|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.55
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
117975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna American Axle |
$17.91
|
| Rate for Payer: Aetna American Axle |
$58.60
|
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Aetna Commercial |
$76.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.60
|
| Rate for Payer: Cash Price |
$22.04
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cofinity Advantage |
$63.11
|
| Rate for Payer: Cofinity Advantage |
$19.29
|
| Rate for Payer: Cofinity Commercial |
$77.54
|
| Rate for Payer: Cofinity Commercial |
$23.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.13
|
| Rate for Payer: Healthscope Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$81.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.62
|
| Rate for Payer: PHP Commercial |
$23.42
|
| Rate for Payer: PHP Commercial |
$76.64
|
| Rate for Payer: Priority Health SBD |
$56.80
|
| Rate for Payer: Priority Health SBD |
$17.36
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: UMR Bronson Commercial |
$39.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.62
|
|
|
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 |
$1.41 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna American Axle |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$1.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.47
|
| Rate for Payer: BCBS Complete |
$1.52
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cofinity Advantage |
$2.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.85
|
| Rate for Payer: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health SBD |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.47
|
| Rate for Payer: UHC Core |
$1.98
|
| Rate for Payer: UHC Exchange |
$1.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
NDC 00121148810
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
NDC 00121148810
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 81033010210
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Advantage |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$3.73
|
| Rate for Payer: UHC Exchange |
$2.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 81033010210
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Advantage |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
NDC 00121148800
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 81033010252
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Advantage |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$3.73
|
| Rate for Payer: UHC Exchange |
$2.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
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 |
$1.67 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna American Axle |
$2.47
|
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.47
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cofinity Advantage |
$2.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.85
|
| Rate for Payer: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health SBD |
$2.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 81033010252
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cofinity Advantage |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$6.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.37
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: Priority Health SBD |
$4.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.37
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
NDC 00121148800
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.91
|
| Rate for Payer: PHP Commercial |
$6.70
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.91
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$269.80
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.83 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna Medicare |
$134.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: BCBS Complete |
$107.92
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Advantage |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.37
|
| Rate for Payer: UHC Core |
$140.57
|
| Rate for Payer: UHC Exchange |
$106.03
|
| Rate for Payer: UMR Bronson Commercial |
$99.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$405.60
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$365.04 |
| Rate for Payer: Aetna American Axle |
$263.64
|
| Rate for Payer: Aetna Commercial |
$344.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.64
|
| Rate for Payer: Cash Price |
$324.48
|
| Rate for Payer: Cofinity Advantage |
$283.92
|
| Rate for Payer: Cofinity Commercial |
$348.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.48
|
| Rate for Payer: Healthscope Commercial |
$365.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.20
|
| Rate for Payer: PHP Commercial |
$344.76
|
| Rate for Payer: Priority Health SBD |
$255.53
|
| Rate for Payer: UMR Bronson Commercial |
$178.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.20
|
|
|
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 |
$558.03 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna American Axle |
$824.36
|
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.36
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Advantage |
$887.77
|
| Rate for Payer: Cofinity Commercial |
$1,090.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.60
|
| Rate for Payer: Healthscope Commercial |
$1,141.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$951.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.19
|
| Rate for Payer: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health SBD |
$799.00
|
| Rate for Payer: UMR Bronson Commercial |
$558.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$951.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 00536116361
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna Medicare |
$187.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: BCBS Complete |
$150.10
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.91
|
| Rate for Payer: UHC Core |
$195.51
|
| Rate for Payer: UHC Exchange |
$147.47
|
| Rate for Payer: UMR Bronson Commercial |
$138.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.71 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Advantage |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UMR Bronson Commercial |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$126.20
|
|
|
Service Code
|
NDC 96295012390
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.53 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna American Axle |
$82.03
|
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Advantage |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.65
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.65
|
|
|
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 |
$469.25 |
| Max. Negotiated Rate |
$1,141.42 |
| Rate for Payer: Aetna American Axle |
$824.36
|
| Rate for Payer: Aetna Commercial |
$1,078.01
|
| Rate for Payer: Aetna Medicare |
$634.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.36
|
| Rate for Payer: BCBS Complete |
$507.30
|
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Cofinity Advantage |
$887.77
|
| Rate for Payer: Cofinity Commercial |
$1,090.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.60
|
| Rate for Payer: Healthscope Commercial |
$1,141.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$951.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,014.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.19
|
| Rate for Payer: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health SBD |
$799.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.36
|
| Rate for Payer: UHC Core |
$660.76
|
| Rate for Payer: UHC Exchange |
$498.42
|
| Rate for Payer: UMR Bronson Commercial |
$469.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$951.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$405.60
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.07 |
| Max. Negotiated Rate |
$365.04 |
| Rate for Payer: Aetna American Axle |
$263.64
|
| Rate for Payer: Aetna Commercial |
$344.76
|
| Rate for Payer: Aetna Medicare |
$202.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.64
|
| Rate for Payer: BCBS Complete |
$162.24
|
| Rate for Payer: Cash Price |
$324.48
|
| Rate for Payer: Cofinity Advantage |
$283.92
|
| Rate for Payer: Cofinity Commercial |
$348.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.48
|
| Rate for Payer: Healthscope Commercial |
$365.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.20
|
| Rate for Payer: PHP Commercial |
$344.76
|
| Rate for Payer: Priority Health SBD |
$255.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.64
|
| Rate for Payer: UHC Core |
$211.32
|
| Rate for Payer: UHC Exchange |
$159.40
|
| Rate for Payer: UMR Bronson Commercial |
$150.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.20
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 00536116361
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna American Axle |
$243.91
|
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.44
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$126.20
|
|
|
Service Code
|
NDC 96295012390
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna American Axle |
$82.03
|
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna Medicare |
$63.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: BCBS Complete |
$50.48
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Advantage |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.65
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.03
|
| Rate for Payer: UHC Core |
$65.75
|
| Rate for Payer: UHC Exchange |
$49.60
|
| Rate for Payer: UMR Bronson Commercial |
$46.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.65
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 42806004801
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$220.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Advantage |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.14
|
| Rate for Payer: UHC Core |
$230.15
|
| Rate for Payer: UHC Exchange |
$173.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
OP
|
$250.08
|
|
|
Service Code
|
NDC 53746071101
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna Medicare |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: BCBS Complete |
$100.03
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Advantage |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.56
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.55
|
| Rate for Payer: UHC Core |
$130.29
|
| Rate for Payer: UHC Exchange |
$98.28
|
| Rate for Payer: UMR Bronson Commercial |
$92.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 42806004801
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Advantage |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
OP
|
$210.96
|
|
|
Service Code
|
NDC 00904714004
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$189.86 |
| Rate for Payer: Aetna American Axle |
$137.12
|
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Aetna Medicare |
$105.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.12
|
| Rate for Payer: BCBS Complete |
$84.38
|
| Rate for Payer: Cash Price |
$168.77
|
| Rate for Payer: Cofinity Advantage |
$147.67
|
| Rate for Payer: Cofinity Commercial |
$181.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.77
|
| Rate for Payer: Healthscope Commercial |
$189.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.22
|
| Rate for Payer: PHP Commercial |
$179.32
|
| Rate for Payer: Priority Health SBD |
$132.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.12
|
| Rate for Payer: UHC Core |
$109.91
|
| Rate for Payer: UHC Exchange |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$78.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.22
|
|
