|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$75.39
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$75.39 |
| Rate for Payer: Aetna Commercial |
$67.85
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$6.78
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna Medicare |
$27.90
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: ASR ASR |
$73.13
|
| Rate for Payer: ASR ASR |
$23.45
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$17.78
|
| Rate for Payer: BCBS Complete |
$5.28
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS Complete |
$30.16
|
| Rate for Payer: BCBS Complete |
$5.95
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.11
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.88
|
| Rate for Payer: BCBS Trust/PPO |
$62.16
|
| Rate for Payer: BCN Commercial |
$62.16
|
| Rate for Payer: BCN Commercial |
$10.88
|
| Rate for Payer: BCN Commercial |
$9.90
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: BCN Commercial |
$15.11
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$60.31
|
| Rate for Payer: Cash Price |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$70.87
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Healthscope Commercial |
$73.13
|
| Rate for Payer: Healthscope Whirlpool |
$18.33
|
| Rate for Payer: Healthscope Whirlpool |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$14.88
|
| Rate for Payer: Healthscope Whirlpool |
$24.18
|
| Rate for Payer: Healthscope Whirlpool |
$75.39
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Mclaren Commercial |
$67.85
|
| Rate for Payer: Mclaren Commercial |
$21.76
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$16.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Nomi Health Commercial |
$15.03
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Nomi Health Commercial |
$61.82
|
| Rate for Payer: Nomi Health Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.39
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: Priority Health Narrow Network |
$0.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.34
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
IP
|
$442.67
|
|
|
Service Code
|
NDC 900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$442.67 |
| Rate for Payer: Aetna Commercial |
$398.40
|
| Rate for Payer: ASR ASR |
$429.39
|
| Rate for Payer: BCBS Trust/PPO |
$363.52
|
| Rate for Payer: BCN Commercial |
$363.52
|
| Rate for Payer: Cash Price |
$354.13
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.13
|
| Rate for Payer: Healthscope Commercial |
$429.39
|
| Rate for Payer: Healthscope Whirlpool |
$442.67
|
| Rate for Payer: Mclaren Commercial |
$398.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: Nomi Health Commercial |
$362.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.55
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
OP
|
$442.67
|
|
|
Service Code
|
NDC 900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$163.79 |
| Max. Negotiated Rate |
$442.67 |
| Rate for Payer: Aetna Commercial |
$398.40
|
| Rate for Payer: Aetna Medicare |
$163.79
|
| Rate for Payer: ASR ASR |
$429.39
|
| Rate for Payer: BCBS Complete |
$177.07
|
| Rate for Payer: BCBS Trust/PPO |
$364.98
|
| Rate for Payer: BCN Commercial |
$364.98
|
| Rate for Payer: Cash Price |
$354.13
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.13
|
| Rate for Payer: Healthscope Commercial |
$429.39
|
| Rate for Payer: Healthscope Whirlpool |
$442.67
|
| Rate for Payer: Mclaren Commercial |
$398.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.27
|
| Rate for Payer: Nomi Health Commercial |
$362.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$387.87
|
| Rate for Payer: Priority Health Narrow Network |
$310.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.55
|
|
|
GOLIMUMAB 100 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$19,425.90
|
|
|
Service Code
|
NDC 57894007102
|
| Hospital Charge Code |
167382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14,569.42 |
| Max. Negotiated Rate |
$19,425.90 |
| Rate for Payer: Aetna Commercial |
$17,483.31
|
| Rate for Payer: ASR ASR |
$18,843.12
|
| Rate for Payer: BCBS Trust/PPO |
$15,952.55
|
| Rate for Payer: BCN Commercial |
$15,952.55
|
| Rate for Payer: Cash Price |
$15,540.72
|
| Rate for Payer: Cofinity Commercial |
$18,260.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,540.72
|
| Rate for Payer: Healthscope Commercial |
$18,843.12
|
| Rate for Payer: Healthscope Whirlpool |
$19,425.90
|
| Rate for Payer: Mclaren Commercial |
$17,483.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,512.01
|
| Rate for Payer: Nomi Health Commercial |
$15,929.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,569.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,094.79
|
|
|
GOLIMUMAB 100 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$19,425.90
|
|
|
Service Code
|
NDC 57894007102
|
| Hospital Charge Code |
167382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,187.58 |
| Max. Negotiated Rate |
$19,425.90 |
| Rate for Payer: Aetna Commercial |
$17,483.31
|
| Rate for Payer: Aetna Medicare |
$7,187.58
|
| Rate for Payer: ASR ASR |
$18,843.12
|
| Rate for Payer: BCBS Complete |
$7,770.36
|
| Rate for Payer: BCBS Trust/PPO |
$16,016.65
|
| Rate for Payer: BCN Commercial |
$16,016.65
|
| Rate for Payer: Cash Price |
$15,540.72
|
| Rate for Payer: Cofinity Commercial |
$18,260.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,540.72
|
| Rate for Payer: Healthscope Commercial |
$18,843.12
|
| Rate for Payer: Healthscope Whirlpool |
$19,425.90
|
| Rate for Payer: Mclaren Commercial |
$17,483.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,540.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,512.01
|
| Rate for Payer: Nomi Health Commercial |
$15,929.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,569.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,020.97
|
| Rate for Payer: Priority Health Narrow Network |
$13,617.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,094.79
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,675.78 |
| Max. Negotiated Rate |
$6,234.37 |
| Rate for Payer: Aetna Commercial |
$5,610.93
|
| Rate for Payer: ASR ASR |
$6,047.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,119.66
|
| Rate for Payer: BCN Commercial |
$5,119.66
|
| Rate for Payer: Cash Price |
$4,987.49
|
| Rate for Payer: Cofinity Commercial |
$5,860.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.49
|
| Rate for Payer: Healthscope Commercial |
$6,047.34
|
| Rate for Payer: Healthscope Whirlpool |
$6,234.37
|
| Rate for Payer: Mclaren Commercial |
$5,610.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: Nomi Health Commercial |
$5,112.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,675.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,486.24
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$6,234.37 |
| Rate for Payer: Aetna Commercial |
$5,610.93
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.11
|
| Rate for Payer: ASR ASR |
$6,047.34
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$11.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,140.24
|
| Rate for Payer: BCN Commercial |
$5,140.24
|
| Rate for Payer: BCN Medicare Advantage |
$11.29
|
| Rate for Payer: Cash Price |
$4,987.49
|
| Rate for Payer: Cash Price |
$4,987.49
|
| Rate for Payer: Cofinity Commercial |
$5,860.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.29
|
| Rate for Payer: Healthscope Commercial |
$6,047.34
|
| Rate for Payer: Healthscope Whirlpool |
$6,234.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.29
|
| Rate for Payer: Mclaren Commercial |
$5,610.93
|
| Rate for Payer: Mclaren Medicaid |
$11.29
|
| Rate for Payer: Mclaren Medicare |
$11.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.85
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: Nomi Health Commercial |
$5,112.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,675.78
|
| Rate for Payer: PACE Medicare |
$10.73
|
| Rate for Payer: PACE SWMI |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.42
|
| Rate for Payer: PHP Medicaid |
$6.05
|
| Rate for Payer: PHP Medicare Advantage |
$11.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.07
|
| Rate for Payer: Priority Health Medicare |
$11.29
|
| Rate for Payer: Priority Health Narrow Network |
$9.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,486.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.29
|
| Rate for Payer: UHC Exchange |
$17.50
|
| Rate for Payer: UHC Medicaid |
$5.90
|
| Rate for Payer: UHCCP DNSP |
$11.29
|
| Rate for Payer: UHCCP Medicaid |
$5.90
|
| Rate for Payer: VA VA |
$11.29
|
|
|
GOLIMUMAB 50 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$16,079.65
|
|
|
Service Code
|
NDC 57894007001
|
| Hospital Charge Code |
97696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,949.47 |
| Max. Negotiated Rate |
$16,079.65 |
| Rate for Payer: Aetna Commercial |
$14,471.68
|
| Rate for Payer: Aetna Medicare |
$5,949.47
|
| Rate for Payer: ASR ASR |
$15,597.26
|
| Rate for Payer: BCBS Complete |
$6,431.86
|
| Rate for Payer: BCBS Trust/PPO |
$13,257.67
|
| Rate for Payer: BCN Commercial |
$13,257.67
|
| Rate for Payer: Cash Price |
$12,863.72
|
| Rate for Payer: Cofinity Commercial |
$15,114.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,863.72
|
| Rate for Payer: Healthscope Commercial |
$15,597.26
|
| Rate for Payer: Healthscope Whirlpool |
$16,079.65
|
| Rate for Payer: Mclaren Commercial |
$14,471.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,863.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,667.70
|
| Rate for Payer: Nomi Health Commercial |
$13,185.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,059.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,088.99
|
| Rate for Payer: Priority Health Narrow Network |
$11,271.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,150.09
|
|
|
GOLIMUMAB 50 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$16,079.65
|
|
|
Service Code
|
NDC 57894007001
|
| Hospital Charge Code |
97696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12,059.74 |
| Max. Negotiated Rate |
$16,079.65 |
| Rate for Payer: Aetna Commercial |
$14,471.68
|
| Rate for Payer: ASR ASR |
$15,597.26
|
| Rate for Payer: BCBS Trust/PPO |
$13,204.61
|
| Rate for Payer: BCN Commercial |
$13,204.61
|
| Rate for Payer: Cash Price |
$12,863.72
|
| Rate for Payer: Cofinity Commercial |
$15,114.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,863.72
|
| Rate for Payer: Healthscope Commercial |
$15,597.26
|
| Rate for Payer: Healthscope Whirlpool |
$16,079.65
|
| Rate for Payer: Mclaren Commercial |
$14,471.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,667.70
|
| Rate for Payer: Nomi Health Commercial |
$13,185.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,059.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,150.09
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.10
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: ASR ASR |
$6.89
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Mclaren Commercial |
$6.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.25
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.82
|
|
|
Service Code
|
NDC 121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: ASR ASR |
$7.59
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Healthscope Whirlpool |
$7.82
|
| Rate for Payer: Mclaren Commercial |
$7.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.65
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.86
|
| Rate for Payer: Priority Health Narrow Network |
$5.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.89
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.10
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: ASR ASR |
$6.89
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Mclaren Commercial |
$6.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.25
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.10
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: ASR ASR |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.83
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Mclaren Commercial |
$6.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.25
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.10
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: ASR ASR |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.83
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Mclaren Commercial |
$6.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: Nomi Health Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.25
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.82
|
|
|
Service Code
|
NDC 121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: ASR ASR |
$7.59
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.26
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Healthscope Whirlpool |
$7.82
|
| Rate for Payer: Mclaren Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.65
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.89
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$405.60
|
|
|
Service Code
|
NDC 904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.20 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: ASR ASR |
$393.43
|
| Rate for Payer: BCBS Trust/PPO |
$333.08
|
| Rate for Payer: BCN Commercial |
$333.08
|
| Rate for Payer: Cash Price |
$324.48
|
| Rate for Payer: Cofinity Commercial |
$381.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.48
|
| Rate for Payer: Healthscope Commercial |
$393.43
|
| Rate for Payer: Healthscope Whirlpool |
$405.60
|
| Rate for Payer: Mclaren Commercial |
$365.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.76
|
| Rate for Payer: Nomi Health Commercial |
$332.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.93
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$580.80
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$522.72
|
| Rate for Payer: ASR ASR |
$563.38
|
| Rate for Payer: BCBS Trust/PPO |
$476.95
|
| Rate for Payer: BCN Commercial |
$476.95
|
| Rate for Payer: Cash Price |
$464.64
|
| Rate for Payer: Cofinity Commercial |
$545.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.64
|
| Rate for Payer: Healthscope Commercial |
$563.38
|
| Rate for Payer: Healthscope Whirlpool |
$580.80
|
| Rate for Payer: Mclaren Commercial |
$522.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.68
|
| Rate for Payer: Nomi Health Commercial |
$476.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$511.10
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$580.80
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$522.72
|
| Rate for Payer: Aetna Medicare |
$214.90
|
| Rate for Payer: ASR ASR |
$563.38
|
| Rate for Payer: BCBS Complete |
$232.32
|
| Rate for Payer: BCBS Trust/PPO |
$478.87
|
| Rate for Payer: BCN Commercial |
$478.87
|
| Rate for Payer: Cash Price |
$464.64
|
| Rate for Payer: Cofinity Commercial |
$545.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.64
|
| Rate for Payer: Healthscope Commercial |
$563.38
|
| Rate for Payer: Healthscope Whirlpool |
$580.80
|
| Rate for Payer: Mclaren Commercial |
$522.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$464.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.68
|
| Rate for Payer: Nomi Health Commercial |
$476.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$508.90
|
| Rate for Payer: Priority Health Narrow Network |
$407.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$511.10
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna Commercial |
$5.23
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.63
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.11
|
|
|
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 |
$202.35 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$242.82
|
| Rate for Payer: ASR ASR |
$261.71
|
| Rate for Payer: BCBS Trust/PPO |
$221.56
|
| Rate for Payer: BCN Commercial |
$221.56
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$253.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$261.71
|
| Rate for Payer: Healthscope Whirlpool |
$269.80
|
| Rate for Payer: Mclaren Commercial |
$242.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Nomi Health Commercial |
$221.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.42
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$405.60
|
|
|
Service Code
|
NDC 904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.07 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Medicare |
$150.07
|
| Rate for Payer: ASR ASR |
$393.43
|
| Rate for Payer: BCBS Complete |
$162.24
|
| Rate for Payer: BCBS Trust/PPO |
$334.42
|
| Rate for Payer: BCN Commercial |
$334.42
|
| Rate for Payer: Cash Price |
$324.48
|
| Rate for Payer: Cofinity Commercial |
$381.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.48
|
| Rate for Payer: Healthscope Commercial |
$393.43
|
| Rate for Payer: Healthscope Whirlpool |
$405.60
|
| Rate for Payer: Mclaren Commercial |
$365.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.76
|
| Rate for Payer: Nomi Health Commercial |
$332.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$355.39
|
| Rate for Payer: Priority Health Narrow Network |
$284.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.93
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna Commercial |
$5.23
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: ASR ASR |
$5.63
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.79
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.63
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.09
|
| Rate for Payer: Priority Health Narrow Network |
$4.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.11
|
|
|
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 |
$269.80 |
| Rate for Payer: Aetna Commercial |
$242.82
|
| Rate for Payer: Aetna Medicare |
$99.83
|
| Rate for Payer: ASR ASR |
$261.71
|
| Rate for Payer: BCBS Complete |
$107.92
|
| Rate for Payer: BCBS Trust/PPO |
$222.45
|
| Rate for Payer: BCN Commercial |
$222.45
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$253.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$261.71
|
| Rate for Payer: Healthscope Whirlpool |
$269.80
|
| Rate for Payer: Mclaren Commercial |
$242.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Nomi Health Commercial |
$221.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.40
|
| Rate for Payer: Priority Health Narrow Network |
$189.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.42
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$63.65
|
|
|
Service Code
|
NDC 63824000832
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cofinity Commercial |
$59.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: Healthscope Whirlpool |
$63.65
|
| Rate for Payer: Mclaren Commercial |
$57.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.10
|
| Rate for Payer: Nomi Health Commercial |
$52.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.01
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$63.65
|
|
|
Service Code
|
NDC 63824000832
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$23.55
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: BCBS Complete |
$25.46
|
| Rate for Payer: BCBS Trust/PPO |
$52.48
|
| Rate for Payer: BCN Commercial |
$52.48
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cofinity Commercial |
$59.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.92
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: Healthscope Whirlpool |
$63.65
|
| Rate for Payer: Mclaren Commercial |
$57.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.10
|
| Rate for Payer: Nomi Health Commercial |
$52.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.77
|
| Rate for Payer: Priority Health Narrow Network |
$44.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.01
|
|
