|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$147.60
|
|
|
Service Code
|
NDC 60687048021
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.73 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: Aetna Commercial |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$121.90
|
| Rate for Payer: BCN Commercial |
$121.90
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.08
|
| Rate for Payer: Healthscope Commercial |
$132.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$121.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.70
|
| Rate for Payer: PHP Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.89
|
| Rate for Payer: UHC Core |
$123.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.70
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.01
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.82
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.69
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.82
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.30
|
| Rate for Payer: BCN Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.82
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
NDC 59651078030
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$9.01
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$40.00
|
| Rate for Payer: BCN Commercial |
$40.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: Mclaren Medicaid |
$8.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: Meridian Medicaid |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Nomi Health Commercial |
$39.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.33
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$40.62
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicaid |
$8.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: UHCCP Medicaid |
$8.58
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$192.53
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: BCBS Trust/PPO |
$159.01
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$157.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: PHP Commercial |
$163.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.43
|
| Rate for Payer: UHC Core |
$160.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.40
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$426.98
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna Medicare |
$111.02
|
| Rate for Payer: Aetna Medicare |
$111.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.44
|
| Rate for Payer: BCBS Complete |
$79.03
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: BCBS MAPPO |
$106.75
|
| Rate for Payer: BCBS MAPPO |
$106.75
|
| Rate for Payer: BCBS Trust/PPO |
$351.02
|
| Rate for Payer: BCBS Trust/PPO |
$351.04
|
| Rate for Payer: BCN Commercial |
$351.04
|
| Rate for Payer: BCN Commercial |
$351.02
|
| Rate for Payer: BCN Medicare Advantage |
$106.75
|
| Rate for Payer: BCN Medicare Advantage |
$106.75
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.75
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Mclaren Medicaid |
$75.28
|
| Rate for Payer: Mclaren Medicaid |
$75.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.08
|
| Rate for Payer: Meridian Medicaid |
$79.03
|
| Rate for Payer: Meridian Medicaid |
$79.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: Nomi Health Commercial |
$350.14
|
| Rate for Payer: Nomi Health Commercial |
$350.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PACE Senior Care Partners |
$101.41
|
| Rate for Payer: PACE Senior Care Partners |
$101.41
|
| Rate for Payer: PACE SWMI |
$106.75
|
| Rate for Payer: PACE SWMI |
$106.75
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: PHP Medicare Advantage |
$106.75
|
| Rate for Payer: PHP Medicare Advantage |
$106.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.47
|
| Rate for Payer: Priority Health Medicare |
$107.82
|
| Rate for Payer: Priority Health Medicare |
$107.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.19
|
| Rate for Payer: Railroad Medicare Medicare |
$106.75
|
| Rate for Payer: Railroad Medicare Medicare |
$106.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.76
|
| Rate for Payer: UHC Core |
$356.55
|
| Rate for Payer: UHC Core |
$356.53
|
| Rate for Payer: UHC Exchange |
$106.75
|
| Rate for Payer: UHC Exchange |
$106.75
|
| Rate for Payer: UHC Medicaid |
$75.28
|
| Rate for Payer: UHC Medicaid |
$75.28
|
| Rate for Payer: UHC Medicare Advantage |
$106.75
|
| Rate for Payer: UHC Medicare Advantage |
$106.75
|
| Rate for Payer: UHCCP Medicaid |
$75.28
|
| Rate for Payer: UHCCP Medicaid |
$75.28
|
| Rate for Payer: VA VA |
$106.75
|
| Rate for Payer: VA VA |
$106.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$426.98
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$297.18 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: BCBS Trust/PPO |
$352.64
|
| Rate for Payer: BCBS Trust/PPO |
$352.66
|
| Rate for Payer: BCN Commercial |
$352.64
|
| Rate for Payer: BCN Commercial |
$352.66
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Nomi Health Commercial |
$350.12
|
| Rate for Payer: Nomi Health Commercial |
$350.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.76
|
| Rate for Payer: UHC Core |
$356.53
|
| Rate for Payer: UHC Core |
$356.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
IP
|
$569.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$396.56 |
| Max. Negotiated Rate |
$512.79 |
| Rate for Payer: Aetna Commercial |
$484.30
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: BCBS Trust/PPO |
$470.57
|
| Rate for Payer: BCBS Trust/PPO |
$470.58
|
| Rate for Payer: BCN Commercial |
$470.57
|
| Rate for Payer: BCN Commercial |
$470.58
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Healthscope Commercial |
$512.79
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: Nomi Health Commercial |
$467.21
|
| Rate for Payer: Nomi Health Commercial |
$467.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: PHP Commercial |
$484.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$495.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$495.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.41
|
| Rate for Payer: UHC Core |
$475.76
|
| Rate for Payer: UHC Core |
$475.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
OP
|
$569.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$512.79 |
| Rate for Payer: Aetna Commercial |
$484.30
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: Aetna Medicare |
$148.14
|
| Rate for Payer: Aetna Medicare |
$148.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.06
|
| Rate for Payer: BCBS Complete |
$105.46
|
| Rate for Payer: BCBS Complete |
$105.47
|
| Rate for Payer: BCBS MAPPO |
$142.44
|
| Rate for Payer: BCBS MAPPO |
$142.44
|
| Rate for Payer: BCBS Trust/PPO |
$468.41
|
| Rate for Payer: BCBS Trust/PPO |
$468.42
|
| Rate for Payer: BCN Commercial |
$468.42
|
| Rate for Payer: BCN Commercial |
$468.41
|
| Rate for Payer: BCN Medicare Advantage |
$142.44
|
| Rate for Payer: BCN Medicare Advantage |
$142.44
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.44
|
| Rate for Payer: Healthscope Commercial |
$512.79
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Mclaren Medicaid |
$100.45
|
| Rate for Payer: Mclaren Medicaid |
$100.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.56
|
| Rate for Payer: Meridian Medicaid |
$105.46
|
| Rate for Payer: Meridian Medicaid |
$105.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.30
|
| Rate for Payer: Nomi Health Commercial |
$467.22
|
| Rate for Payer: Nomi Health Commercial |
$467.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: PACE Senior Care Partners |
$135.32
|
| Rate for Payer: PACE Senior Care Partners |
$135.32
|
| Rate for Payer: PACE SWMI |
$142.44
|
| Rate for Payer: PACE SWMI |
$142.44
|
| Rate for Payer: PHP Commercial |
$484.30
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: PHP Medicare Advantage |
$142.44
|
| Rate for Payer: PHP Medicare Advantage |
$142.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$495.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$495.70
|
| Rate for Payer: Priority Health Medicare |
$143.87
|
| Rate for Payer: Priority Health Medicare |
$143.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.57
|
| Rate for Payer: Railroad Medicare Medicare |
$142.44
|
| Rate for Payer: Railroad Medicare Medicare |
$142.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.41
|
| Rate for Payer: UHC Core |
$475.77
|
| Rate for Payer: UHC Core |
$475.76
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicaid |
$100.45
|
| Rate for Payer: UHC Medicaid |
$100.45
|
| Rate for Payer: UHC Medicare Advantage |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$142.44
|
| Rate for Payer: UHCCP Medicaid |
$100.45
|
| Rate for Payer: UHCCP Medicaid |
$100.45
|
| Rate for Payer: VA VA |
$142.44
|
| Rate for Payer: VA VA |
$142.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
NDC 80681010000
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.73
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.52
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.79
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$2.03
|
|
|
Service Code
|
NDC 80681010000
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: BCBS Complete |
$0.38
|
| Rate for Payer: BCBS MAPPO |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.51
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.51
|
| Rate for Payer: Healthscope Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Mclaren Medicaid |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Meridian Medicaid |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.73
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.52
|
| Rate for Payer: PACE Senior Care Partners |
$0.48
|
| Rate for Payer: PACE SWMI |
$0.51
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.77
|
| Rate for Payer: Priority Health Medicare |
$0.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.41
|
| Rate for Payer: Railroad Medicare Medicare |
$0.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.79
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Medicaid |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.51
|
| Rate for Payer: UHCCP Medicaid |
$0.36
|
| Rate for Payer: VA VA |
$0.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$83.46
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna Medicare |
$26.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.58
|
| Rate for Payer: BCBS Complete |
$18.70
|
| Rate for Payer: BCBS MAPPO |
$25.26
|
| Rate for Payer: BCBS Trust/PPO |
$83.07
|
| Rate for Payer: BCN Commercial |
$83.07
|
| Rate for Payer: BCN Medicare Advantage |
$25.26
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Mclaren Medicaid |
$17.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: Meridian Medicaid |
$18.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PACE Senior Care Partners |
$24.00
|
| Rate for Payer: PACE SWMI |
$25.26
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.33
|
| Rate for Payer: Railroad Medicare Medicare |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: UHC Exchange |
$25.26
|
| Rate for Payer: UHC Medicaid |
$17.82
|
| Rate for Payer: UHC Medicare Advantage |
$25.26
|
| Rate for Payer: UHCCP Medicaid |
$17.82
|
| Rate for Payer: VA VA |
$25.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: Aetna Commercial |
$35.48
|
| Rate for Payer: Aetna Medicare |
$10.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.04
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$10.44
|
| Rate for Payer: BCBS Trust/PPO |
$34.31
|
| Rate for Payer: BCN Commercial |
$34.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.44
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$35.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$37.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.30
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.96
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.30
|
| Rate for Payer: PACE Senior Care Partners |
$9.91
|
| Rate for Payer: PACE SWMI |
$10.44
|
| Rate for Payer: PHP Commercial |
$35.48
|
| Rate for Payer: PHP Medicare Advantage |
$10.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.73
|
| Rate for Payer: UHC Core |
$34.85
|
| Rate for Payer: UHC Exchange |
$10.44
|
| Rate for Payer: UHC Medicaid |
$7.36
|
| Rate for Payer: UHC Medicare Advantage |
$10.44
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$10.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.30
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: Aetna Commercial |
$35.48
|
| Rate for Payer: BCBS Trust/PPO |
$34.47
|
| Rate for Payer: BCN Commercial |
$34.47
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$35.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$37.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.30
|
| Rate for Payer: PHP Commercial |
$35.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.73
|
| Rate for Payer: UHC Core |
$34.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.30
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$26.91
|
|
|
Service Code
|
NDC 57237032621
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: BCBS Complete |
$4.98
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$22.12
|
| Rate for Payer: BCN Commercial |
$22.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Mclaren Medicaid |
$4.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.06
|
| Rate for Payer: Meridian Medicaid |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Nomi Health Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PACE Senior Care Partners |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.41
|
| Rate for Payer: Priority Health Medicare |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.68
|
| Rate for Payer: UHC Core |
$22.47
|
| Rate for Payer: UHC Exchange |
$6.73
|
| Rate for Payer: UHC Medicaid |
$4.74
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$4.74
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$26.91
|
|
|
Service Code
|
NDC 57237032621
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: BCBS Trust/PPO |
$22.22
|
| Rate for Payer: BCN Commercial |
$22.22
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Nomi Health Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.68
|
| Rate for Payer: UHC Core |
$22.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$31.86
|
| Rate for Payer: BCN Commercial |
$31.86
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Mclaren Medicaid |
$6.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: Meridian Medicaid |
$7.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.95
|
| Rate for Payer: Nomi Health Commercial |
$31.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.07
|
| Rate for Payer: PACE Senior Care Partners |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$9.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: UHC Exchange |
$9.69
|
| Rate for Payer: UHC Medicaid |
$6.83
|
| Rate for Payer: UHC Medicare Advantage |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$6.83
|
| Rate for Payer: VA VA |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.01
|
| Rate for Payer: BCN Commercial |
$32.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.95
|
| Rate for Payer: Nomi Health Commercial |
$31.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.07
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
GLYCERIN-DIMETHICONE-WHITE PETROLATUM TOPICAL CREAM
|
Facility
|
OP
|
$23.72
|
|
|
Service Code
|
NDC 00299391753
|
| Hospital Charge Code |
100949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna Commercial |
$20.16
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.41
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$5.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$19.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.93
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$20.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.79
|
| Rate for Payer: Mclaren Medicaid |
$4.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.23
|
| Rate for Payer: Meridian Medicaid |
$4.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.16
|
| Rate for Payer: Nomi Health Commercial |
$19.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.79
|
| Rate for Payer: PACE Senior Care Partners |
$5.63
|
| Rate for Payer: PACE SWMI |
$5.93
|
| Rate for Payer: PHP Commercial |
$20.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.64
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.51
|
| Rate for Payer: Railroad Medicare Medicare |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.87
|
| Rate for Payer: UHC Core |
$19.81
|
| Rate for Payer: UHC Exchange |
$5.93
|
| Rate for Payer: UHC Medicaid |
$4.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.93
|
| Rate for Payer: UHCCP Medicaid |
$4.18
|
| Rate for Payer: VA VA |
$5.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.79
|
|
|
GLYCERIN-DIMETHICONE-WHITE PETROLATUM TOPICAL CREAM
|
Facility
|
IP
|
$23.72
|
|
|
Service Code
|
NDC 00299391753
|
| Hospital Charge Code |
100949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna Commercial |
$20.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$20.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$21.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.16
|
| Rate for Payer: Nomi Health Commercial |
$19.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.79
|
| Rate for Payer: PHP Commercial |
$20.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.87
|
| Rate for Payer: UHC Core |
$19.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.79
|
|
|
GLYCINE 1.5 % UROLOGIC SOLUTION FOR IRRIGATION
|
Facility
|
OP
|
$194.88
|
|
|
Service Code
|
NDC 00338028947
|
| Hospital Charge Code |
3493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$175.39 |
| Rate for Payer: Aetna Commercial |
$165.65
|
| Rate for Payer: Aetna Medicare |
$50.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.90
|
| Rate for Payer: BCBS Complete |
$36.07
|
| Rate for Payer: BCBS MAPPO |
$48.72
|
| Rate for Payer: BCBS Trust/PPO |
$160.21
|
| Rate for Payer: BCN Commercial |
$160.21
|
| Rate for Payer: BCN Medicare Advantage |
$48.72
|
| Rate for Payer: Cash Price |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$167.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.72
|
| Rate for Payer: Healthscope Commercial |
$175.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.16
|
| Rate for Payer: Mclaren Medicaid |
$34.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.16
|
| Rate for Payer: Meridian Medicaid |
$36.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: Nomi Health Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.16
|
| Rate for Payer: PACE Senior Care Partners |
$46.28
|
| Rate for Payer: PACE SWMI |
$48.72
|
| Rate for Payer: PHP Commercial |
$165.65
|
| Rate for Payer: PHP Medicare Advantage |
$48.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.55
|
| Rate for Payer: Priority Health Medicare |
$49.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.64
|
| Rate for Payer: Railroad Medicare Medicare |
$48.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.49
|
| Rate for Payer: UHC Core |
$162.72
|
| Rate for Payer: UHC Exchange |
$48.72
|
| Rate for Payer: UHC Medicaid |
$34.36
|
| Rate for Payer: UHC Medicare Advantage |
$48.72
|
| Rate for Payer: UHCCP Medicaid |
$34.36
|
| Rate for Payer: VA VA |
$48.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.16
|
|
|
GLYCINE 1.5 % UROLOGIC SOLUTION FOR IRRIGATION
|
Facility
|
IP
|
$194.88
|
|
|
Service Code
|
NDC 00338028947
|
| Hospital Charge Code |
3493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.64 |
| Max. Negotiated Rate |
$175.39 |
| Rate for Payer: Aetna Commercial |
$165.65
|
| Rate for Payer: BCBS Trust/PPO |
$160.95
|
| Rate for Payer: BCN Commercial |
$160.95
|
| Rate for Payer: Cash Price |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$167.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.90
|
| Rate for Payer: Healthscope Commercial |
$175.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: Nomi Health Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.16
|
| Rate for Payer: PHP Commercial |
$165.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.49
|
| Rate for Payer: UHC Core |
$162.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.16
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.16
|
| Rate for Payer: BCBS Complete |
$5.91
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS MAPPO |
$7.98
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$15.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: BCN Commercial |
$26.25
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.13
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$27.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Mclaren Medicaid |
$3.35
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Mclaren Medicaid |
$5.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: Meridian Medicaid |
$3.06
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: Meridian Medicaid |
$5.91
|
| Rate for Payer: Meridian Medicaid |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.14
|
| Rate for Payer: Nomi Health Commercial |
$15.60
|
| Rate for Payer: Nomi Health Commercial |
$13.54
|
| Rate for Payer: Nomi Health Commercial |
$14.02
|
| Rate for Payer: Nomi Health Commercial |
$26.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.52
|
| Rate for Payer: PACE Senior Care Partners |
$7.58
|
| Rate for Payer: PACE Senior Care Partners |
$3.92
|
| Rate for Payer: PACE Senior Care Partners |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.13
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.13
|
| Rate for Payer: PHP Medicare Advantage |
$7.98
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health Medicare |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$4.17
|
| Rate for Payer: Priority Health Medicare |
$4.80
|
| Rate for Payer: Priority Health Medicare |
$8.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.49
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.10
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: UHC Core |
$15.88
|
| Rate for Payer: UHC Core |
$14.28
|
| Rate for Payer: UHC Core |
$26.66
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UHC Medicaid |
$2.91
|
| Rate for Payer: UHC Medicaid |
$3.01
|
| Rate for Payer: UHC Medicaid |
$3.35
|
| Rate for Payer: UHC Medicaid |
$5.63
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.13
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$3.35
|
| Rate for Payer: UHCCP Medicaid |
$5.63
|
| Rate for Payer: UHCCP Medicaid |
$3.01
|
| Rate for Payer: UHCCP Medicaid |
$2.91
|
| Rate for Payer: VA VA |
$4.13
|
| Rate for Payer: VA VA |
$7.98
|
| Rate for Payer: VA VA |
$4.75
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.95
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$13.64
|
| Rate for Payer: BCN Commercial |
$15.71
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Commercial |
$26.37
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.14
|
| Rate for Payer: Nomi Health Commercial |
$13.54
|
| Rate for Payer: Nomi Health Commercial |
$14.02
|
| Rate for Payer: Nomi Health Commercial |
$26.18
|
| Rate for Payer: Nomi Health Commercial |
$15.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.95
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.74
|
| Rate for Payer: UHC Core |
$15.88
|
| Rate for Payer: UHC Core |
$26.66
|
| Rate for Payer: UHC Core |
$14.28
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.27
|
|
