|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| 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: Cofinity Medicare Advantage |
$2.40
|
| 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 Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| 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
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| 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 Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
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 |
$13.25
|
| Rate for Payer: Aetna American Axle |
$53.25
|
| 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) |
$11.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.35
|
| 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 |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$16.15
|
| 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 |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$69.64
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: PHP Commercial |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| 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 |
$61.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$81.93
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$73.74 |
| Rate for Payer: Aetna American Axle |
$53.25
|
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna American Axle |
$11.66
|
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna Medicare |
$8.97
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Complete |
$32.77
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS Trust/PPO |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.53
|
| Rate for Payer: BCN Commercial |
$19.53
|
| Rate for Payer: BCN Commercial |
$19.53
|
| Rate for Payer: BCN Commercial |
$19.53
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$65.54
|
| Rate for Payer: Cash Price |
$14.35
|
| 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 Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| 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 Medicare Advantage |
$57.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.27
|
| 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 |
$73.74
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$16.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.56
|
| 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 |
$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: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.64
|
| Rate for Payer: PHP Commercial |
$69.64
|
| Rate for Payer: PHP Commercial |
$15.25
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.25
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| 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 |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
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 |
$99.40 |
| 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 Commercial |
$77.32
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| 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
|
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 Commercial |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.08
|
| 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: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.51
|
| 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
|
$2.06
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna American Axle |
$1.34
|
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
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 Commercial |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.08
|
| 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: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.51
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UMR Bronson Commercial |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.66
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna American Axle |
$1.34
|
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| 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 |
$1.54
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$75.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 43547040510
|
| 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: Cofinity Medicare Advantage |
$116.80
|
| 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 Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| 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 500 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 43547040510
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.80
|
| 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 Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$61.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
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 |
$45.82
|
| 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 Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| 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: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| 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
|
$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 Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| 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: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| 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
|
$110.45
|
|
|
Service Code
|
NDC 31722053301
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.22
|
| 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 Commercial |
$77.32
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 63739099210
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$111.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.02
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$1,069.25
|
|
|
Service Code
|
NDC 43547022650
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.62 |
| Max. Negotiated Rate |
$962.32 |
| Rate for Payer: Aetna American Axle |
$695.01
|
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Medicare |
$534.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.01
|
| Rate for Payer: BCBS Complete |
$427.70
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cofinity Commercial |
$748.48
|
| Rate for Payer: Cofinity Commercial |
$919.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.40
|
| Rate for Payer: Healthscope Commercial |
$962.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$748.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.86
|
| Rate for Payer: PHP Commercial |
$908.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.01
|
| Rate for Payer: Priority Health SBD |
$673.63
|
| Rate for Payer: UMR Bronson Commercial |
$395.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.94
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00904705861
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: BCBS Complete |
$47.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.02
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$1,069.25
|
|
|
Service Code
|
NDC 43547022650
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.47 |
| Max. Negotiated Rate |
$962.32 |
| Rate for Payer: Aetna American Axle |
$695.01
|
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.01
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cofinity Commercial |
$748.48
|
| Rate for Payer: Cofinity Commercial |
$919.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.40
|
| Rate for Payer: Healthscope Commercial |
$962.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$748.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.86
|
| Rate for Payer: PHP Commercial |
$908.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.01
|
| Rate for Payer: Priority Health SBD |
$673.63
|
| Rate for Payer: UMR Bronson Commercial |
$470.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.94
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 60687056811
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 31722053401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
METHOCARBAMOL 750 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 31722053401
|
| Hospital Charge Code |
4972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
