|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
NDC 09900000010
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: BCBS Trust/PPO |
$35.94
|
| Rate for Payer: BCN Commercial |
$34.03
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.22
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.43
|
| Rate for Payer: Nomi Health Commercial |
$36.10
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.62
|
| Rate for Payer: Priority Health HMO/PPO |
$38.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.75
|
| Rate for Payer: UHC Core |
$36.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.02
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$131.88
|
|
|
Service Code
|
NDC 00527192736
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$107.65
|
| Rate for Payer: BCN Commercial |
$101.92
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cofinity Commercial |
$113.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.50
|
| Rate for Payer: Healthscope Commercial |
$118.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: PHP Commercial |
$112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.72
|
| Rate for Payer: Priority Health HMO/PPO |
$114.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.05
|
| Rate for Payer: UHC Core |
$110.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.91
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.96 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: BCBS Trust/PPO |
$352.85
|
| Rate for Payer: BCN Commercial |
$334.04
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Nomi Health Commercial |
$354.44
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.96
|
| Rate for Payer: Priority Health HMO/PPO |
$376.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$432.25
|
|
|
Service Code
|
NDC 00406577162
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.66 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Medicare |
$112.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.08
|
| Rate for Payer: BCBS Complete |
$172.90
|
| Rate for Payer: BCBS MAPPO |
$108.06
|
| Rate for Payer: BCBS Trust/PPO |
$355.35
|
| Rate for Payer: BCN Commercial |
$336.07
|
| Rate for Payer: BCN Medicare Advantage |
$108.06
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.06
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.41
|
| Rate for Payer: Nomi Health Commercial |
$354.44
|
| Rate for Payer: PACE Senior Care Partners |
$102.66
|
| Rate for Payer: PACE SWMI |
$108.06
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: PHP Medicare Advantage |
$108.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.96
|
| Rate for Payer: Priority Health HMO/PPO |
$376.06
|
| Rate for Payer: Priority Health Medicare |
$109.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.61
|
| Rate for Payer: Railroad Medicare Medicare |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.06
|
| Rate for Payer: UHC Exchange |
$108.06
|
| Rate for Payer: UHC Medicare Advantage |
$108.06
|
| Rate for Payer: VA VA |
$108.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 00406577123
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$251.04
|
|
|
Service Code
|
NDC 60687037001
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna Medicare |
$65.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.45
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$62.76
|
| Rate for Payer: BCBS Trust/PPO |
$206.38
|
| Rate for Payer: BCN Commercial |
$195.18
|
| Rate for Payer: BCN Medicare Advantage |
$62.76
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: Nomi Health Commercial |
$205.85
|
| Rate for Payer: PACE Senior Care Partners |
$59.62
|
| Rate for Payer: PACE SWMI |
$62.76
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: PHP Medicare Advantage |
$62.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health HMO/PPO |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.20
|
| Rate for Payer: Railroad Medicare Medicare |
$62.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.76
|
| Rate for Payer: UHC Exchange |
$62.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.76
|
| Rate for Payer: VA VA |
$62.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 60687037001
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.18 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: BCBS Trust/PPO |
$204.92
|
| Rate for Payer: BCN Commercial |
$194.00
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: Nomi Health Commercial |
$205.85
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health HMO/PPO |
$218.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.92
|
| Rate for Payer: UHC Core |
$209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 60687037011
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 60687037011
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: BCBS Trust/PPO |
$247.46
|
| Rate for Payer: BCN Commercial |
$234.27
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$78.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.73
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: BCBS MAPPO |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$235.70
|
| Rate for Payer: BCN Medicare Advantage |
$75.79
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.79
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Nomi Health Commercial |
$248.58
|
| Rate for Payer: PACE Senior Care Partners |
$72.00
|
| Rate for Payer: PACE SWMI |
$75.79
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health HMO/PPO |
$263.74
|
| Rate for Payer: Priority Health Medicare |
$76.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: Railroad Medicare Medicare |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.77
|
| Rate for Payer: UHC Core |
$253.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.79
|
| Rate for Payer: UHC Exchange |
$75.79
|
| Rate for Payer: UHC Medicare Advantage |
$75.79
|
| Rate for Payer: VA VA |
$75.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.92 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: BCBS Trust/PPO |
$279.95
|
| Rate for Payer: BCN Commercial |
$265.03
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Healthscope Commercial |
$308.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: Nomi Health Commercial |
$281.22
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health HMO/PPO |
$298.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.80
|
| Rate for Payer: UHC Core |
$286.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS MAPPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.86
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$2.81
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.86
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2.98
|
| Rate for Payer: Priority Health Medicare |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.86
|
| Rate for Payer: UHC Exchange |
$0.86
|
| Rate for Payer: UHC Medicare Advantage |
$0.86
|
| Rate for Payer: VA VA |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$168.81
|
| Rate for Payer: BCN Commercial |
$159.82
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$342.95
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: Aetna Medicare |
$89.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.17
|
| Rate for Payer: BCBS Complete |
$137.18
|
| Rate for Payer: BCBS MAPPO |
$85.74
|
| Rate for Payer: BCBS Trust/PPO |
$281.94
|
| Rate for Payer: BCN Commercial |
$266.64
|
| Rate for Payer: BCN Medicare Advantage |
$85.74
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.74
|
| Rate for Payer: Healthscope Commercial |
$308.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.51
|
| Rate for Payer: Nomi Health Commercial |
$281.22
|
| Rate for Payer: PACE Senior Care Partners |
$81.45
|
| Rate for Payer: PACE SWMI |
$85.74
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: PHP Medicare Advantage |
$85.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.92
|
| Rate for Payer: Priority Health HMO/PPO |
$298.37
|
| Rate for Payer: Priority Health Medicare |
$86.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.78
|
| Rate for Payer: Railroad Medicare Medicare |
$85.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.80
|
| Rate for Payer: UHC Core |
$286.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.74
|
| Rate for Payer: UHC Exchange |
$85.74
|
| Rate for Payer: UHC Medicare Advantage |
$85.74
|
| Rate for Payer: VA VA |
$85.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.62
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: BCBS MAPPO |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.01
|
| Rate for Payer: BCN Commercial |
$160.79
|
| Rate for Payer: BCN Medicare Advantage |
$51.70
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PACE Senior Care Partners |
$49.12
|
| Rate for Payer: PACE SWMI |
$51.70
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Medicare |
$52.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.70
|
| Rate for Payer: UHC Exchange |
$51.70
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
| Rate for Payer: VA VA |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.28
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| Rate for Payer: BCN Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$374.07
|
| Rate for Payer: BCN Commercial |
$354.14
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.03
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.56
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.64
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1.79
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.38
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.12
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.54
|
| Rate for Payer: BCN Medicare Advantage |
$51.30
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PACE Senior Care Partners |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.30
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Medicare |
$51.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.30
|
| Rate for Payer: UHC Exchange |
$51.30
|
| Rate for Payer: UHC Medicare Advantage |
$51.30
|
| Rate for Payer: VA VA |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
