.52
|
| Rate for Payer: PHP Commercial |
$56.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.22
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UMR Bronson Commercial |
$24.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
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 |
$1.84
|
| 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 Commercial |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.57
|
| 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: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
METHYLDOPA 250 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 16729003001
|
| Hospital Charge Code |
4982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.92
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.92
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
