Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION

Facility

$170.19

Service Code	HCPCS J7674
Hospital Charge Code	180308
Hospital Revenue Code	636
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$170.19
Rate for Payer: Aetna Commercial	$153.17
Rate for Payer: Aetna Medicare	$85.09
Rate for Payer: ASR ASR	$165.08
Rate for Payer: ASR Commercial	$165.08
Rate for Payer: BCBS Complete	$68.08
Rate for Payer: BCBS Trust/PPO	$139.37
Rate for Payer: BCN Commercial	$131.95
Rate for Payer: Cash Price	$136.15
Rate for Payer: Cofinity Commercial	$159.98
Rate for Payer: Encore Health Key Benefits Commercial	$136.15
Rate for Payer: Healthscope Commercial	$170.19
Rate for Payer: Healthscope Whirlpool	$165.08
Rate for Payer: Mclaren Commercial	$153.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$144.66
Rate for Payer: Nomi Health Commercial	$139.56
Rate for Payer: Priority Health Cigna Priority Health	$110.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.12
Rate for Payer: Priority Health Narrow Network	$119.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$149.77

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION

Facility

$285.60

Service Code	HCPCS J7674
Hospital Charge Code	27032
Hospital Revenue Code	636
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$285.60
Rate for Payer: Aetna Commercial	$257.04
Rate for Payer: ASR ASR	$277.03
Rate for Payer: ASR Commercial	$277.03
Rate for Payer: BCBS Trust/PPO	$232.74
Rate for Payer: BCN Commercial	$221.43
Rate for Payer: Cash Price	$228.48
Rate for Payer: Cofinity Commercial	$268.46
Rate for Payer: Encore Health Key Benefits Commercial	$228.48
Rate for Payer: Healthscope Commercial	$285.60
Rate for Payer: Healthscope Whirlpool	$277.03
Rate for Payer: Mclaren Commercial	$257.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.76
Rate for Payer: Nomi Health Commercial	$234.19
Rate for Payer: Priority Health Cigna Priority Health	$185.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$251.33

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION

Facility

$285.60

Service Code	HCPCS J7674
Hospital Charge Code	27032
Hospital Revenue Code	636
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$285.60
Rate for Payer: Aetna Commercial	$257.04
Rate for Payer: Aetna Medicare	$142.80
Rate for Payer: ASR ASR	$277.03
Rate for Payer: ASR Commercial	$277.03
Rate for Payer: BCBS Complete	$114.24
Rate for Payer: BCBS Trust/PPO	$233.88
Rate for Payer: BCN Commercial	$221.43
Rate for Payer: Cash Price	$228.48
Rate for Payer: Cofinity Commercial	$268.46
Rate for Payer: Encore Health Key Benefits Commercial	$228.48
Rate for Payer: Healthscope Commercial	$285.60
Rate for Payer: Healthscope Whirlpool	$277.03
Rate for Payer: Mclaren Commercial	$257.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.76
Rate for Payer: Nomi Health Commercial	$234.19
Rate for Payer: Priority Health Cigna Priority Health	$185.64
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$250.24
Rate for Payer: Priority Health Narrow Network	$200.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$251.33

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00054355344
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$52.84
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Commercial	$118.88
Rate for Payer: Aetna Medicare	$66.05
Rate for Payer: ASR ASR	$128.13
Rate for Payer: ASR Commercial	$128.13
Rate for Payer: BCBS Complete	$52.84
Rate for Payer: BCBS Trust/PPO	$108.17
Rate for Payer: BCN Commercial	$102.41
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$132.09
Rate for Payer: Healthscope Whirlpool	$128.13
Rate for Payer: Mclaren Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: Nomi Health Commercial	$108.31
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.74
Rate for Payer: Priority Health Narrow Network	$92.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.24

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00406412303
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$52.84
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Commercial	$118.88
Rate for Payer: Aetna Medicare	$66.05
Rate for Payer: ASR ASR	$128.13
Rate for Payer: ASR Commercial	$128.13
Rate for Payer: BCBS Complete	$52.84
Rate for Payer: BCBS Trust/PPO	$108.17
Rate for Payer: BCN Commercial	$102.41
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$132.09
Rate for Payer: Healthscope Whirlpool	$128.13
Rate for Payer: Mclaren Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: Nomi Health Commercial	$108.31
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.74
Rate for Payer: Priority Health Narrow Network	$92.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.24

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00054355344
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$85.86
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Commercial	$118.88
Rate for Payer: ASR ASR	$128.13
Rate for Payer: ASR Commercial	$128.13
Rate for Payer: BCBS Trust/PPO	$107.64
Rate for Payer: BCN Commercial	$102.41
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$132.09
Rate for Payer: Healthscope Whirlpool	$128.13
Rate for Payer: Mclaren Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: Nomi Health Commercial	$108.31
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.24

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00406412303
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$85.86
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Commercial	$118.88
Rate for Payer: ASR ASR	$128.13
Rate for Payer: ASR Commercial	$128.13
Rate for Payer: BCBS Trust/PPO	$107.64
Rate for Payer: BCN Commercial	$102.41
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$124.16
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$132.09
Rate for Payer: Healthscope Whirlpool	$128.13
Rate for Payer: Mclaren Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: Nomi Health Commercial	$108.31
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.24

METHADONE 10 MG TABLET

Facility

$336.00

Service Code	NDC 00904653061
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$302.40
Rate for Payer: Aetna Medicare	$168.00
Rate for Payer: ASR ASR	$325.92
Rate for Payer: ASR Commercial	$325.92
Rate for Payer: BCBS Complete	$134.40
Rate for Payer: BCBS Trust/PPO	$275.15
Rate for Payer: BCN Commercial	$260.50
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cofinity Commercial	$315.84
Rate for Payer: Encore Health Key Benefits Commercial	$268.80
Rate for Payer: Healthscope Commercial	$336.00
Rate for Payer: Healthscope Whirlpool	$325.92
Rate for Payer: Mclaren Commercial	$302.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.60
Rate for Payer: Nomi Health Commercial	$275.52
Rate for Payer: Priority Health Cigna Priority Health	$218.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.40
Rate for Payer: Priority Health Narrow Network	$235.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$295.68

METHADONE 10 MG TABLET

Facility

$336.00

Service Code	NDC 00904653061
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$302.40
Rate for Payer: ASR ASR	$325.92
Rate for Payer: ASR Commercial	$325.92
Rate for Payer: BCBS Trust/PPO	$273.81
Rate for Payer: BCN Commercial	$260.50
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cofinity Commercial	$315.84
Rate for Payer: Encore Health Key Benefits Commercial	$268.80
Rate for Payer: Healthscope Commercial	$336.00
Rate for Payer: Healthscope Whirlpool	$325.92
Rate for Payer: Mclaren Commercial	$302.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.60
Rate for Payer: Nomi Health Commercial	$275.52
Rate for Payer: Priority Health Cigna Priority Health	$218.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$295.68

METHADONE 5 MG TABLET

Facility

$500.50

Service Code	NDC 00054070920
Hospital Charge Code	4954
Hospital Revenue Code	637
Min. Negotiated Rate	$325.32
Max. Negotiated Rate	$500.50
Rate for Payer: Aetna Commercial	$450.45
Rate for Payer: ASR ASR	$485.49
Rate for Payer: ASR Commercial	$485.49
Rate for Payer: BCBS Trust/PPO	$407.86
Rate for Payer: BCN Commercial	$388.04
Rate for Payer: Cash Price	$400.40
Rate for Payer: Cofinity Commercial	$470.47
Rate for Payer: Encore Health Key Benefits Commercial	$400.40
Rate for Payer: Healthscope Commercial	$500.50
Rate for Payer: Healthscope Whirlpool	$485.49
Rate for Payer: Mclaren Commercial	$450.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$425.43
Rate for Payer: Nomi Health Commercial	$410.41
Rate for Payer: Priority Health Cigna Priority Health	$325.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$440.44

METHADONE 5 MG TABLET

Facility

$500.50

Service Code	NDC 00054070920
Hospital Charge Code	4954
Hospital Revenue Code	637
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$500.50
Rate for Payer: Aetna Commercial	$450.45
Rate for Payer: Aetna Medicare	$250.25
Rate for Payer: ASR ASR	$485.49
Rate for Payer: ASR Commercial	$485.49
Rate for Payer: BCBS Complete	$200.20
Rate for Payer: BCBS Trust/PPO	$409.86
Rate for Payer: BCN Commercial	$388.04
Rate for Payer: Cash Price	$400.40
Rate for Payer: Cofinity Commercial	$470.47
Rate for Payer: Encore Health Key Benefits Commercial	$400.40
Rate for Payer: Healthscope Commercial	$500.50
Rate for Payer: Healthscope Whirlpool	$485.49
Rate for Payer: Mclaren Commercial	$450.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$425.43
Rate for Payer: Nomi Health Commercial	$410.41
Rate for Payer: Priority Health Cigna Priority Health	$325.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$438.54
Rate for Payer: Priority Health Narrow Network	$350.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$440.44

METHENAMINE HIPPURATE 1 GRAM TABLET

Facility

$350.88

Service Code	NDC 65862078201
Hospital Charge Code	10549
Hospital Revenue Code	637
Min. Negotiated Rate	$228.07
Max. Negotiated Rate	$350.88
Rate for Payer: Aetna Commercial	$315.79
Rate for Payer: ASR ASR	$340.35
Rate for Payer: ASR Commercial	$340.35
Rate for Payer: BCBS Trust/PPO	$285.93
Rate for Payer: BCN Commercial	$272.04
Rate for Payer: Cash Price	$280.70
Rate for Payer: Cofinity Commercial	$329.83
Rate for Payer: Encore Health Key Benefits Commercial	$280.70
Rate for Payer: Healthscope Commercial	$350.88
Rate for Payer: Healthscope Whirlpool	$340.35
Rate for Payer: Mclaren Commercial	$315.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$298.25
Rate for Payer: Nomi Health Commercial	$287.72
Rate for Payer: Priority Health Cigna Priority Health	$228.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$308.77

METHENAMINE HIPPURATE 1 GRAM TABLET

Facility

$350.88

Service Code	NDC 65862078201
Hospital Charge Code	10549
Hospital Revenue Code	637
Min. Negotiated Rate	$140.35
Max. Negotiated Rate	$350.88
Rate for Payer: Aetna Commercial	$315.79
Rate for Payer: Aetna Medicare	$175.44
Rate for Payer: ASR ASR	$340.35
Rate for Payer: ASR Commercial	$340.35
Rate for Payer: BCBS Complete	$140.35
Rate for Payer: BCBS Trust/PPO	$287.34
Rate for Payer: BCN Commercial	$272.04
Rate for Payer: Cash Price	$280.70
Rate for Payer: Cofinity Commercial	$329.83
Rate for Payer: Encore Health Key Benefits Commercial	$280.70
Rate for Payer: Healthscope Commercial	$350.88
Rate for Payer: Healthscope Whirlpool	$340.35
Rate for Payer: Mclaren Commercial	$315.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$298.25
Rate for Payer: Nomi Health Commercial	$287.72
Rate for Payer: Priority Health Cigna Priority Health	$228.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$307.44
Rate for Payer: Priority Health Narrow Network	$245.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$308.77

METHIMAZOLE 5 MG TABLET

Facility

$3.43

Service Code	NDC 60687035711
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$3.43
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: ASR ASR	$3.33
Rate for Payer: ASR Commercial	$3.33
Rate for Payer: BCBS Trust/PPO	$2.80
Rate for Payer: BCN Commercial	$2.66
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.43
Rate for Payer: Healthscope Whirlpool	$3.33
Rate for Payer: Mclaren Commercial	$3.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.92
Rate for Payer: Nomi Health Commercial	$2.81
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.02

METHIMAZOLE 5 MG TABLET

Facility

$206.80

Service Code	NDC 23155007001
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$82.72
Max. Negotiated Rate	$206.80
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: Aetna Medicare	$103.40
Rate for Payer: ASR ASR	$200.60
Rate for Payer: ASR Commercial	$200.60
Rate for Payer: BCBS Complete	$82.72
Rate for Payer: BCBS Trust/PPO	$169.35
Rate for Payer: BCN Commercial	$160.33
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cofinity Commercial	$194.39
Rate for Payer: Encore Health Key Benefits Commercial	$165.44
Rate for Payer: Healthscope Commercial	$206.80
Rate for Payer: Healthscope Whirlpool	$200.60
Rate for Payer: Mclaren Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.78
Rate for Payer: Nomi Health Commercial	$169.58
Rate for Payer: Priority Health Cigna Priority Health	$134.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.20
Rate for Payer: Priority Health Narrow Network	$144.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.98

METHIMAZOLE 5 MG TABLET

Facility

$3.43

Service Code	NDC 60687035711
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.43
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare	$1.72
Rate for Payer: ASR ASR	$3.33
Rate for Payer: ASR Commercial	$3.33
Rate for Payer: BCBS Complete	$1.37
Rate for Payer: BCBS Trust/PPO	$2.81
Rate for Payer: BCN Commercial	$2.66
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.43
Rate for Payer: Healthscope Whirlpool	$3.33
Rate for Payer: Mclaren Commercial	$3.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.92
Rate for Payer: Nomi Health Commercial	$2.81
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.01
Rate for Payer: Priority Health Narrow Network	$2.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.02

METHIMAZOLE 5 MG TABLET

Facility

$342.95

Service Code	NDC 60687035701
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$222.92
Max. Negotiated Rate	$342.95
Rate for Payer: Aetna Commercial	$308.65
Rate for Payer: ASR ASR	$332.66
Rate for Payer: ASR Commercial	$332.66
Rate for Payer: BCBS Trust/PPO	$279.47
Rate for Payer: BCN Commercial	$265.89
Rate for Payer: Cash Price	$274.36
Rate for Payer: Cofinity Commercial	$322.37
Rate for Payer: Encore Health Key Benefits Commercial	$274.36
Rate for Payer: Healthscope Commercial	$342.95
Rate for Payer: Healthscope Whirlpool	$332.66
Rate for Payer: Mclaren Commercial	$308.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$291.51
Rate for Payer: Nomi Health Commercial	$281.22
Rate for Payer: Priority Health Cigna Priority Health	$222.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$301.80

METHIMAZOLE 5 MG TABLET

Facility

$342.95

Service Code	NDC 60687035701
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$137.18
Max. Negotiated Rate	$342.95
Rate for Payer: Aetna Commercial	$308.65
Rate for Payer: Aetna Medicare	$171.47
Rate for Payer: ASR ASR	$332.66
Rate for Payer: ASR Commercial	$332.66
Rate for Payer: BCBS Complete	$137.18
Rate for Payer: BCBS Trust/PPO	$280.84
Rate for Payer: BCN Commercial	$265.89
Rate for Payer: Cash Price	$274.36
Rate for Payer: Cofinity Commercial	$322.37
Rate for Payer: Encore Health Key Benefits Commercial	$274.36
Rate for Payer: Healthscope Commercial	$342.95
Rate for Payer: Healthscope Whirlpool	$332.66
Rate for Payer: Mclaren Commercial	$308.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$291.51
Rate for Payer: Nomi Health Commercial	$281.22
Rate for Payer: Priority Health Cigna Priority Health	$222.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$300.49
Rate for Payer: Priority Health Narrow Network	$240.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$301.80

METHIMAZOLE 5 MG TABLET

Facility

$206.80

Service Code	NDC 23155007001
Hospital Charge Code	10553
Hospital Revenue Code	637
Min. Negotiated Rate	$134.42
Max. Negotiated Rate	$206.80
Rate for Payer: Aetna Commercial	$186.12
Rate for Payer: ASR ASR	$200.60
Rate for Payer: ASR Commercial	$200.60
Rate for Payer: BCBS Trust/PPO	$168.52
Rate for Payer: BCN Commercial	$160.33
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cofinity Commercial	$194.39
Rate for Payer: Encore Health Key Benefits Commercial	$165.44
Rate for Payer: Healthscope Commercial	$206.80
Rate for Payer: Healthscope Whirlpool	$200.60
Rate for Payer: Mclaren Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.78
Rate for Payer: Nomi Health Commercial	$169.58
Rate for Payer: Priority Health Cigna Priority Health	$134.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.98

METHOCARBAMOL 100 MG/ML INJECTION SOLUTION

Facility

$24.79

Service Code	HCPCS J2800
Hospital Charge Code	4970
Hospital Revenue Code	636
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$24.79
Rate for Payer: Aetna Commercial	$22.31
Rate for Payer: ASR ASR	$24.05
Rate for Payer: ASR Commercial	$24.05
Rate for Payer: BCBS Trust/PPO	$20.20
Rate for Payer: BCN Commercial	$19.22
Rate for Payer: Cash Price	$19.83
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Encore Health Key Benefits Commercial	$19.83
Rate for Payer: Healthscope Commercial	$24.79
Rate for Payer: Healthscope Whirlpool	$24.05
Rate for Payer: Mclaren Commercial	$22.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.07
Rate for Payer: Nomi Health Commercial	$20.33
Rate for Payer: Priority Health Cigna Priority Health	$16.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.82

METHOCARBAMOL 100 MG/ML INJECTION SOLUTION

Facility

$24.79

Service Code	HCPCS J2800
Hospital Charge Code	4970
Hospital Revenue Code	636
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$24.79
Rate for Payer: Aetna Commercial	$22.31
Rate for Payer: Aetna Medicare	$12.39
Rate for Payer: ASR ASR	$24.05
Rate for Payer: ASR Commercial	$24.05
Rate for Payer: BCBS Complete	$9.92
Rate for Payer: BCBS Trust/PPO	$20.30
Rate for Payer: BCN Commercial	$19.22
Rate for Payer: Cash Price	$19.83
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Encore Health Key Benefits Commercial	$19.83
Rate for Payer: Healthscope Commercial	$24.79
Rate for Payer: Healthscope Whirlpool	$24.05
Rate for Payer: Mclaren Commercial	$22.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.07
Rate for Payer: Nomi Health Commercial	$20.33
Rate for Payer: Priority Health Cigna Priority Health	$16.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.72
Rate for Payer: Priority Health Narrow Network	$17.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.82

METHOCARBAMOL 500 MG TABLET

Facility

$204.25

Service Code	NDC 63739099110
Hospital Charge Code	4971
Hospital Revenue Code	637
Min. Negotiated Rate	$81.70
Max. Negotiated Rate	$204.25
Rate for Payer: Aetna Commercial	$183.82
Rate for Payer: Aetna Medicare	$102.12
Rate for Payer: ASR ASR	$198.12
Rate for Payer: ASR Commercial	$198.12
Rate for Payer: BCBS Complete	$81.70
Rate for Payer: BCBS Trust/PPO	$167.26
Rate for Payer: BCN Commercial	$158.36
Rate for Payer: Cash Price	$163.40
Rate for Payer: Cofinity Commercial	$192.00
Rate for Payer: Encore Health Key Benefits Commercial	$163.40
Rate for Payer: Healthscope Commercial	$204.25
Rate for Payer: Healthscope Whirlpool	$198.12
Rate for Payer: Mclaren Commercial	$183.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.61
Rate for Payer: Nomi Health Commercial	$167.49
Rate for Payer: Priority Health Cigna Priority Health	$132.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.96
Rate for Payer: Priority Health Narrow Network	$143.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.74

METHOCARBAMOL 500 MG TABLET

Facility

$376.00

Service Code	NDC 70010075405
Hospital Charge Code	4971
Hospital Revenue Code	637
Min. Negotiated Rate	$150.40
Max. Negotiated Rate	$376.00
Rate for Payer: Aetna Commercial	$338.40
Rate for Payer: Aetna Medicare	$188.00
Rate for Payer: ASR ASR	$364.72
Rate for Payer: ASR Commercial	$364.72
Rate for Payer: BCBS Complete	$150.40
Rate for Payer: BCBS Trust/PPO	$307.91
Rate for Payer: BCN Commercial	$291.51
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cofinity Commercial	$353.44
Rate for Payer: Encore Health Key Benefits Commercial	$300.80
Rate for Payer: Healthscope Commercial	$376.00
Rate for Payer: Healthscope Whirlpool	$364.72
Rate for Payer: Mclaren Commercial	$338.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.60
Rate for Payer: Nomi Health Commercial	$308.32
Rate for Payer: Priority Health Cigna Priority Health	$244.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$329.45
Rate for Payer: Priority Health Narrow Network	$263.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.88

METHOCARBAMOL 500 MG TABLET

Facility

$376.00

Service Code	NDC 70010075405
Hospital Charge Code	4971
Hospital Revenue Code	637
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$376.00
Rate for Payer: Aetna Commercial	$338.40
Rate for Payer: ASR ASR	$364.72
Rate for Payer: ASR Commercial	$364.72
Rate for Payer: BCBS Trust/PPO	$306.40
Rate for Payer: BCN Commercial	$291.51
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cofinity Commercial	$353.44
Rate for Payer: Encore Health Key Benefits Commercial	$300.80
Rate for Payer: Healthscope Commercial	$376.00
Rate for Payer: Healthscope Whirlpool	$364.72
Rate for Payer: Mclaren Commercial	$338.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.60
Rate for Payer: Nomi Health Commercial	$308.32
Rate for Payer: Priority Health Cigna Priority Health	$244.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.88

METHOCARBAMOL 500 MG TABLET

Facility

$458.25

Service Code	NDC 00904705761
Hospital Charge Code	4971
Hospital Revenue Code	637
Min. Negotiated Rate	$297.86
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$412.43
Rate for Payer: ASR ASR	$444.50
Rate for Payer: ASR Commercial	$444.50
Rate for Payer: BCBS Trust/PPO	$373.43
Rate for Payer: BCN Commercial	$355.28
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$430.75
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$458.25
Rate for Payer: Healthscope Whirlpool	$444.50
Rate for Payer: Mclaren Commercial	$412.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: Nomi Health Commercial	$375.76
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.26

Know your out-of-pocket cost for care.

All Charges