|
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
|
$446.50
|
|
|
Service Code
|
NDC 00591044401
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Advantage |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.88
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.23
|
| Rate for Payer: UHC Core |
$232.63
|
| Rate for Payer: UHC Exchange |
$175.47
|
| Rate for Payer: UMR Bronson Commercial |
$165.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
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
|
$210.96
|
|
|
Service Code
|
NDC 00904714004
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$189.86 |
| Rate for Payer: Aetna American Axle |
$137.12
|
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.12
|
| 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: 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: UMR Bronson Commercial |
$92.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.22
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 24979053301
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,342.58
|
|
|
Service Code
|
NDC 54092051302
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,236.75 |
| Max. Negotiated Rate |
$3,008.32 |
| Rate for Payer: Aetna American Axle |
$2,172.68
|
| Rate for Payer: Aetna Commercial |
$2,841.19
|
| Rate for Payer: Aetna Medicare |
$1,671.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.68
|
| Rate for Payer: BCBS Complete |
$1,337.03
|
| Rate for Payer: Cash Price |
$2,674.06
|
| Rate for Payer: Cofinity Advantage |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.06
|
| Rate for Payer: Healthscope Commercial |
$3,008.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,506.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,674.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,506.93
|
| Rate for Payer: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,172.68
|
| Rate for Payer: UHC Core |
$1,741.48
|
| Rate for Payer: UHC Exchange |
$1,313.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,506.93
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
NDC 24979053301
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.09 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.82
|
| Rate for Payer: UHC Core |
$193.03
|
| Rate for Payer: UHC Exchange |
$145.61
|
| Rate for Payer: UMR Bronson Commercial |
$137.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,342.58
|
|
|
Service Code
|
NDC 54092051302
|
| Hospital Charge Code |
99835
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,470.74 |
| Max. Negotiated Rate |
$3,008.32 |
| Rate for Payer: Aetna American Axle |
$2,172.68
|
| Rate for Payer: Aetna Commercial |
$2,841.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.68
|
| Rate for Payer: Cash Price |
$2,674.06
|
| Rate for Payer: Cofinity Advantage |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.06
|
| Rate for Payer: Healthscope Commercial |
$3,008.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,506.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,506.93
|
| Rate for Payer: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,506.93
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,342.58
|
|
|
Service Code
|
NDC 54092051502
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,470.74 |
| Max. Negotiated Rate |
$3,008.32 |
| Rate for Payer: Aetna American Axle |
$2,172.68
|
| Rate for Payer: Aetna Commercial |
$2,841.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.68
|
| Rate for Payer: Cash Price |
$2,674.06
|
| Rate for Payer: Cofinity Advantage |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.06
|
| Rate for Payer: Healthscope Commercial |
$3,008.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,506.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,506.93
|
| Rate for Payer: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,506.93
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
NDC 24979053401
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.09 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.82
|
| Rate for Payer: UHC Core |
$193.03
|
| Rate for Payer: UHC Exchange |
$145.61
|
| Rate for Payer: UMR Bronson Commercial |
$137.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 24979053401
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,342.58
|
|
|
Service Code
|
NDC 54092051502
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,236.75 |
| Max. Negotiated Rate |
$3,008.32 |
| Rate for Payer: Aetna American Axle |
$2,172.68
|
| Rate for Payer: Aetna Commercial |
$2,841.19
|
| Rate for Payer: Aetna Medicare |
$1,671.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.68
|
| Rate for Payer: BCBS Complete |
$1,337.03
|
| Rate for Payer: Cash Price |
$2,674.06
|
| Rate for Payer: Cofinity Advantage |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.06
|
| Rate for Payer: Healthscope Commercial |
$3,008.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,506.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,674.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,506.93
|
| Rate for Payer: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,172.68
|
| Rate for Payer: UHC Core |
$1,741.48
|
| Rate for Payer: UHC Exchange |
$1,313.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,506.93
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 62332074631
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.91
|
| Rate for Payer: UHC Core |
$129.78
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 62332074631
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 60505392801
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
NDC 60505392801
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.09 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.82
|
| Rate for Payer: UHC Core |
$193.03
|
| Rate for Payer: UHC Exchange |
$145.61
|
| Rate for Payer: UMR Bronson Commercial |
$137.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
GUAR GUM ORAL POWDER FOR PEDIATRIC FEEDS
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
150949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
GUAR GUM ORAL POWDER FOR PEDIATRIC FEEDS
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
150949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health SBD |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.09
|
|
|
GUSELKUMAB 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32,949.28
|
|
|
Service Code
|
HCPCS J1628
|
| Hospital Charge Code |
208655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$29,654.35 |
| Rate for Payer: Aetna American Axle |
$21,417.03
|
| Rate for Payer: Aetna Commercial |
$28,006.89
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,417.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.76
|
| Rate for Payer: BCBS Complete |
$37.24
|
| Rate for Payer: BCBS MAPPO |
$67.81
|
| Rate for Payer: BCBS Trust/PPO |
$236.50
|
| Rate for Payer: BCN Commercial |
$236.50
|
| Rate for Payer: BCN Medicare Advantage |
$67.81
|
| Rate for Payer: Cash Price |
$26,359.42
|
| Rate for Payer: Cash Price |
$26,359.42
|
| Rate for Payer: Cofinity Advantage |
$23,064.50
|
| Rate for Payer: Cofinity Commercial |
$28,336.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,359.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.81
|
| Rate for Payer: Healthscope Commercial |
$29,654.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,064.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,711.96
|
| Rate for Payer: Mclaren Medicaid |
$67.81
|
| Rate for Payer: Mclaren Medicare |
$67.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.20
|
| Rate for Payer: Meridian Medicaid |
$71.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,006.89
|
| Rate for Payer: Nomi Health Commercial |
$203.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,711.96
|
| Rate for Payer: PACE Medicare |
$64.42
|
| Rate for Payer: PACE SWMI |
$67.81
|
| Rate for Payer: PHP Commercial |
$28,006.89
|
| Rate for Payer: PHP Medicare Advantage |
$67.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$239.62
|
| Rate for Payer: Priority Health Medicare |
$67.81
|
| Rate for Payer: Priority Health SBD |
$20,758.05
|
| Rate for Payer: Priority Health Tiered Network |
$191.70
|
| Rate for Payer: Railroad Medicare Medicare |
$67.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.35
|
| Rate for Payer: UHC Core |
$120.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.81
|
| Rate for Payer: UHC Exchange |
$120.35
|
| Rate for Payer: UHC Medicaid |
$35.46
|
| Rate for Payer: UHCCP Medicaid |
$35.46
|
| Rate for Payer: UMR Bronson Commercial |
$12,191.23
|
| Rate for Payer: VA VA |
$67.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,711.96
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$10,049.00
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$9,570.48 |
| Max. Negotiated Rate |
$10,049.00 |
| Rate for Payer: BCBS Complete |
$10,049.00
|
| Rate for Payer: Mclaren Medicaid |
$9,570.48
|
| Rate for Payer: Meridian Medicaid |
$10,049.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,570.48
|
| Rate for Payer: UHC Medicaid |
$9,570.48
|
| Rate for Payer: UHCCP Medicaid |
$9,570.48
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$7,301.43
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$6,953.74 |
| Max. Negotiated Rate |
$7,301.43 |
| Rate for Payer: BCBS Complete |
$7,301.43
|
| Rate for Payer: Mclaren Medicaid |
$6,953.74
|
| Rate for Payer: Meridian Medicaid |
$7,301.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,953.74
|
| Rate for Payer: UHC Medicaid |
$6,953.74
|
| Rate for Payer: UHCCP Medicaid |
$6,953.74
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$23,794.72
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$22,661.64 |
| Max. Negotiated Rate |
$23,794.72 |
| Rate for Payer: BCBS Complete |
$23,794.72
|
| Rate for Payer: Mclaren Medicaid |
$22,661.64
|
| Rate for Payer: Meridian Medicaid |
$23,794.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,661.64
|
| Rate for Payer: UHC Medicaid |
$22,661.64
|
| Rate for Payer: UHCCP Medicaid |
$22,661.64
|
|
|
GYNECOLOGIC PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$14,981.79
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$14,268.38 |
| Max. Negotiated Rate |
$14,981.79 |
| Rate for Payer: BCBS Complete |
$14,981.79
|
| Rate for Payer: Mclaren Medicaid |
$14,268.38
|
| Rate for Payer: Meridian Medicaid |
$14,981.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,268.38
|
| Rate for Payer: UHC Medicaid |
$14,268.38
|
| Rate for Payer: UHCCP Medicaid |
$14,268.38
|
|
