|
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 |
$101.41 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna Medicare |
$111.01
|
| Rate for Payer: Aetna Medicare |
$111.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.44
|
| 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 |
$113.11
|
| Rate for Payer: BCBS Complete |
$113.11
|
| 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 |
$331.98
|
| Rate for Payer: BCN Commercial |
$331.99
|
| Rate for Payer: BCN Medicare Advantage |
$106.75
|
| Rate for Payer: BCN Medicare Advantage |
$106.75
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.58
|
| 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 |
$384.30
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| 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 |
$107.72
|
| Rate for Payer: Mclaren Medicaid |
$107.72
|
| 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 |
$113.11
|
| Rate for Payer: Meridian Medicaid |
$113.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.76
|
| 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: 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 |
$362.95
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Medicare Advantage |
$106.75
|
| Rate for Payer: PHP Medicare Advantage |
$106.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health HMO/PPO |
$371.49
|
| Rate for Payer: Priority Health HMO/PPO |
$371.47
|
| Rate for Payer: Priority Health Medicare |
$107.81
|
| Rate for Payer: Priority Health Medicare |
$107.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.09
|
| Rate for Payer: Railroad Medicare Medicare |
$106.75
|
| Rate for Payer: Railroad Medicare Medicare |
$106.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.74
|
| Rate for Payer: UHC Core |
$356.55
|
| Rate for Payer: UHC Core |
$356.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.75
|
| Rate for Payer: UHC Exchange |
$106.75
|
| Rate for Payer: UHC Exchange |
$106.75
|
| Rate for Payer: UHC Medicare Advantage |
$106.75
|
| Rate for Payer: UHC Medicare Advantage |
$106.75
|
| Rate for Payer: UHCCP Medicaid |
$107.72
|
| Rate for Payer: UHCCP Medicaid |
$107.72
|
| Rate for Payer: VA VA |
$106.75
|
| Rate for Payer: VA VA |
$106.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
|
|
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 |
$277.54 |
| 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 |
$348.54
|
| Rate for Payer: BCBS Trust/PPO |
$348.56
|
| Rate for Payer: BCN Commercial |
$329.97
|
| Rate for Payer: BCN Commercial |
$329.99
|
| 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: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.54
|
| Rate for Payer: Priority Health HMO/PPO |
$371.49
|
| Rate for Payer: Priority Health HMO/PPO |
$371.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.09
|
| 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 |
$370.35 |
| 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 |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$465.11
|
| Rate for Payer: BCN Commercial |
$440.32
|
| Rate for Payer: BCN Commercial |
$440.33
|
| 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: PHP Commercial |
$484.30
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.35
|
| Rate for Payer: Priority Health HMO/PPO |
$495.71
|
| Rate for Payer: Priority Health HMO/PPO |
$495.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.75
|
| 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 |
$131.91 |
| 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 |
$178.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.06
|
| 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 |
$138.52
|
| Rate for Payer: BCBS Complete |
$138.52
|
| 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 |
$443.00
|
| Rate for Payer: BCN Commercial |
$443.00
|
| 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: 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 |
$512.80
|
| Rate for Payer: Healthscope Commercial |
$512.79
|
| 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 |
$131.91
|
| Rate for Payer: Mclaren Medicaid |
$131.91
|
| 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 |
$138.52
|
| Rate for Payer: Meridian Medicaid |
$138.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.81
|
| 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: 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 |
$484.31
|
| Rate for Payer: PHP Commercial |
$484.30
|
| Rate for Payer: PHP Medicare Advantage |
$142.44
|
| Rate for Payer: PHP Medicare Advantage |
$142.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.36
|
| Rate for Payer: Priority Health HMO/PPO |
$495.71
|
| Rate for Payer: 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 |
$381.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.75
|
| Rate for Payer: Railroad Medicare Medicare |
$142.44
|
| Rate for Payer: Railroad Medicare Medicare |
$142.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.40
|
| Rate for Payer: UHC Core |
$475.77
|
| Rate for Payer: UHC Core |
$475.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.44
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$142.44
|
| Rate for Payer: UHCCP Medicaid |
$131.91
|
| Rate for Payer: UHCCP Medicaid |
$131.91
|
| 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
|
$4.35
|
|
|
Service Code
|
NDC 80681010000
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 80681010000
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.36
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
IP
|
$86.95
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: BCBS Trust/PPO |
$70.98
|
| Rate for Payer: BCN Commercial |
$67.19
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.52
|
| Rate for Payer: Priority Health HMO/PPO |
$75.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.52
|
| Rate for Payer: UHC Core |
$72.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
OP
|
$86.95
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.17
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: BCBS MAPPO |
$21.74
|
| Rate for Payer: BCBS Trust/PPO |
$71.48
|
| Rate for Payer: BCN Commercial |
$67.60
|
| Rate for Payer: BCN Medicare Advantage |
$21.74
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.74
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: PACE Senior Care Partners |
$20.65
|
| Rate for Payer: PACE SWMI |
$21.74
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.52
|
| Rate for Payer: Priority Health HMO/PPO |
$75.65
|
| Rate for Payer: Priority Health Medicare |
$21.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.26
|
| Rate for Payer: Railroad Medicare Medicare |
$21.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.52
|
| Rate for Payer: UHC Core |
$72.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.74
|
| Rate for Payer: UHC Exchange |
$21.74
|
| Rate for Payer: UHC Medicare Advantage |
$21.74
|
| Rate for Payer: VA VA |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| 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 |
$16.70
|
| Rate for Payer: BCBS MAPPO |
$10.44
|
| Rate for Payer: BCBS Trust/PPO |
$34.31
|
| Rate for Payer: BCN Commercial |
$32.45
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.23
|
| 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 Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.97
|
| 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 Dual Complete DSNP |
$10.44
|
| Rate for Payer: UHC Exchange |
$10.44
|
| Rate for Payer: UHC Medicare Advantage |
$10.44
|
| 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 |
$27.13 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: Aetna Commercial |
$35.48
|
| Rate for Payer: BCBS Trust/PPO |
$34.07
|
| Rate for Payer: BCN Commercial |
$32.26
|
| 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: PHP Commercial |
$35.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO |
$36.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.97
|
| 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
|
$38.19
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna Medicare |
$9.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.93
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: BCBS MAPPO |
$9.55
|
| Rate for Payer: BCBS Trust/PPO |
$31.40
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Medicare Advantage |
$9.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: PACE Senior Care Partners |
$9.07
|
| Rate for Payer: PACE SWMI |
$9.55
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: PHP Medicare Advantage |
$9.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health HMO/PPO |
$33.23
|
| Rate for Payer: Priority Health Medicare |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.59
|
| Rate for Payer: Railroad Medicare Medicare |
$9.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.61
|
| Rate for Payer: UHC Core |
$31.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.55
|
| Rate for Payer: UHC Exchange |
$9.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.55
|
| Rate for Payer: VA VA |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: BCN Commercial |
$29.51
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health HMO/PPO |
$33.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.61
|
| Rate for Payer: UHC Core |
$31.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
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 |
$126.67 |
| Max. Negotiated Rate |
$175.39 |
| Rate for Payer: Aetna Commercial |
$165.65
|
| Rate for Payer: BCBS Trust/PPO |
$159.08
|
| Rate for Payer: BCN Commercial |
$150.60
|
| 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: PHP Commercial |
$165.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health HMO/PPO |
$169.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.57
|
| 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
|
|
|
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 |
$46.28 |
| 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 |
$77.95
|
| Rate for Payer: BCBS MAPPO |
$48.72
|
| Rate for Payer: BCBS Trust/PPO |
$160.21
|
| Rate for Payer: BCN Commercial |
$151.52
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: Nomi Health Commercial |
$159.80
|
| 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 Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health HMO/PPO |
$169.55
|
| Rate for Payer: Priority Health Medicare |
$49.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.57
|
| 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 Dual Complete DSNP |
$48.72
|
| Rate for Payer: UHC Exchange |
$48.72
|
| Rate for Payer: UHC Medicare Advantage |
$48.72
|
| Rate for Payer: VA VA |
$48.72
|
| 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 |
$0.33 |
| 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 |
$4.29
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| 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: Allen County Amish Medical Aid Commercial |
$5.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.98
|
| Rate for Payer: BCBS Complete |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.35
|
| 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 |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$15.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: BCN Commercial |
$14.79
|
| Rate for Payer: BCN Commercial |
$12.84
|
| Rate for Payer: BCN Commercial |
$24.83
|
| Rate for Payer: BCN Medicare Advantage |
$4.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.22
|
| 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 |
$4.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| 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 |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.27
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| 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 |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: Meridian Medicaid |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.18
|
| 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 |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.14
|
| 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: Nomi Health Commercial |
$13.54
|
| Rate for Payer: PACE Senior Care Partners |
$4.06
|
| Rate for Payer: PACE Senior Care Partners |
$7.58
|
| Rate for Payer: PACE Senior Care Partners |
$4.52
|
| Rate for Payer: PACE Senior Care Partners |
$3.92
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PACE SWMI |
$4.13
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$16.17
|
| 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: PHP Medicare Advantage |
$4.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health HMO/PPO |
$27.78
|
| Rate for Payer: Priority Health HMO/PPO |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO |
$16.55
|
| Rate for Payer: Priority Health HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health Medicare |
$8.06
|
| Rate for Payer: Priority Health Medicare |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$4.80
|
| Rate for Payer: Priority Health Medicare |
$4.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.06
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.05
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: UHC Core |
$26.66
|
| Rate for Payer: UHC Core |
$15.88
|
| Rate for Payer: UHC Core |
$14.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.13
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: VA VA |
$7.98
|
| Rate for Payer: VA VA |
$4.13
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: VA VA |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
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 |
$12.36 |
| 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 |
$15.53
|
| Rate for Payer: BCBS Trust/PPO |
$26.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.96
|
| Rate for Payer: BCBS Trust/PPO |
$13.48
|
| Rate for Payer: BCN Commercial |
$14.70
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: BCN Commercial |
$24.68
|
| Rate for Payer: BCN Commercial |
$13.21
|
| 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: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$16.17
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health HMO/PPO |
$16.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.78
|
| Rate for Payer: Priority Health HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health HMO/PPO |
$14.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.06
|
| 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
|
|
|
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 |
$105.13 |
| 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 |
$177.07
|
| Rate for Payer: BCBS MAPPO |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$363.92
|
| Rate for Payer: BCN Commercial |
$344.18
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: Nomi Health Commercial |
$362.99
|
| 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 Cigna Priority Health |
$287.74
|
| Rate for Payer: Priority Health HMO/PPO |
$385.12
|
| Rate for Payer: Priority Health Medicare |
$111.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.59
|
| 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 Dual Complete DSNP |
$110.67
|
| Rate for Payer: UHC Exchange |
$110.67
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
| Rate for Payer: VA VA |
$110.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.00
|
|
|
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 |
$287.74 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: BCBS Trust/PPO |
$361.35
|
| Rate for Payer: BCN Commercial |
$342.10
|
| 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: PHP Commercial |
$376.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.74
|
| Rate for Payer: Priority Health HMO/PPO |
$385.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.59
|
| 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 1 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$64.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.11
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: BCBS MAPPO |
$61.69
|
| Rate for Payer: BCBS Trust/PPO |
$202.85
|
| Rate for Payer: BCN Commercial |
$191.85
|
| Rate for Payer: BCN Medicare Advantage |
$61.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.69
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: PACE Senior Care Partners |
$58.60
|
| Rate for Payer: PACE SWMI |
$61.69
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: PHP Medicare Advantage |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health HMO/PPO |
$214.67
|
| Rate for Payer: Priority Health Medicare |
$62.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.32
|
| Rate for Payer: Railroad Medicare Medicare |
$61.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.14
|
| Rate for Payer: UHC Core |
$206.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.69
|
| Rate for Payer: UHC Exchange |
$61.69
|
| Rate for Payer: UHC Medicare Advantage |
$61.69
|
| Rate for Payer: VA VA |
$61.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$190.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health HMO/PPO |
$214.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.14
|
| Rate for Payer: UHC Core |
$206.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
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 |
$0.90 |
| 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 |
$1.52
|
| Rate for Payer: BCBS MAPPO |
$0.95
|
| Rate for Payer: BCBS Trust/PPO |
$3.12
|
| Rate for Payer: BCN Commercial |
$2.95
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.23
|
| Rate for Payer: Nomi Health Commercial |
$3.12
|
| 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 Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health HMO/PPO |
$3.31
|
| Rate for Payer: Priority Health Medicare |
$0.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.55
|
| 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 Dual Complete DSNP |
$0.95
|
| Rate for Payer: UHC Exchange |
$0.95
|
| Rate for Payer: UHC Medicare Advantage |
$0.95
|
| 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
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.06
|
| Rate for Payer: Priority Health HMO/PPO |
$6.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
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 |
$2.47 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$2.94
|
| 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: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health HMO/PPO |
$3.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.55
|
| 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
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.43
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: BCN Medicare Advantage |
$1.95
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: PACE Senior Care Partners |
$1.85
|
| Rate for Payer: PACE SWMI |
$1.95
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.06
|
| Rate for Payer: Priority Health HMO/PPO |
$6.77
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| Rate for Payer: VA VA |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$327.02 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: BCBS Trust/PPO |
$296.61
|
| Rate for Payer: BCN Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Commercial |
$312.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$327.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: PHP Commercial |
$308.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: Priority Health HMO/PPO |
$316.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.76
|
| Rate for Payer: UHC Core |
$303.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.52
|
|
