|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$513.12
|
|
|
Service Code
|
NDC 68682-022-10
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.77 |
| Max. Negotiated Rate |
$461.81 |
| Rate for Payer: Aetna American Axle |
$333.53
|
| Rate for Payer: Aetna Commercial |
$436.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.53
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cofinity Commercial |
$359.18
|
| Rate for Payer: Cofinity Commercial |
$441.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.50
|
| Rate for Payer: Healthscope Commercial |
$461.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$436.15
|
| Rate for Payer: PHP Commercial |
$436.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.18
|
| Rate for Payer: Priority Health SBD |
$323.27
|
| Rate for Payer: UMR Bronson Commercial |
$225.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.84
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$781.44
|
|
|
Service Code
|
NDC 62559-240-01
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.83 |
| Max. Negotiated Rate |
$703.30 |
| Rate for Payer: Aetna American Axle |
$507.94
|
| Rate for Payer: Aetna Commercial |
$664.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.94
|
| Rate for Payer: Cash Price |
$625.15
|
| Rate for Payer: Cofinity Commercial |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$672.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$625.15
|
| Rate for Payer: Healthscope Commercial |
$703.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$664.22
|
| Rate for Payer: PHP Commercial |
$664.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.01
|
| Rate for Payer: Priority Health SBD |
$492.31
|
| Rate for Payer: UMR Bronson Commercial |
$343.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.08
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$791.43
|
|
|
Service Code
|
NDC 0574-0790-01
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.23 |
| Max. Negotiated Rate |
$712.29 |
| Rate for Payer: Aetna American Axle |
$514.43
|
| Rate for Payer: Aetna Commercial |
$672.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.43
|
| Rate for Payer: Cash Price |
$633.14
|
| Rate for Payer: Cofinity Commercial |
$554.00
|
| Rate for Payer: Cofinity Commercial |
$680.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.14
|
| Rate for Payer: Healthscope Commercial |
$712.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$672.72
|
| Rate for Payer: PHP Commercial |
$672.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.00
|
| Rate for Payer: Priority Health SBD |
$498.60
|
| Rate for Payer: UMR Bronson Commercial |
$348.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.57
|
|
|
METHAZOLAMIDE 25 MG TABLET
|
Facility
|
IP
|
$1,061.53
|
|
|
Service Code
|
NDC 0781-1072-01
|
| Hospital Charge Code |
4961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$467.07 |
| Max. Negotiated Rate |
$955.38 |
| Rate for Payer: Aetna American Axle |
$689.99
|
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.99
|
| Rate for Payer: Cash Price |
$849.22
|
| Rate for Payer: Cofinity Commercial |
$743.07
|
| Rate for Payer: Cofinity Commercial |
$912.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.22
|
| Rate for Payer: Healthscope Commercial |
$955.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$902.30
|
| Rate for Payer: PHP Commercial |
$902.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.07
|
| Rate for Payer: Priority Health SBD |
$668.76
|
| Rate for Payer: UMR Bronson Commercial |
$467.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.15
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$357.12
|
|
|
Service Code
|
NDC 65862-782-01
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Commercial |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.55
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.98
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UMR Bronson Commercial |
$157.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 0185-0210-01
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.92
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 23155-071-01
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.92
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$247.95
|
|
|
Service Code
|
NDC 0185-0205-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.10 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna American Axle |
$161.17
|
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.17
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Commercial |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.76
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.56
|
| Rate for Payer: Priority Health SBD |
$156.21
|
| Rate for Payer: UMR Bronson Commercial |
$109.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.96
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$342.95
|
|
|
Service Code
|
NDC 60687-357-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.90 |
| Max. Negotiated Rate |
$308.66 |
| Rate for Payer: Aetna American Axle |
$222.92
|
| Rate for Payer: Aetna Commercial |
$291.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.92
|
| Rate for Payer: Cash Price |
$274.36
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$240.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.51
|
| Rate for Payer: PHP Commercial |
$291.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.06
|
| Rate for Payer: Priority Health SBD |
$216.06
|
| Rate for Payer: UMR Bronson Commercial |
$150.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.21
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 60687-669-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna American Axle |
$308.75
|
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$332.50
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health SBD |
$299.25
|
| Rate for Payer: UMR Bronson Commercial |
$209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 60687-669-11
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 23155-070-01
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.18 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687-357-11
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.93
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.74 |
| Rate for Payer: Aetna American Axle |
$53.25
|
| Rate for Payer: Aetna American Axle |
$12.90
|
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Commercial |
$16.87
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$15.88
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cofinity Commercial |
$13.90
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Cofinity Commercial |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.54
|
| Rate for Payer: Healthscope Commercial |
$17.86
|
| Rate for Payer: Healthscope Commercial |
$73.74
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.87
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$69.64
|
| Rate for Payer: PHP Commercial |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.27
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Priority Health SBD |
$12.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$8.97
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
METHOCARBAMOL 250 MG CUSTOM TAB
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 9900-0011-67
|
| Hospital Charge Code |
300425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 70010-754-01
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 31722-533-01
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$171.55
|
|
|
Service Code
|
NDC 76385-123-01
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Aetna American Axle |
$111.51
|
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Commercial |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.82
|
| Rate for Payer: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.08
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.66
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 60687-559-01
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$185.54 |
| Rate for Payer: Aetna American Axle |
$134.00
|
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.00
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$144.30
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$185.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.23
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.30
|
| Rate for Payer: Priority Health SBD |
$129.87
|
| Rate for Payer: UMR Bronson Commercial |
$90.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 60687-559-11
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.76
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 43547-405-10
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.80
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 70010-770-01
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687-568-11
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 63739-992-10
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$162.92
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 60687-568-01
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.95
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: UMR Bronson Commercial |
$108.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
