|
METHADONE 5 MG TABLET
|
Facility
|
IP
|
$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 |
$485.48
|
| Rate for Payer: ASR Commercial |
$485.48
|
| 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 |
$485.48
|
| Rate for Payer: Mclaren Commercial |
$450.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.42
|
| 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
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$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
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
IP
|
$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
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 60687035711
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$3.43 |
| 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
|
IP
|
$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
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
OP
|
$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
|
OP
|
$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 |
$308.66
|
| Rate for Payer: Aetna Medicare |
$171.48
|
| 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 |
$308.66
|
| 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
|
IP
|
$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 |
$308.66
|
| 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 |
$308.66
|
| 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
|
OP
|
$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
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.79
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
4970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| 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: 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 |
$6.60
|
| Rate for Payer: Priority Health Narrow Network |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$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 500 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Trust/PPO |
$167.22
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$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 |
$167.48
|
| 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
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: ASR Commercial |
$199.04
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$168.04
|
| Rate for Payer: BCN Commercial |
$159.09
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.80
|
| Rate for Payer: Priority Health Narrow Network |
$143.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$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
|
IP
|
$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 |
$412.42
|
| 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 |
$430.76
|
| 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 |
$412.42
|
| 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
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.42
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$355.28
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.76
|
| 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 |
$412.42
|
| 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: Priority Health HMO/PPO/Tiered Network |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 63739099110
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.76 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: ASR ASR |
$198.12
|
| Rate for Payer: ASR Commercial |
$198.12
|
| Rate for Payer: BCBS Trust/PPO |
$166.44
|
| 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 |
$167.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.74
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 60687055911
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: ASR ASR |
$1.99
|
| Rate for Payer: ASR Commercial |
$1.99
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Mclaren Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.80
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$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
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$61.27
|
| Rate for Payer: Aetna Medicare |
$34.04
|
| Rate for Payer: ASR ASR |
$66.04
|
| Rate for Payer: ASR Commercial |
$66.04
|
| Rate for Payer: BCBS Complete |
$27.23
|
| Rate for Payer: BCBS Trust/PPO |
$55.75
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$64.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Healthscope Whirlpool |
$66.04
|
| Rate for Payer: Mclaren Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: Nomi Health Commercial |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.09
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.91
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$68.08
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$61.27
|
| Rate for Payer: ASR ASR |
$66.04
|
| Rate for Payer: ASR Commercial |
$66.04
|
| Rate for Payer: BCBS Trust/PPO |
$55.48
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$64.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$68.08
|
| Rate for Payer: Healthscope Whirlpool |
$66.04
|
| Rate for Payer: Mclaren Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.87
|
| Rate for Payer: Nomi Health Commercial |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.91
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$529.24 |
| Rate for Payer: Aetna Commercial |
$476.32
|
| Rate for Payer: Aetna Medicare |
$264.62
|
| Rate for Payer: ASR ASR |
$513.36
|
| Rate for Payer: ASR Commercial |
$513.36
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: BCBS Trust/PPO |
$433.39
|
| Rate for Payer: BCN Commercial |
$410.32
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$497.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$529.24
|
| Rate for Payer: Healthscope Whirlpool |
$513.36
|
| Rate for Payer: Mclaren Commercial |
$476.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: Nomi Health Commercial |
$433.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.45
|
| Rate for Payer: Priority Health Narrow Network |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.73
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$529.24
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
91651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$344.01 |
| Max. Negotiated Rate |
$529.24 |
| Rate for Payer: Aetna Commercial |
$476.32
|
| Rate for Payer: ASR ASR |
$513.36
|
| Rate for Payer: ASR Commercial |
$513.36
|
| Rate for Payer: BCBS Trust/PPO |
$431.28
|
| Rate for Payer: BCN Commercial |
$410.32
|
| Rate for Payer: Cash Price |
$423.39
|
| Rate for Payer: Cofinity Commercial |
$497.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.39
|
| Rate for Payer: Healthscope Commercial |
$529.24
|
| Rate for Payer: Healthscope Whirlpool |
$513.36
|
| Rate for Payer: Mclaren Commercial |
$476.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.85
|
| Rate for Payer: Nomi Health Commercial |
$433.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.73
|
|
