|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$313.13
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$313.13 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: ASR ASR |
$303.74
|
| Rate for Payer: BCBS Complete |
$125.25
|
| Rate for Payer: BCBS Trust/PPO |
$258.18
|
| Rate for Payer: BCN Commercial |
$258.18
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.50
|
| Rate for Payer: Healthscope Commercial |
$303.74
|
| Rate for Payer: Healthscope Whirlpool |
$313.13
|
| Rate for Payer: Mclaren Commercial |
$281.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.16
|
| Rate for Payer: Nomi Health Commercial |
$256.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.97
|
| Rate for Payer: Priority Health Narrow Network |
$1.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.56
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$313.13
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.85 |
| Max. Negotiated Rate |
$313.13 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: ASR ASR |
$303.74
|
| Rate for Payer: BCBS Trust/PPO |
$257.14
|
| Rate for Payer: BCN Commercial |
$257.14
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.50
|
| Rate for Payer: Healthscope Commercial |
$303.74
|
| Rate for Payer: Healthscope Whirlpool |
$313.13
|
| Rate for Payer: Mclaren Commercial |
$281.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.16
|
| Rate for Payer: Nomi Health Commercial |
$256.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.56
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$132.09
|
|
|
Service Code
|
NDC 54355344
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Aetna Medicare |
$48.87
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Complete |
$52.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: BCN Commercial |
$108.91
|
| 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 |
$128.13
|
| Rate for Payer: Healthscope Whirlpool |
$132.09
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: Priority Health Cigna 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
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 406412303
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$108.47
|
| Rate for Payer: BCN Commercial |
$108.47
|
| 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 |
$128.13
|
| Rate for Payer: Healthscope Whirlpool |
$132.09
|
| 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: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
NDC 54355344
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$108.47
|
| Rate for Payer: BCN Commercial |
$108.47
|
| 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 |
$128.13
|
| Rate for Payer: Healthscope Whirlpool |
$132.09
|
| 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: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.24
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$132.09
|
|
|
Service Code
|
NDC 406412303
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$118.88
|
| Rate for Payer: Aetna Medicare |
$48.87
|
| Rate for Payer: ASR ASR |
$128.13
|
| Rate for Payer: BCBS Complete |
$52.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: BCN Commercial |
$108.91
|
| 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 |
$128.13
|
| Rate for Payer: Healthscope Whirlpool |
$132.09
|
| Rate for Payer: Mclaren Commercial |
$118.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$108.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.07
|
| Rate for Payer: Priority Health Cigna 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 TABLET
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
NDC 904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: ASR ASR |
$325.92
|
| Rate for Payer: BCBS Trust/PPO |
$275.92
|
| Rate for Payer: BCN Commercial |
$275.92
|
| 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 |
$325.92
|
| Rate for Payer: Healthscope Whirlpool |
$336.00
|
| 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: Opus (Opus Packaging Group) HMA |
$252.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.68
|
|
|
METHADONE 10 MG TABLET
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
NDC 904653061
|
| Hospital Charge Code |
4953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Aetna Medicare |
$124.32
|
| Rate for Payer: ASR ASR |
$325.92
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS Trust/PPO |
$277.03
|
| Rate for Payer: BCN Commercial |
$277.03
|
| 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 |
$325.92
|
| Rate for Payer: Healthscope Whirlpool |
$336.00
|
| Rate for Payer: Mclaren Commercial |
$302.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.60
|
| Rate for Payer: Nomi Health Commercial |
$275.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.00
|
| Rate for Payer: Priority Health Cigna 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 5 MG TABLET
|
Facility
|
IP
|
$500.50
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: ASR ASR |
$485.49
|
| Rate for Payer: BCBS Trust/PPO |
$411.01
|
| Rate for Payer: BCN Commercial |
$411.01
|
| 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 |
$485.49
|
| Rate for Payer: Healthscope Whirlpool |
$500.50
|
| 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: Opus (Opus Packaging Group) HMA |
$375.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.44
|
|
|
METHADONE 5 MG TABLET
|
Facility
|
OP
|
$500.50
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.19 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Aetna Medicare |
$185.19
|
| Rate for Payer: ASR ASR |
$485.49
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS Trust/PPO |
$412.66
|
| Rate for Payer: BCN Commercial |
$412.66
|
| 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 |
$485.49
|
| Rate for Payer: Healthscope Whirlpool |
$500.50
|
| Rate for Payer: Mclaren Commercial |
$450.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.43
|
| Rate for Payer: Nomi Health Commercial |
$410.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.38
|
| Rate for Payer: Priority Health Cigna 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
|
IP
|
$328.80
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$328.80 |
| Rate for Payer: Aetna Commercial |
$295.92
|
| Rate for Payer: ASR ASR |
$318.94
|
| Rate for Payer: BCBS Trust/PPO |
$270.01
|
| Rate for Payer: BCN Commercial |
$270.01
|
| Rate for Payer: Cash Price |
$263.04
|
| Rate for Payer: Cofinity Commercial |
$309.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.04
|
| Rate for Payer: Healthscope Commercial |
$318.94
|
| Rate for Payer: Healthscope Whirlpool |
$328.80
|
| Rate for Payer: Mclaren Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.48
|
| Rate for Payer: Nomi Health Commercial |
$269.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.34
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET
|
Facility
|
OP
|
$328.80
|
|
|
Service Code
|
NDC 65862078201
|
| Hospital Charge Code |
10549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.66 |
| Max. Negotiated Rate |
$328.80 |
| Rate for Payer: Aetna Commercial |
$295.92
|
| Rate for Payer: Aetna Medicare |
$121.66
|
| Rate for Payer: ASR ASR |
$318.94
|
| Rate for Payer: BCBS Complete |
$131.52
|
| Rate for Payer: BCBS Trust/PPO |
$271.10
|
| Rate for Payer: BCN Commercial |
$271.10
|
| Rate for Payer: Cash Price |
$263.04
|
| Rate for Payer: Cofinity Commercial |
$309.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.04
|
| Rate for Payer: Healthscope Commercial |
$318.94
|
| Rate for Payer: Healthscope Whirlpool |
$328.80
|
| Rate for Payer: Mclaren Commercial |
$295.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.48
|
| Rate for Payer: Nomi Health Commercial |
$269.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$288.09
|
| Rate for Payer: Priority Health Narrow Network |
$230.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.34
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$288.48
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.36 |
| Max. Negotiated Rate |
$288.48 |
| Rate for Payer: Aetna Commercial |
$259.63
|
| Rate for Payer: ASR ASR |
$279.83
|
| Rate for Payer: BCBS Trust/PPO |
$236.90
|
| Rate for Payer: BCN Commercial |
$236.90
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Commercial |
$271.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Healthscope Commercial |
$279.83
|
| Rate for Payer: Healthscope Whirlpool |
$288.48
|
| Rate for Payer: Mclaren Commercial |
$259.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Nomi Health Commercial |
$236.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.86
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.88
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
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 |
$288.48 |
| Rate for Payer: Aetna Commercial |
$259.63
|
| Rate for Payer: Aetna Medicare |
$106.74
|
| Rate for Payer: ASR ASR |
$279.83
|
| Rate for Payer: BCBS Complete |
$115.39
|
| Rate for Payer: BCBS Trust/PPO |
$237.85
|
| Rate for Payer: BCN Commercial |
$237.85
|
| Rate for Payer: Cash Price |
$230.78
|
| Rate for Payer: Cofinity Commercial |
$271.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.78
|
| Rate for Payer: Healthscope Commercial |
$279.83
|
| Rate for Payer: Healthscope Whirlpool |
$288.48
|
| Rate for Payer: Mclaren Commercial |
$259.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.21
|
| Rate for Payer: Nomi Health Commercial |
$236.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$252.77
|
| Rate for Payer: Priority Health Narrow Network |
$202.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.86
|
|
|
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 |
$211.50 |
| Rate for Payer: Aetna Commercial |
$190.35
|
| Rate for Payer: Aetna Medicare |
$78.25
|
| Rate for Payer: ASR ASR |
$205.16
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$174.38
|
| Rate for Payer: BCN Commercial |
$174.38
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$198.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Healthscope Whirlpool |
$211.50
|
| Rate for Payer: Mclaren Commercial |
$190.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.32
|
| Rate for Payer: Priority Health Narrow Network |
$148.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.12
|
|
|
METHIMAZOLE 5 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 23155007001
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$190.35
|
| Rate for Payer: ASR ASR |
$205.16
|
| Rate for Payer: BCBS Trust/PPO |
$173.68
|
| Rate for Payer: BCN Commercial |
$173.68
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$198.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Healthscope Whirlpool |
$211.50
|
| Rate for Payer: Mclaren Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.12
|
|
|
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 |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.88
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.53
|
| Rate for Payer: Priority Health Narrow Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
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 |
$18.59 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.36
|
| Rate for Payer: BCN Commercial |
$20.36
|
| 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 |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| 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: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
|
|
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 |
$3.77 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$20.44
|
| Rate for Payer: BCN Commercial |
$20.44
|
| 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 |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.71
|
| Rate for Payer: Priority Health Narrow Network |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 70010075405
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.47 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$348.98
|
| Rate for Payer: Aetna Medicare |
$143.47
|
| Rate for Payer: ASR ASR |
$376.12
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: BCBS Trust/PPO |
$319.70
|
| Rate for Payer: BCN Commercial |
$319.70
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$376.12
|
| Rate for Payer: Healthscope Whirlpool |
$387.75
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$339.75
|
| Rate for Payer: Priority Health Narrow Network |
$271.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.22
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: ASR ASR |
$239.59
|
| Rate for Payer: BCBS Trust/PPO |
$202.84
|
| Rate for Payer: BCN Commercial |
$202.84
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$232.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$239.59
|
| Rate for Payer: Healthscope Whirlpool |
$247.00
|
| Rate for Payer: Mclaren Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.36
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 63739099110
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.19 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: ASR ASR |
$198.12
|
| Rate for Payer: BCBS Trust/PPO |
$167.73
|
| Rate for Payer: BCN Commercial |
$167.73
|
| 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 |
$198.12
|
| Rate for Payer: Healthscope Whirlpool |
$204.25
|
| 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: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.74
|
|
|
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 |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| Rate for Payer: BCN Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.40
|
| Rate for Payer: Healthscope Whirlpool |
$2.47
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.16
|
| Rate for Payer: Priority Health Narrow Network |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
|
|
METHOCARBAMOL 500 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 904705761
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna Commercial |
$201.78
|
| Rate for Payer: Aetna Medicare |
$82.95
|
| Rate for Payer: ASR ASR |
$217.47
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.85
|
| Rate for Payer: BCN Commercial |
$184.85
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$210.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$217.47
|
| Rate for Payer: Healthscope Whirlpool |
$224.20
|
| Rate for Payer: Mclaren Commercial |
$201.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Nomi Health Commercial |
$183.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$196.44
|
| Rate for Payer: Priority Health Narrow Network |
$157.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
|
