|
GRANISETRON HCL 1 MG TABLET
|
Facility
|
IP
|
$12.39
|
|
|
Service Code
|
HCPCS Q0166
|
| Hospital Charge Code |
14720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna American Axle |
$8.05
|
| Rate for Payer: Aetna American Axle |
$161.04
|
| Rate for Payer: Aetna Commercial |
$10.53
|
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Cofinity Commercial |
$173.43
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.53
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: PHP Commercial |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.04
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: Priority Health SBD |
$156.09
|
| Rate for Payer: UMR Bronson Commercial |
$5.45
|
| Rate for Payer: UMR Bronson Commercial |
$109.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.82
|
|
|
GRANISETRON HCL 1 MG TABLET
|
Facility
|
OP
|
$12.39
|
|
|
Service Code
|
HCPCS Q0166
|
| Hospital Charge Code |
14720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna American Axle |
$8.05
|
| Rate for Payer: Aetna American Axle |
$161.04
|
| Rate for Payer: Aetna Commercial |
$10.53
|
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Medicare |
$6.20
|
| Rate for Payer: Aetna Medicare |
$123.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: BCBS Complete |
$99.10
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$173.43
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: PHP Commercial |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.04
|
| Rate for Payer: Priority Health SBD |
$156.09
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: UMR Bronson Commercial |
$91.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.29
|
|
|
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 |
$57.80
|
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: Cash Price |
$22.04
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$19.29
|
| Rate for Payer: Cofinity Commercial |
$23.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.42
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: PHP Commercial |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.80
|
| Rate for Payer: Priority Health SBD |
$17.36
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: UMR Bronson Commercial |
$39.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.55
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
117975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna American Axle |
$17.91
|
| Rate for Payer: Aetna American Axle |
$57.80
|
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: BCBS Complete |
$35.57
|
| Rate for Payer: BCBS Complete |
$11.02
|
| Rate for Payer: Cash Price |
$22.04
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Commercial |
$23.69
|
| Rate for Payer: Cofinity Commercial |
$19.29
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Healthscope Commercial |
$24.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: PHP Commercial |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.80
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: Priority Health SBD |
$17.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
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 Commercial |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.66
|
| 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: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health SBD |
$2.39
|
| 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
|
OP
|
$7.01
|
|
|
Service Code
|
NDC 81033010210
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Aetna American Axle |
$4.56
|
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.56
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cofinity Commercial |
$4.91
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.96
|
| Rate for Payer: PHP Commercial |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.56
|
| Rate for Payer: Priority Health SBD |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.26
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 00121148800
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 00121148810
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 00121148810
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
NDC 81033010252
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Aetna American Axle |
$4.56
|
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.56
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cofinity Commercial |
$4.91
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.96
|
| Rate for Payer: PHP Commercial |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.56
|
| Rate for Payer: Priority Health SBD |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.26
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
NDC 81033010252
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Aetna American Axle |
$4.56
|
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.56
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cofinity Commercial |
$4.91
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.96
|
| Rate for Payer: PHP Commercial |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.56
|
| Rate for Payer: Priority Health SBD |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.26
|
|
|
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 Commercial |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.66
|
| 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: PHP Commercial |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| 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
|
$7.01
|
|
|
Service Code
|
NDC 81033010210
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Aetna American Axle |
$4.56
|
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.56
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cofinity Commercial |
$4.91
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.96
|
| Rate for Payer: PHP Commercial |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.56
|
| Rate for Payer: Priority Health SBD |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.26
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 00121148800
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
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 Commercial |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.86
|
| 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: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| 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
|
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 Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.34
|
| 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: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.03
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UMR Bronson Commercial |
$46.69
|
| 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 Commercial |
$1,090.69
|
| Rate for Payer: Cofinity Commercial |
$887.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.77
|
| 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: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.36
|
| Rate for Payer: Priority Health SBD |
$799.00
|
| 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
|
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 Commercial |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.86
|
| 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: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| 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
|
$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 Commercial |
$1,090.69
|
| Rate for Payer: Cofinity Commercial |
$887.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.77
|
| 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: PHP Commercial |
$1,078.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.36
|
| 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
|
$367.65
|
|
|
Service Code
|
NDC 00536116361
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.03 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna American Axle |
$238.97
|
| Rate for Payer: Aetna Commercial |
$312.50
|
| Rate for Payer: Aetna Medicare |
$183.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.97
|
| Rate for Payer: BCBS Complete |
$147.06
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Cofinity Commercial |
$316.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.50
|
| Rate for Payer: PHP Commercial |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.97
|
| Rate for Payer: Priority Health SBD |
$231.62
|
| Rate for Payer: UMR Bronson Commercial |
$136.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.74
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$367.65
|
|
|
Service Code
|
NDC 00536116361
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna American Axle |
$238.97
|
| Rate for Payer: Aetna Commercial |
$312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.97
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Cofinity Commercial |
$316.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.12
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.50
|
| Rate for Payer: PHP Commercial |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.97
|
| Rate for Payer: Priority Health SBD |
$231.62
|
| Rate for Payer: UMR Bronson Commercial |
$161.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.74
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
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 Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.34
|
| 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: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.03
|
| 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
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.19 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna Medicare |
$165.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: BCBS Complete |
$132.10
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$122.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 00591044401
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| 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: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
