|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$328.80
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.67 |
| Max. Negotiated Rate |
$295.92 |
| Rate for Payer: Aetna American Axle |
$213.72
|
| Rate for Payer: Aetna Commercial |
$279.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.72
|
| Rate for Payer: Cash Price |
$263.04
|
| Rate for Payer: Cofinity Advantage |
$230.16
|
| Rate for Payer: Cofinity Commercial |
$282.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.04
|
| Rate for Payer: Healthscope Commercial |
$295.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.60
|
| Rate for Payer: PHP Commercial |
$279.48
|
| Rate for Payer: Priority Health SBD |
$207.14
|
| Rate for Payer: UMR Bronson Commercial |
$144.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.60
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$151.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Advantage |
$212.21
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.36
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.05
|
| Rate for Payer: UHC Core |
$157.94
|
| Rate for Payer: UHC Exchange |
$119.14
|
| Rate for Payer: UMR Bronson Commercial |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 10 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155007101
|
| Hospital Charge Code |
10552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.39 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Advantage |
$212.21
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.36
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$133.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$288.48
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna American Axle |
$187.51
|
| Rate for Payer: Aetna Commercial |
$245.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.51
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Advantage |
$201.94
|
| Rate for Payer: Cofinity Commercial |
$248.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Healthscope Commercial |
$259.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: PHP Commercial |
$245.21
|
| Rate for Payer: Priority Health SBD |
$181.74
|
| Rate for Payer: UMR Bronson Commercial |
$126.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.47
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: UHC Exchange |
$83.12
|
| Rate for Payer: UMR Bronson Commercial |
$78.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$288.48
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna American Axle |
$187.51
|
| Rate for Payer: Aetna Commercial |
$245.21
|
| Rate for Payer: Aetna Medicare |
$144.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.51
|
| Rate for Payer: BCBS Complete |
$115.39
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Advantage |
$201.94
|
| Rate for Payer: Cofinity Commercial |
$248.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Healthscope Commercial |
$259.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: PHP Commercial |
$245.21
|
| Rate for Payer: Priority Health SBD |
$181.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.51
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Exchange |
$113.37
|
| Rate for Payer: UMR Bronson Commercial |
$106.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.36
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.88
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.39
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna American Axle |
$11.66
|
| Rate for Payer: Aetna American Axle |
$53.25
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna Medicare |
$8.97
|
| Rate for Payer: Aetna Medicare |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.25
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Complete |
$32.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Commercial |
$14.70
|
| Rate for Payer: BCN Commercial |
$14.70
|
| Rate for Payer: BCN Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Advantage |
$57.35
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Advantage |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$70.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$16.15
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$73.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$15.25
|
| Rate for Payer: PHP Commercial |
$69.64
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UMR Bronson Commercial |
$30.31
|
| Rate for Payer: UMR Bronson Commercial |
$6.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.94
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna American Axle |
$11.66
|
| Rate for Payer: Aetna American Axle |
$53.25
|
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cofinity Advantage |
$57.35
|
| Rate for Payer: Cofinity Advantage |
$12.56
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.54
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$73.74
|
| Rate for Payer: Healthscope Commercial |
$16.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$15.25
|
| Rate for Payer: PHP Commercial |
$69.64
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$7.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: UMR Bronson Commercial |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
METHOCARBAMOL 250 MG CUSTOM TAB
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 09900001167
|
| Hospital Charge Code |
300425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
METHOCARBAMOL 250 MG CUSTOM TAB
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 09900001167
|
| 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 Advantage |
$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 Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.18
|
| 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
|
$129.25
|
|
|
Service Code
|
NDC 43547040510
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Advantage |
$90.47
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.94
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 70010075401
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 70010075401
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 31722053301
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 43547040510
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Advantage |
$90.47
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.94
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.01
|
| Rate for Payer: UHC Core |
$67.34
|
| Rate for Payer: UHC Exchange |
$50.80
|
| Rate for Payer: UMR Bronson Commercial |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$197.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.55
|
| Rate for Payer: UHC Core |
$128.69
|
| Rate for Payer: UHC Exchange |
$97.07
|
| Rate for Payer: UMR Bronson Commercial |
$91.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$171.55
|
|
|
Service Code
|
NDC 76385012301
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Aetna American Axle |
$111.51
|
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna Medicare |
$85.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: BCBS Complete |
$68.62
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.51
|
| Rate for Payer: UHC Core |
$89.38
|
| Rate for Payer: UHC Exchange |
$67.42
|
| Rate for Payer: UMR Bronson Commercial |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.66
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 31722053301
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$171.55
|
|
|
Service Code
|
NDC 76385012301
|
| 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 Advantage |
$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 Commercial |
$145.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: PHP Commercial |
$145.82
|
| 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
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.61
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
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 Advantage |
$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 Commercial |
$209.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PHP Commercial |
$209.95
|
| 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
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
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 Advantage |
$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 Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| 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
|
|
