|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: Aetna American Axle |
$27.13
|
| Rate for Payer: Aetna Commercial |
$35.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.13
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Advantage |
$29.22
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.30
|
| Rate for Payer: PHP Commercial |
$35.48
|
| Rate for Payer: Priority Health SBD |
$26.30
|
| Rate for Payer: UMR Bronson Commercial |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.30
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$35.82
|
|
|
Service Code
|
NDC 00132007912
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$32.24 |
| Rate for Payer: Aetna American Axle |
$23.28
|
| Rate for Payer: Aetna Commercial |
$30.45
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.28
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cofinity Advantage |
$25.07
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$32.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.86
|
| Rate for Payer: PHP Commercial |
$30.45
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.28
|
| Rate for Payer: UHC Core |
$18.66
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.86
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 51552009404
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
NDC 09900001967
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna Medicare |
$110.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Advantage |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.00
|
| Rate for Payer: UHC Core |
$114.62
|
| Rate for Payer: UHC Exchange |
$86.46
|
| Rate for Payer: UMR Bronson Commercial |
$81.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
NDC 09900001967
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Advantage |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 51552009404
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$71.97
|
|
|
Service Code
|
NDC 58980040925
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Aetna American Axle |
$46.78
|
| Rate for Payer: Aetna Commercial |
$61.17
|
| Rate for Payer: Aetna Medicare |
$35.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.78
|
| Rate for Payer: BCBS Complete |
$28.79
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cofinity Advantage |
$50.38
|
| Rate for Payer: Cofinity Commercial |
$61.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.58
|
| Rate for Payer: Healthscope Commercial |
$64.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.98
|
| Rate for Payer: PHP Commercial |
$61.17
|
| Rate for Payer: Priority Health SBD |
$45.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.78
|
| Rate for Payer: UHC Core |
$37.50
|
| Rate for Payer: UHC Exchange |
$28.28
|
| Rate for Payer: UMR Bronson Commercial |
$26.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.98
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 70000042901
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.08
|
| Rate for Payer: UHC Core |
$25.71
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 09900001043
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 09900001043
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$71.97
|
|
|
Service Code
|
NDC 58980040925
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Aetna American Axle |
$46.78
|
| Rate for Payer: Aetna Commercial |
$61.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.78
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cofinity Advantage |
$50.38
|
| Rate for Payer: Cofinity Commercial |
$61.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.58
|
| Rate for Payer: Healthscope Commercial |
$64.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.98
|
| Rate for Payer: PHP Commercial |
$61.17
|
| Rate for Payer: Priority Health SBD |
$45.34
|
| Rate for Payer: UMR Bronson Commercial |
$31.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.98
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 70000042901
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
OP
|
$12.78
|
|
|
Service Code
|
NDC 50289825005
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna American Axle |
$8.31
|
| Rate for Payer: Aetna Commercial |
$10.86
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.31
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cofinity Advantage |
$8.95
|
| Rate for Payer: Cofinity Commercial |
$10.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.22
|
| Rate for Payer: Healthscope Commercial |
$11.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.59
|
| Rate for Payer: PHP Commercial |
$10.86
|
| Rate for Payer: Priority Health SBD |
$8.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.31
|
| Rate for Payer: UHC Core |
$6.66
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$4.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.59
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
IP
|
$12.78
|
|
|
Service Code
|
NDC 50289825005
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna American Axle |
$8.31
|
| Rate for Payer: Aetna Commercial |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.31
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cofinity Advantage |
$8.95
|
| Rate for Payer: Cofinity Commercial |
$10.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.22
|
| Rate for Payer: Healthscope Commercial |
$11.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.59
|
| Rate for Payer: PHP Commercial |
$10.86
|
| Rate for Payer: Priority Health SBD |
$8.05
|
| Rate for Payer: UMR Bronson Commercial |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.59
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$29.18
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$26.26 |
| Rate for Payer: Aetna American Axle |
$18.97
|
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$31.99
|
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna American Axle |
$14.53
|
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna American Axle |
$11.21
|
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna American Axle |
$59.64
|
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna American Axle |
$15.35
|
| Rate for Payer: Aetna American Axle |
$89.09
|
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna Commercial |
$18.47
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Commercial |
$41.61
|
| Rate for Payer: Aetna Commercial |
$24.80
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$116.50
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$78.00
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$41.84
|
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$39.16
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Advantage |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$34.45
|
| Rate for Payer: Cofinity Advantage |
$16.53
|
| Rate for Payer: Cofinity Advantage |
$11.97
|
| Rate for Payer: Cofinity Advantage |
$64.23
|
| Rate for Payer: Cofinity Advantage |
$11.33
|
| Rate for Payer: Cofinity Advantage |
$12.07
|
| Rate for Payer: Cofinity Advantage |
$15.64
|
| Rate for Payer: Cofinity Advantage |
$95.94
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Advantage |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$20.43
|
| Rate for Payer: Cofinity Advantage |
$17.72
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Cofinity Commercial |
$78.91
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$25.09
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.41
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$44.05
|
| Rate for Payer: Healthscope Commercial |
$44.30
|
| Rate for Payer: Healthscope Commercial |
$21.25
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$123.35
|
| Rate for Payer: Healthscope Commercial |
$26.26
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$41.84
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$24.80
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$41.61
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$18.47
|
| Rate for Payer: PHP Commercial |
$20.07
|
| Rate for Payer: PHP Commercial |
$78.00
|
| Rate for Payer: PHP Commercial |
$116.50
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$13.69
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: Priority Health SBD |
$31.01
|
| Rate for Payer: Priority Health SBD |
$86.35
|
| Rate for Payer: Priority Health SBD |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$57.81
|
| Rate for Payer: Priority Health SBD |
$10.87
|
| Rate for Payer: Priority Health SBD |
$18.38
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Priority Health SBD |
$15.95
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$12.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: UMR Bronson Commercial |
$21.54
|
| Rate for Payer: UMR Bronson Commercial |
$60.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: UMR Bronson Commercial |
$40.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.83
|
| Rate for Payer: UMR Bronson Commercial |
$11.14
|
| Rate for Payer: UMR Bronson Commercial |
$21.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.91
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$25.31
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna American Axle |
$10.52
|
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna American Axle |
$31.99
|
| Rate for Payer: Aetna American Axle |
$89.09
|
| Rate for Payer: Aetna American Axle |
$11.21
|
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna American Axle |
$59.64
|
| Rate for Payer: Aetna American Axle |
$15.35
|
| Rate for Payer: Aetna American Axle |
$18.97
|
| Rate for Payer: Aetna American Axle |
$14.53
|
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Commercial |
$41.61
|
| Rate for Payer: Aetna Commercial |
$24.80
|
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$18.47
|
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$116.50
|
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna Commercial |
$78.00
|
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Aetna Commercial |
$41.84
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna Medicare |
$45.88
|
| Rate for Payer: Aetna Medicare |
$68.53
|
| Rate for Payer: Aetna Medicare |
$14.59
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Aetna Medicare |
$8.55
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Aetna Medicare |
$24.48
|
| Rate for Payer: Aetna Medicare |
$24.61
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.09
|
| Rate for Payer: BCBS Complete |
$6.84
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Complete |
$54.82
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Complete |
$36.70
|
| Rate for Payer: BCBS Complete |
$19.69
|
| Rate for Payer: BCBS Complete |
$19.58
|
| Rate for Payer: BCBS Complete |
$11.67
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Complete |
$8.69
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cash Price |
$39.16
|
| Rate for Payer: Cash Price |
$39.16
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cash Price |
$73.41
|
| Rate for Payer: Cofinity Advantage |
$11.97
|
| Rate for Payer: Cofinity Advantage |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$12.07
|
| Rate for Payer: Cofinity Advantage |
$64.23
|
| Rate for Payer: Cofinity Advantage |
$11.33
|
| Rate for Payer: Cofinity Advantage |
$15.64
|
| Rate for Payer: Cofinity Advantage |
$20.43
|
| Rate for Payer: Cofinity Advantage |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$16.53
|
| Rate for Payer: Cofinity Advantage |
$17.72
|
| Rate for Payer: Cofinity Advantage |
$95.94
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Advantage |
$34.45
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$78.91
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Cofinity Commercial |
$25.09
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.16
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$26.26
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$44.30
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$44.05
|
| Rate for Payer: Healthscope Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$21.25
|
| Rate for Payer: Healthscope Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$123.35
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$41.84
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$18.47
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Commercial |
$20.07
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: PHP Commercial |
$116.50
|
| Rate for Payer: PHP Commercial |
$13.76
|
| Rate for Payer: PHP Commercial |
$24.80
|
| Rate for Payer: PHP Commercial |
$41.61
|
| Rate for Payer: PHP Commercial |
$78.00
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: Priority Health SBD |
$15.95
|
| Rate for Payer: Priority Health SBD |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: Priority Health SBD |
$57.81
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: Priority Health SBD |
$86.35
|
| Rate for Payer: Priority Health SBD |
$10.20
|
| Rate for Payer: Priority Health SBD |
$31.01
|
| Rate for Payer: Priority Health SBD |
$10.87
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Priority Health SBD |
$18.38
|
| Rate for Payer: Priority Health SBD |
$13.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Core |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: UMR Bronson Commercial |
$33.95
|
| Rate for Payer: UMR Bronson Commercial |
$18.11
|
| Rate for Payer: UMR Bronson Commercial |
$6.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.80
|
| Rate for Payer: UMR Bronson Commercial |
$50.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.89
|
|
|
GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$1,500.83
|
|
|
Service Code
|
NDC 31722001647
|
| Hospital Charge Code |
107829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$555.31 |
| Max. Negotiated Rate |
$1,350.75 |
| Rate for Payer: Aetna American Axle |
$975.54
|
| Rate for Payer: Aetna Commercial |
$1,275.71
|
| Rate for Payer: Aetna Medicare |
$750.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.54
|
| Rate for Payer: BCBS Complete |
$600.33
|
| Rate for Payer: Cash Price |
$1,200.66
|
| Rate for Payer: Cofinity Advantage |
$1,050.58
|
| Rate for Payer: Cofinity Commercial |
$1,290.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.66
|
| Rate for Payer: Healthscope Commercial |
$1,350.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,050.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,200.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.62
|
| Rate for Payer: PHP Commercial |
$1,275.71
|
| Rate for Payer: Priority Health SBD |
$945.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.54
|
| Rate for Payer: UHC Core |
$781.93
|
| Rate for Payer: UHC Exchange |
$589.83
|
| Rate for Payer: UMR Bronson Commercial |
$555.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.62
|
|
|
GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$1,500.83
|
|
|
Service Code
|
NDC 31722001647
|
| Hospital Charge Code |
107829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$660.37 |
| Max. Negotiated Rate |
$1,350.75 |
| Rate for Payer: Aetna American Axle |
$975.54
|
| Rate for Payer: Aetna Commercial |
$1,275.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.54
|
| Rate for Payer: Cash Price |
$1,200.66
|
| Rate for Payer: Cofinity Advantage |
$1,050.58
|
| Rate for Payer: Cofinity Commercial |
$1,290.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.66
|
| Rate for Payer: Healthscope Commercial |
$1,350.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,050.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.62
|
| Rate for Payer: PHP Commercial |
$1,275.71
|
| Rate for Payer: Priority Health SBD |
$945.52
|
| Rate for Payer: UMR Bronson Commercial |
$660.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.62
|
|
|
GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$1,397.48
|
|
|
Service Code
|
NDC 51672531609
|
| Hospital Charge Code |
107829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$614.89 |
| Max. Negotiated Rate |
$1,257.73 |
| Rate for Payer: Aetna American Axle |
$908.36
|
| Rate for Payer: Aetna Commercial |
$1,187.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$908.36
|
| Rate for Payer: Cash Price |
$1,117.98
|
| Rate for Payer: Cofinity Advantage |
$978.24
|
| Rate for Payer: Cofinity Commercial |
$1,201.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,117.98
|
| Rate for Payer: Healthscope Commercial |
$1,257.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$978.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,048.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,187.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,048.11
|
| Rate for Payer: PHP Commercial |
$1,187.86
|
| Rate for Payer: Priority Health SBD |
$880.41
|
| Rate for Payer: UMR Bronson Commercial |
$614.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,048.11
|
|
|
GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$1,397.48
|
|
|
Service Code
|
NDC 51672531609
|
| Hospital Charge Code |
107829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$517.07 |
| Max. Negotiated Rate |
$1,257.73 |
| Rate for Payer: Aetna American Axle |
$908.36
|
| Rate for Payer: Aetna Commercial |
$1,187.86
|
| Rate for Payer: Aetna Medicare |
$698.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$908.36
|
| Rate for Payer: BCBS Complete |
$558.99
|
| Rate for Payer: Cash Price |
$1,117.98
|
| Rate for Payer: Cofinity Advantage |
$978.24
|
| Rate for Payer: Cofinity Commercial |
$1,201.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,117.98
|
| Rate for Payer: Healthscope Commercial |
$1,257.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$978.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,048.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,187.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,048.11
|
| Rate for Payer: PHP Commercial |
$1,187.86
|
| Rate for Payer: Priority Health SBD |
$880.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$908.36
|
| Rate for Payer: UHC Core |
$728.09
|
| Rate for Payer: UHC Exchange |
$549.21
|
| Rate for Payer: UMR Bronson Commercial |
$517.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,048.11
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$192.70
|
|
|
Service Code
|
NDC 70752010810
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna Medicare |
$96.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: BCBS Complete |
$77.08
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.25
|
| Rate for Payer: UHC Core |
$100.40
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$385.70
|
|
|
Service Code
|
NDC 69076047501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna American Axle |
$250.71
|
| Rate for Payer: Aetna Commercial |
$327.85
|
| Rate for Payer: Aetna Medicare |
$192.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.71
|
| Rate for Payer: BCBS Complete |
$154.28
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Advantage |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.27
|
| Rate for Payer: PHP Commercial |
$327.85
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.71
|
| Rate for Payer: UHC Core |
$200.95
|
| Rate for Payer: UHC Exchange |
$151.58
|
| Rate for Payer: UMR Bronson Commercial |
$142.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.27
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$407.04
|
|
|
Service Code
|
NDC 55111064801
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.60 |
| Max. Negotiated Rate |
$366.34 |
| Rate for Payer: Aetna American Axle |
$264.58
|
| Rate for Payer: Aetna Commercial |
$345.98
|
| Rate for Payer: Aetna Medicare |
$203.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.58
|
| Rate for Payer: BCBS Complete |
$162.82
|
| Rate for Payer: Cash Price |
$325.63
|
| Rate for Payer: Cofinity Advantage |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$350.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$366.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.28
|
| Rate for Payer: PHP Commercial |
$345.98
|
| Rate for Payer: Priority Health SBD |
$256.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.58
|
| Rate for Payer: UHC Core |
$212.07
|
| Rate for Payer: UHC Exchange |
$159.97
|
| Rate for Payer: UMR Bronson Commercial |
$150.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.28
|
|
