|
GUANFACINE 1 MG TABLET
|
Facility
|
IP
|
$215.28
|
|
|
Service Code
|
NDC 00904714004
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$193.75 |
| Rate for Payer: Aetna American Axle |
$139.93
|
| Rate for Payer: Aetna Commercial |
$182.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.93
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cofinity Commercial |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$185.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.22
|
| Rate for Payer: Healthscope Commercial |
$193.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.99
|
| Rate for Payer: PHP Commercial |
$182.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.93
|
| Rate for Payer: Priority Health SBD |
$135.63
|
| Rate for Payer: UMR Bronson Commercial |
$94.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.46
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
IP
|
$317.25
|
|
|
Service Code
|
NDC 00378116001
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.59 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna American Axle |
$206.21
|
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.66
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.21
|
| Rate for Payer: Priority Health SBD |
$199.87
|
| Rate for Payer: UMR Bronson Commercial |
$139.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.94
|
|
|
GUANFACINE 1 MG TABLET
|
Facility
|
OP
|
$317.25
|
|
|
Service Code
|
NDC 00378116001
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.38 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna American Axle |
$206.21
|
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna Medicare |
$158.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: BCBS Complete |
$126.90
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$272.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.66
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.21
|
| Rate for Payer: Priority Health SBD |
$199.87
|
| Rate for Payer: UMR Bronson Commercial |
$117.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.94
|
|
|
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 Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| 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: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| 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 Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.06
|
| 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: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| 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 Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| 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: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| 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
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 53746071101
|
| Hospital Charge Code |
10149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.06
|
| 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: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
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 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 |
$165.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
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
|
|
|
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 Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| 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: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| 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 Commercial |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.81
|
| 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: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.68
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| 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
|
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 Commercial |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.81
|
| 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: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.68
|
| 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 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 Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| 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: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| 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
|
$453.55
|
|
|
Service Code
|
NDC 60505392801
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
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 Commercial |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.81
|
| 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: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.68
|
| 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
|
$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 Commercial |
$2,339.81
|
| Rate for Payer: Cofinity Commercial |
$2,874.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.81
|
| 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: PHP Commercial |
$2,841.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.68
|
| Rate for Payer: Priority Health SBD |
$2,105.83
|
| 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
|
$453.55
|
|
|
Service Code
|
NDC 60505392801
|
| Hospital Charge Code |
99836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$167.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
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 Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| 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: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| 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 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 Commercial |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.35
|
| 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: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| 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
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
150949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
GUAR GUM ORAL POWDER FOR PEDIATRIC FEEDS
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
150949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
OP
|
$51.03
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna American Axle |
$33.17
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.17
|
| Rate for Payer: BCBS Complete |
$20.41
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.17
|
| Rate for Payer: Priority Health SBD |
$32.15
|
| Rate for Payer: UMR Bronson Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.27
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$51.03
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna American Axle |
$33.17
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.17
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.17
|
| Rate for Payer: Priority Health SBD |
$32.15
|
| Rate for Payer: UMR Bronson Commercial |
$22.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.27
|
|
