|
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 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 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 |
$222.08 |
| 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 |
$212.20
|
| 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 |
$222.08
|
| 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 |
$222.08 |
| 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 |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| 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
|
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 |
$5.84
|
| 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 |
$5.84
|
|
|
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 |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: BCN Medicare Advantage |
$1.94
|
| 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 |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.84
|
| 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 |
$1.94
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.94
|
| 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 |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.94
|
| Rate for Payer: UHC Exchange |
$1.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.94
|
| Rate for Payer: VA VA |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.84
|
|
|
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
|
$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 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
|
|
|
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 |
$824.36 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.27
|
| Rate for Payer: BCN Commercial |
$980.10
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Commercial |
$1,090.70
|
| 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: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,103.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.73
|
| 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
|
$3.64
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.14
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.91
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.30 |
| Max. Negotiated Rate |
$327.02 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Aetna Medicare |
$94.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.55
|
| Rate for Payer: BCBS Complete |
$145.34
|
| Rate for Payer: BCBS MAPPO |
$90.84
|
| Rate for Payer: BCBS Trust/PPO |
$298.72
|
| Rate for Payer: BCN Commercial |
$282.51
|
| Rate for Payer: BCN Medicare Advantage |
$90.84
|
| 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: Health Alliance Plan Medicare Advantage |
$90.84
|
| Rate for Payer: Healthscope Commercial |
$327.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: PACE Senior Care Partners |
$86.30
|
| Rate for Payer: PACE SWMI |
$90.84
|
| Rate for Payer: PHP Commercial |
$308.86
|
| Rate for Payer: PHP Medicare Advantage |
$90.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: Priority Health HMO/PPO |
$316.12
|
| Rate for Payer: Priority Health Medicare |
$91.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.45
|
| Rate for Payer: Railroad Medicare Medicare |
$90.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.76
|
| Rate for Payer: UHC Core |
$303.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.84
|
| Rate for Payer: UHC Exchange |
$90.84
|
| Rate for Payer: UHC Medicare Advantage |
$90.84
|
| Rate for Payer: VA VA |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.52
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
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 |
$301.21 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: Aetna Medicare |
$329.74
|
| 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 |
$507.30
|
| Rate for Payer: BCBS MAPPO |
$317.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.63
|
| Rate for Payer: BCN Commercial |
$986.06
|
| Rate for Payer: BCN Medicare Advantage |
$317.06
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Commercial |
$1,090.70
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.01
|
| Rate for Payer: Nomi Health Commercial |
$1,039.96
|
| 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 Cigna Priority Health |
$824.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,103.38
|
| Rate for Payer: Priority Health Medicare |
$320.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.73
|
| 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 Dual Complete DSNP |
$317.06
|
| Rate for Payer: UHC Exchange |
$317.06
|
| Rate for Payer: UHC Medicare Advantage |
$317.06
|
| Rate for Payer: VA VA |
$317.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$951.19
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 00904739061
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$233.42
|
| Rate for Payer: BCN Commercial |
$220.98
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.70 |
| Max. Negotiated Rate |
$370.22 |
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.55
|
| Rate for Payer: BCBS Complete |
$164.54
|
| Rate for Payer: BCBS MAPPO |
$102.84
|
| Rate for Payer: BCBS Trust/PPO |
$338.17
|
| Rate for Payer: BCN Commercial |
$319.82
|
| Rate for Payer: BCN Medicare Advantage |
$102.84
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.84
|
| Rate for Payer: Healthscope Commercial |
$370.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Nomi Health Commercial |
$337.31
|
| Rate for Payer: PACE Senior Care Partners |
$97.70
|
| Rate for Payer: PACE SWMI |
$102.84
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: PHP Medicare Advantage |
$102.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: Priority Health HMO/PPO |
$357.87
|
| Rate for Payer: Priority Health Medicare |
$103.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.60
|
| Rate for Payer: Railroad Medicare Medicare |
$102.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.99
|
| Rate for Payer: UHC Core |
$343.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.84
|
| Rate for Payer: UHC Exchange |
$102.84
|
| Rate for Payer: UHC Medicare Advantage |
$102.84
|
| Rate for Payer: VA VA |
$102.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 00904739061
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.36
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$222.33
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PACE Senior Care Partners |
$67.91
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.49
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| Rate for Payer: VA VA |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.29
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: PACE Senior Care Partners |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.03
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.38 |
| Max. Negotiated Rate |
$370.22 |
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: BCBS Trust/PPO |
$335.79
|
| Rate for Payer: BCN Commercial |
$317.89
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$370.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Nomi Health Commercial |
$337.31
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: Priority Health HMO/PPO |
$357.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.99
|
| Rate for Payer: UHC Core |
$343.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.08 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna Medicare |
$110.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.00
|
| Rate for Payer: BCBS Complete |
$170.24
|
| Rate for Payer: BCBS MAPPO |
$106.40
|
| Rate for Payer: BCBS Trust/PPO |
$349.89
|
| Rate for Payer: BCN Commercial |
$330.90
|
| Rate for Payer: BCN Medicare Advantage |
$106.40
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Nomi Health Commercial |
$348.99
|
| Rate for Payer: PACE Senior Care Partners |
$101.08
|
| Rate for Payer: PACE SWMI |
$106.40
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: PHP Medicare Advantage |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health HMO/PPO |
$370.27
|
| Rate for Payer: Priority Health Medicare |
$107.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.15
|
| Rate for Payer: Railroad Medicare Medicare |
$106.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.53
|
| Rate for Payer: UHC Core |
$355.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.40
|
| Rate for Payer: UHC Exchange |
$106.40
|
| Rate for Payer: UHC Medicare Advantage |
$106.40
|
| Rate for Payer: VA VA |
$106.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.20
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 00904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: BCBS Trust/PPO |
$338.89
|
| Rate for Payer: BCN Commercial |
$320.83
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Nomi Health Commercial |
$340.42
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.85
|
| Rate for Payer: Priority Health HMO/PPO |
$361.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.33
|
| Rate for Payer: UHC Core |
$346.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.42
|
| Rate for Payer: BCN Commercial |
$328.90
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Nomi Health Commercial |
$348.99
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health HMO/PPO |
$370.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.53
|
| Rate for Payer: UHC Core |
$355.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.20
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$415.15
|
|
|
Service Code
|
NDC 00904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: Aetna Medicare |
$107.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.73
|
| Rate for Payer: BCBS Complete |
$166.06
|
| Rate for Payer: BCBS MAPPO |
$103.79
|
| Rate for Payer: BCBS Trust/PPO |
$341.29
|
| Rate for Payer: BCN Commercial |
$322.78
|
| Rate for Payer: BCN Medicare Advantage |
$103.79
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.79
|
| Rate for Payer: Healthscope Commercial |
$373.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: Nomi Health Commercial |
$340.42
|
| Rate for Payer: PACE Senior Care Partners |
$98.60
|
| Rate for Payer: PACE SWMI |
$103.79
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: PHP Medicare Advantage |
$103.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.85
|
| Rate for Payer: Priority Health HMO/PPO |
$361.18
|
| Rate for Payer: Priority Health Medicare |
$104.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.15
|
| Rate for Payer: Railroad Medicare Medicare |
$103.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.33
|
| Rate for Payer: UHC Core |
$346.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.79
|
| Rate for Payer: UHC Exchange |
$103.79
|
| Rate for Payer: UHC Medicare Advantage |
$103.79
|
| Rate for Payer: VA VA |
$103.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
