|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
IP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$308.10 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: BCBS Trust/PPO |
$365.60
|
| Rate for Payer: BCN Commercial |
$365.60
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Healthscope Commercial |
$398.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: Nomi Health Commercial |
$362.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.00
|
| Rate for Payer: PHP Commercial |
$376.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.55
|
| Rate for Payer: UHC Core |
$369.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.00
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
OP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.04 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: Aetna Medicare |
$115.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.33
|
| Rate for Payer: BCBS Complete |
$81.94
|
| Rate for Payer: BCBS MAPPO |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$363.92
|
| Rate for Payer: BCN Commercial |
$363.92
|
| Rate for Payer: BCN Medicare Advantage |
$110.67
|
| Rate for Payer: Cash Price |
$354.14
|
| Rate for Payer: Cofinity Commercial |
$380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.67
|
| Rate for Payer: Healthscope Commercial |
$398.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.00
|
| Rate for Payer: Mclaren Medicaid |
$78.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.20
|
| Rate for Payer: Meridian Medicaid |
$81.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: Nomi Health Commercial |
$362.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.00
|
| Rate for Payer: PACE Senior Care Partners |
$105.13
|
| Rate for Payer: PACE SWMI |
$110.67
|
| Rate for Payer: PHP Commercial |
$376.27
|
| Rate for Payer: PHP Medicare Advantage |
$110.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.12
|
| Rate for Payer: Priority Health Medicare |
$111.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.10
|
| Rate for Payer: Railroad Medicare Medicare |
$110.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.55
|
| Rate for Payer: UHC Core |
$369.63
|
| Rate for Payer: UHC Exchange |
$110.67
|
| Rate for Payer: UHC Medicaid |
$78.04
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
| Rate for Payer: UHCCP Medicaid |
$78.04
|
| Rate for Payer: VA VA |
$110.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.00
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$67.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.52
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS MAPPO |
$65.21
|
| Rate for Payer: BCBS Trust/PPO |
$214.44
|
| Rate for Payer: BCN Commercial |
$214.44
|
| Rate for Payer: BCN Medicare Advantage |
$65.21
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.21
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Mclaren Medicaid |
$45.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.47
|
| Rate for Payer: Meridian Medicaid |
$48.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PACE Senior Care Partners |
$61.95
|
| Rate for Payer: PACE SWMI |
$65.21
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$65.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: Railroad Medicare Medicare |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: UHC Exchange |
$65.21
|
| Rate for Payer: UHC Medicaid |
$45.99
|
| Rate for Payer: UHC Medicare Advantage |
$65.21
|
| Rate for Payer: UHCCP Medicaid |
$45.99
|
| Rate for Payer: VA VA |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$215.44
|
| Rate for Payer: BCN Commercial |
$215.44
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
NDC 00121174410
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.19
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS MAPPO |
$0.95
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$3.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.95
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.95
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.85
|
| Rate for Payer: Mclaren Medicaid |
$0.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.00
|
| Rate for Payer: Meridian Medicaid |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.23
|
| Rate for Payer: Nomi Health Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.90
|
| Rate for Payer: PACE SWMI |
$0.95
|
| Rate for Payer: PHP Commercial |
$3.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.31
|
| Rate for Payer: Priority Health Medicare |
$0.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.34
|
| Rate for Payer: UHC Core |
$3.17
|
| Rate for Payer: UHC Exchange |
$0.95
|
| Rate for Payer: UHC Medicaid |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.95
|
| Rate for Payer: UHCCP Medicaid |
$0.67
|
| Rate for Payer: VA VA |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS MAPPO |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.85
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.78
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Mclaren Medicaid |
$1.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.87
|
| Rate for Payer: Meridian Medicaid |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.69
|
| Rate for Payer: PACE SWMI |
$1.78
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.19
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$5.94
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Medicaid |
$1.25
|
| Rate for Payer: UHC Medicare Advantage |
$1.78
|
| Rate for Payer: UHCCP Medicaid |
$1.25
|
| Rate for Payer: VA VA |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.11
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.83
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna Commercial |
$6.66
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.44
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$6.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$7.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.87
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: Meridian Medicaid |
$1.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.66
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: PACE Senior Care Partners |
$1.86
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PHP Commercial |
$6.66
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.81
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.89
|
| Rate for Payer: UHC Core |
$6.54
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.96
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: VA VA |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.87
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
NDC 00121174410
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.04
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.23
|
| Rate for Payer: Nomi Health Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.85
|
| Rate for Payer: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.34
|
| Rate for Payer: UHC Core |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.83
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna Commercial |
$6.66
|
| Rate for Payer: BCBS Trust/PPO |
$6.47
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$6.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Healthscope Commercial |
$7.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.66
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: PHP Commercial |
$6.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.89
|
| Rate for Payer: UHC Core |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.87
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.11
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS MAPPO |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.85
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.78
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Mclaren Medicaid |
$1.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.87
|
| Rate for Payer: Meridian Medicaid |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.69
|
| Rate for Payer: PACE SWMI |
$1.78
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.19
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$5.94
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Medicaid |
$1.25
|
| Rate for Payer: UHC Medicare Advantage |
$1.78
|
| Rate for Payer: UHCCP Medicaid |
$1.25
|
| Rate for Payer: VA VA |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,268.25
|
|
|
Service Code
|
NDC 63824000850
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$882.70 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,047.45
|
| Rate for Payer: BCN Commercial |
$1,047.45
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Commercial |
$1,090.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.60
|
| Rate for Payer: Healthscope Commercial |
$1,141.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$951.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.01
|
| Rate for Payer: Nomi Health Commercial |
$1,039.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.19
|
| Rate for Payer: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,103.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,116.06
|
| Rate for Payer: UHC Core |
$1,058.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$951.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$580.80
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$522.72 |
| Rate for Payer: Aetna Commercial |
$493.68
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.50
|
| Rate for Payer: BCBS Complete |
$107.51
|
| Rate for Payer: BCBS MAPPO |
$145.20
|
| Rate for Payer: BCBS Trust/PPO |
$477.48
|
| Rate for Payer: BCN Commercial |
$477.48
|
| Rate for Payer: BCN Medicare Advantage |
$145.20
|
| Rate for Payer: Cash Price |
$464.64
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.20
|
| Rate for Payer: Healthscope Commercial |
$522.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.60
|
| Rate for Payer: Mclaren Medicaid |
$102.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.46
|
| Rate for Payer: Meridian Medicaid |
$107.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.68
|
| Rate for Payer: Nomi Health Commercial |
$476.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.60
|
| Rate for Payer: PACE Senior Care Partners |
$137.94
|
| Rate for Payer: PACE SWMI |
$145.20
|
| Rate for Payer: PHP Commercial |
$493.68
|
| Rate for Payer: PHP Medicare Advantage |
$145.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$505.30
|
| Rate for Payer: Priority Health Medicare |
$146.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.24
|
| Rate for Payer: Railroad Medicare Medicare |
$145.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.10
|
| Rate for Payer: UHC Core |
$484.97
|
| Rate for Payer: UHC Exchange |
$145.20
|
| Rate for Payer: UHC Medicaid |
$102.40
|
| Rate for Payer: UHC Medicare Advantage |
$145.20
|
| Rate for Payer: UHCCP Medicaid |
$102.40
|
| Rate for Payer: VA VA |
$145.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.60
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: Meridian Medicaid |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$1,268.25
|
|
|
Service Code
|
NDC 63824000850
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.59 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: Aetna Medicare |
$329.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$396.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$396.33
|
| Rate for Payer: BCBS Complete |
$234.75
|
| Rate for Payer: BCBS MAPPO |
$317.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.63
|
| Rate for Payer: BCN Commercial |
$1,042.63
|
| Rate for Payer: BCN Medicare Advantage |
$317.06
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Commercial |
$1,090.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.06
|
| Rate for Payer: Healthscope Commercial |
$1,141.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$951.19
|
| Rate for Payer: Mclaren Medicaid |
$223.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.92
|
| Rate for Payer: Meridian Medicaid |
$234.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$348.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.01
|
| Rate for Payer: Nomi Health Commercial |
$1,039.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.19
|
| Rate for Payer: PACE Senior Care Partners |
$301.21
|
| Rate for Payer: PACE SWMI |
$317.06
|
| Rate for Payer: PHP Commercial |
$1,078.01
|
| Rate for Payer: PHP Medicare Advantage |
$317.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,103.38
|
| Rate for Payer: Priority Health Medicare |
$320.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.70
|
| Rate for Payer: Railroad Medicare Medicare |
$317.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,116.06
|
| Rate for Payer: UHC Core |
$1,058.99
|
| Rate for Payer: UHC Exchange |
$317.06
|
| Rate for Payer: UHC Medicaid |
$223.59
|
| Rate for Payer: UHC Medicare Advantage |
$317.06
|
| Rate for Payer: UHCCP Medicaid |
$223.59
|
| Rate for Payer: VA VA |
$317.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$951.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$580.80
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.24 |
| Max. Negotiated Rate |
$522.72 |
| Rate for Payer: Aetna Commercial |
$493.68
|
| Rate for Payer: BCBS Trust/PPO |
$479.68
|
| Rate for Payer: BCN Commercial |
$479.68
|
| Rate for Payer: Cash Price |
$464.64
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.64
|
| Rate for Payer: Healthscope Commercial |
$522.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.68
|
| Rate for Payer: Nomi Health Commercial |
$476.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.60
|
| Rate for Payer: PHP Commercial |
$493.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$505.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.10
|
| Rate for Payer: UHC Core |
$484.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.60
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 24979053301
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.87 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: BCBS Trust/PPO |
$306.00
|
| Rate for Payer: BCN Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
NDC 24979053301
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$96.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.78
|
| Rate for Payer: BCBS Complete |
$68.58
|
| Rate for Payer: BCBS MAPPO |
$92.62
|
| Rate for Payer: BCBS Trust/PPO |
$304.59
|
| Rate for Payer: BCN Commercial |
$304.59
|
| Rate for Payer: BCN Medicare Advantage |
$92.62
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.62
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Mclaren Medicaid |
$65.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.26
|
| Rate for Payer: Meridian Medicaid |
$68.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PACE Senior Care Partners |
$87.99
|
| Rate for Payer: PACE SWMI |
$92.62
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Medicare Advantage |
$92.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Medicare |
$93.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.87
|
| Rate for Payer: Railroad Medicare Medicare |
$92.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Exchange |
$92.62
|
| Rate for Payer: UHC Medicaid |
$65.32
|
| Rate for Payer: UHC Medicare Advantage |
$92.62
|
| Rate for Payer: UHCCP Medicaid |
$65.32
|
| Rate for Payer: VA VA |
$92.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$20,670.24
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$19,685.95 |
| Max. Negotiated Rate |
$20,670.24 |
| Rate for Payer: BCBS Complete |
$20,670.24
|
| Rate for Payer: Mclaren Medicaid |
$19,685.95
|
| Rate for Payer: Meridian Medicaid |
$20,670.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,685.95
|
| Rate for Payer: UHC Medicaid |
$19,685.95
|
| Rate for Payer: UHCCP Medicaid |
$19,685.95
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$8,729.47
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$8,313.78 |
| Max. Negotiated Rate |
$8,729.47 |
| Rate for Payer: BCBS Complete |
$8,729.47
|
| Rate for Payer: Mclaren Medicaid |
$8,313.78
|
| Rate for Payer: Meridian Medicaid |
$8,729.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,313.78
|
| Rate for Payer: UHC Medicaid |
$8,313.78
|
| Rate for Payer: UHCCP Medicaid |
$8,313.78
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$6,342.68
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$6,040.65 |
| Max. Negotiated Rate |
$6,342.68 |
| Rate for Payer: BCBS Complete |
$6,342.68
|
| Rate for Payer: Mclaren Medicaid |
$6,040.65
|
| Rate for Payer: Meridian Medicaid |
$6,342.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,040.65
|
| Rate for Payer: UHC Medicaid |
$6,040.65
|
| Rate for Payer: UHCCP Medicaid |
$6,040.65
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$13,014.54
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$12,394.80 |
| Max. Negotiated Rate |
$13,014.54 |
| Rate for Payer: BCBS Complete |
$13,014.54
|
| Rate for Payer: Mclaren Medicaid |
$12,394.80
|
| Rate for Payer: Meridian Medicaid |
$13,014.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,394.80
|
| Rate for Payer: UHC Medicaid |
$12,394.80
|
| Rate for Payer: UHCCP Medicaid |
$12,394.80
|
|
|
GYNECOLOGIC PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$7,235.03
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$6,890.51 |
| Max. Negotiated Rate |
$7,235.03 |
| Rate for Payer: BCBS Complete |
$7,235.03
|
| Rate for Payer: Mclaren Medicaid |
$6,890.51
|
| Rate for Payer: Meridian Medicaid |
$7,235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,890.51
|
| Rate for Payer: UHC Medicaid |
$6,890.51
|
| Rate for Payer: UHCCP Medicaid |
$6,890.51
|
|
