|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$213.85
|
|
|
Service Code
|
NDC 59651026901
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: ASR ASR |
$207.43
|
| Rate for Payer: ASR Commercial |
$207.43
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: BCBS Trust/PPO |
$175.12
|
| Rate for Payer: BCN Commercial |
$165.80
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$213.85
|
| Rate for Payer: Healthscope Whirlpool |
$207.43
|
| Rate for Payer: Mclaren Commercial |
$192.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Nomi Health Commercial |
$175.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.38
|
| Rate for Payer: Priority Health Narrow Network |
$149.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.19
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$481.14
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.74 |
| Max. Negotiated Rate |
$481.14 |
| Rate for Payer: Aetna Commercial |
$433.03
|
| Rate for Payer: Aetna Commercial |
$433.04
|
| Rate for Payer: ASR ASR |
$466.73
|
| Rate for Payer: ASR ASR |
$466.71
|
| Rate for Payer: ASR Commercial |
$466.73
|
| Rate for Payer: ASR Commercial |
$466.71
|
| Rate for Payer: BCBS Trust/PPO |
$392.10
|
| Rate for Payer: BCBS Trust/PPO |
$392.08
|
| Rate for Payer: BCN Commercial |
$373.04
|
| Rate for Payer: BCN Commercial |
$373.03
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cofinity Commercial |
$452.29
|
| Rate for Payer: Cofinity Commercial |
$452.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.93
|
| Rate for Payer: Healthscope Commercial |
$481.14
|
| Rate for Payer: Healthscope Commercial |
$481.16
|
| Rate for Payer: Healthscope Whirlpool |
$466.73
|
| Rate for Payer: Healthscope Whirlpool |
$466.71
|
| Rate for Payer: Mclaren Commercial |
$433.03
|
| Rate for Payer: Mclaren Commercial |
$433.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.97
|
| Rate for Payer: Nomi Health Commercial |
$394.55
|
| Rate for Payer: Nomi Health Commercial |
$394.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.42
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$481.16
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$433.04
|
| Rate for Payer: Aetna Commercial |
$433.03
|
| Rate for Payer: Aetna Medicare |
$148.99
|
| Rate for Payer: Aetna Medicare |
$148.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: ASR ASR |
$466.73
|
| Rate for Payer: ASR ASR |
$466.71
|
| Rate for Payer: ASR Commercial |
$466.71
|
| Rate for Payer: ASR Commercial |
$466.73
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.01
|
| Rate for Payer: BCBS Trust/PPO |
$394.02
|
| Rate for Payer: BCN Commercial |
$373.03
|
| Rate for Payer: BCN Commercial |
$373.04
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cofinity Commercial |
$452.29
|
| Rate for Payer: Cofinity Commercial |
$452.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$481.16
|
| Rate for Payer: Healthscope Commercial |
$481.14
|
| Rate for Payer: Healthscope Whirlpool |
$466.71
|
| Rate for Payer: Healthscope Whirlpool |
$466.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$148.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$148.99
|
| Rate for Payer: Mclaren Commercial |
$433.03
|
| Rate for Payer: Mclaren Commercial |
$433.04
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.97
|
| Rate for Payer: Nomi Health Commercial |
$394.53
|
| Rate for Payer: Nomi Health Commercial |
$394.55
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PHP Commercial |
$163.89
|
| Rate for Payer: PHP Commercial |
$163.89
|
| Rate for Payer: PHP Medicaid |
$79.86
|
| Rate for Payer: PHP Medicaid |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.59
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Priority Health Narrow Network |
$337.29
|
| Rate for Payer: Priority Health Narrow Network |
$337.28
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Exchange |
$230.93
|
| Rate for Payer: UHC Exchange |
$230.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHCCP DNSP |
$148.99
|
| Rate for Payer: UHCCP DNSP |
$148.99
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: VA VA |
$148.99
|
| Rate for Payer: VA VA |
$148.99
|
|
|
GLYBURIDE 5 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.84 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$42.30
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: ASR Commercial |
$82.06
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: BCBS Trust/PPO |
$69.28
|
| Rate for Payer: BCN Commercial |
$65.59
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: Healthscope Whirlpool |
$82.06
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.13
|
| Rate for Payer: Priority Health Narrow Network |
$59.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
GLYBURIDE 5 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: ASR Commercial |
$82.06
|
| Rate for Payer: BCBS Trust/PPO |
$68.94
|
| Rate for Payer: BCN Commercial |
$65.59
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: Healthscope Whirlpool |
$82.06
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$37.57
|
| Rate for Payer: ASR ASR |
$40.49
|
| Rate for Payer: ASR Commercial |
$40.49
|
| Rate for Payer: BCBS Trust/PPO |
$34.01
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$41.74
|
| Rate for Payer: Healthscope Whirlpool |
$40.49
|
| Rate for Payer: Mclaren Commercial |
$37.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.73
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$35.81
|
|
|
Service Code
|
NDC 00132007912
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: ASR ASR |
$34.74
|
| Rate for Payer: ASR Commercial |
$34.74
|
| Rate for Payer: BCBS Trust/PPO |
$29.18
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Healthscope Whirlpool |
$34.74
|
| Rate for Payer: Mclaren Commercial |
$32.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.51
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$35.81
|
|
|
Service Code
|
NDC 00132007912
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: ASR ASR |
$34.74
|
| Rate for Payer: ASR Commercial |
$34.74
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.32
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Healthscope Whirlpool |
$34.74
|
| Rate for Payer: Mclaren Commercial |
$32.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Narrow Network |
$25.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.51
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$37.57
|
| Rate for Payer: Aetna Medicare |
$20.87
|
| Rate for Payer: ASR ASR |
$40.49
|
| Rate for Payer: ASR Commercial |
$40.49
|
| Rate for Payer: BCBS Complete |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$41.74
|
| Rate for Payer: Healthscope Whirlpool |
$40.49
|
| Rate for Payer: Mclaren Commercial |
$37.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Narrow Network |
$29.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.73
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$37.51
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$37.51 |
| Rate for Payer: Aetna Commercial |
$33.76
|
| Rate for Payer: Aetna Medicare |
$18.75
|
| Rate for Payer: ASR ASR |
$36.38
|
| Rate for Payer: ASR Commercial |
$36.38
|
| Rate for Payer: BCBS Complete |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.72
|
| Rate for Payer: BCN Commercial |
$29.08
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cofinity Commercial |
$35.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$37.51
|
| Rate for Payer: Healthscope Whirlpool |
$36.38
|
| Rate for Payer: Mclaren Commercial |
$33.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.88
|
| Rate for Payer: Nomi Health Commercial |
$30.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.87
|
| Rate for Payer: Priority Health Narrow Network |
$26.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.01
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$37.51
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$37.51 |
| Rate for Payer: Aetna Commercial |
$33.76
|
| Rate for Payer: ASR ASR |
$36.38
|
| Rate for Payer: ASR Commercial |
$36.38
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: BCN Commercial |
$29.08
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cofinity Commercial |
$35.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$37.51
|
| Rate for Payer: Healthscope Whirlpool |
$36.38
|
| Rate for Payer: Mclaren Commercial |
$33.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.88
|
| Rate for Payer: Nomi Health Commercial |
$30.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.01
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.19
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Commercial |
$34.37
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: ASR ASR |
$37.04
|
| Rate for Payer: ASR Commercial |
$37.04
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$31.27
|
| Rate for Payer: BCN Commercial |
$29.61
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$35.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$38.19
|
| Rate for Payer: Healthscope Whirlpool |
$37.04
|
| Rate for Payer: Mclaren Commercial |
$34.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.46
|
| Rate for Payer: Priority Health Narrow Network |
$26.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.61
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Commercial |
$34.37
|
| Rate for Payer: ASR ASR |
$37.04
|
| Rate for Payer: ASR Commercial |
$37.04
|
| Rate for Payer: BCBS Trust/PPO |
$31.12
|
| Rate for Payer: BCN Commercial |
$29.61
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$35.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$38.19
|
| Rate for Payer: Healthscope Whirlpool |
$37.04
|
| Rate for Payer: Mclaren Commercial |
$34.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.61
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.42
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$15.42 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: ASR ASR |
$23.45
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$73.21
|
| Rate for Payer: ASR ASR |
$14.96
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR Commercial |
$73.21
|
| Rate for Payer: ASR Commercial |
$14.43
|
| Rate for Payer: ASR Commercial |
$23.45
|
| Rate for Payer: ASR Commercial |
$14.96
|
| Rate for Payer: ASR Commercial |
$12.80
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$61.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: BCN Commercial |
$11.54
|
| Rate for Payer: BCN Commercial |
$58.51
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$70.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Commercial |
$75.47
|
| Rate for Payer: Healthscope Commercial |
$14.88
|
| Rate for Payer: Healthscope Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Healthscope Whirlpool |
$23.45
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$73.21
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$21.76
|
| Rate for Payer: Mclaren Commercial |
$13.88
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$67.92
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Nomi Health Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Nomi Health Commercial |
$12.64
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Nomi Health Commercial |
$19.83
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.88
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$14.88 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: ASR ASR |
$23.45
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR ASR |
$73.21
|
| Rate for Payer: ASR ASR |
$14.96
|
| Rate for Payer: ASR Commercial |
$14.43
|
| Rate for Payer: ASR Commercial |
$12.80
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: ASR Commercial |
$14.96
|
| Rate for Payer: ASR Commercial |
$73.21
|
| Rate for Payer: ASR Commercial |
$23.45
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS Trust/PPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.81
|
| Rate for Payer: BCBS Trust/PPO |
$12.63
|
| Rate for Payer: BCBS Trust/PPO |
$61.80
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$11.54
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: BCN Commercial |
$58.51
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$70.94
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$14.88
|
| Rate for Payer: Healthscope Commercial |
$75.47
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Healthscope Whirlpool |
$23.45
|
| Rate for Payer: Healthscope Whirlpool |
$73.21
|
| Rate for Payer: Healthscope Whirlpool |
$14.96
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.46
|
| Rate for Payer: Mclaren Commercial |
$13.88
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$67.92
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$21.76
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicaid |
$0.25
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Mclaren Medicare |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: Meridian Medicaid |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.65
|
| Rate for Payer: Nomi Health Commercial |
$12.64
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: Nomi Health Commercial |
$19.83
|
| Rate for Payer: Nomi Health Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE Medicare |
$0.44
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicaid |
$0.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.52
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Narrow Network |
$8.42
|
| Rate for Payer: Priority Health Narrow Network |
$52.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.95
|
| Rate for Payer: Priority Health Narrow Network |
$10.43
|
| Rate for Payer: Priority Health Narrow Network |
$9.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.81
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.46
|
| 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 |
$21.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP DNSP |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: UHCCP Medicaid |
$0.25
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
| Rate for Payer: VA VA |
$0.46
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
OP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.07 |
| Max. Negotiated Rate |
$442.67 |
| Rate for Payer: Aetna Commercial |
$398.40
|
| Rate for Payer: Aetna Medicare |
$221.34
|
| Rate for Payer: ASR ASR |
$429.39
|
| Rate for Payer: ASR Commercial |
$429.39
|
| Rate for Payer: BCBS Complete |
$177.07
|
| Rate for Payer: BCBS Trust/PPO |
$362.50
|
| Rate for Payer: BCN Commercial |
$343.20
|
| Rate for Payer: Cash Price |
$354.13
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Healthscope Commercial |
$442.67
|
| Rate for Payer: Healthscope Whirlpool |
$429.39
|
| 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: Priority Health Cigna Priority Health |
$287.74
|
| Rate for Payer: 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
|
|
|
GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)
|
Facility
|
IP
|
$442.67
|
|
|
Service Code
|
NDC 00900000230
|
| Hospital Charge Code |
158482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$442.67 |
| Rate for Payer: Aetna Commercial |
$398.40
|
| Rate for Payer: ASR ASR |
$429.39
|
| Rate for Payer: ASR Commercial |
$429.39
|
| Rate for Payer: BCBS Trust/PPO |
$360.73
|
| Rate for Payer: BCN Commercial |
$343.20
|
| Rate for Payer: Cash Price |
$354.13
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.14
|
| Rate for Payer: Healthscope Commercial |
$442.67
|
| Rate for Payer: Healthscope Whirlpool |
$429.39
|
| 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: Priority Health Cigna Priority Health |
$287.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.55
|
|
|
GOLIMUMAB 100 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$18,500.87
|
|
|
Service Code
|
NDC 57894007102
|
| Hospital Charge Code |
167382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,400.35 |
| Max. Negotiated Rate |
$18,500.87 |
| Rate for Payer: Aetna Commercial |
$16,650.78
|
| Rate for Payer: Aetna Medicare |
$9,250.43
|
| Rate for Payer: ASR ASR |
$17,945.84
|
| Rate for Payer: ASR Commercial |
$17,945.84
|
| Rate for Payer: BCBS Complete |
$7,400.35
|
| Rate for Payer: BCBS Trust/PPO |
$15,150.36
|
| Rate for Payer: BCN Commercial |
$14,343.72
|
| Rate for Payer: Cash Price |
$14,800.70
|
| Rate for Payer: Cofinity Commercial |
$17,390.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,800.70
|
| Rate for Payer: Healthscope Commercial |
$18,500.87
|
| Rate for Payer: Healthscope Whirlpool |
$17,945.84
|
| Rate for Payer: Mclaren Commercial |
$16,650.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,725.74
|
| Rate for Payer: Nomi Health Commercial |
$15,170.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,025.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,210.46
|
| Rate for Payer: Priority Health Narrow Network |
$12,969.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,280.77
|
|
|
GOLIMUMAB 100 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$18,500.87
|
|
|
Service Code
|
NDC 57894007102
|
| Hospital Charge Code |
167382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12,025.57 |
| Max. Negotiated Rate |
$18,500.87 |
| Rate for Payer: Aetna Commercial |
$16,650.78
|
| Rate for Payer: ASR ASR |
$17,945.84
|
| Rate for Payer: ASR Commercial |
$17,945.84
|
| Rate for Payer: BCBS Trust/PPO |
$15,076.36
|
| Rate for Payer: BCN Commercial |
$14,343.72
|
| Rate for Payer: Cash Price |
$14,800.70
|
| Rate for Payer: Cofinity Commercial |
$17,390.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,800.70
|
| Rate for Payer: Healthscope Commercial |
$18,500.87
|
| Rate for Payer: Healthscope Whirlpool |
$17,945.84
|
| Rate for Payer: Mclaren Commercial |
$16,650.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,725.74
|
| Rate for Payer: Nomi Health Commercial |
$15,170.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,025.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,280.77
|
|
|
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 |
$4,052.34 |
| 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: ASR Commercial |
$6,047.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,080.39
|
| Rate for Payer: BCN Commercial |
$4,833.51
|
| Rate for Payer: Cash Price |
$4,987.49
|
| Rate for Payer: Cofinity Commercial |
$5,860.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Healthscope Commercial |
$6,234.37
|
| Rate for Payer: Healthscope Whirlpool |
$6,047.34
|
| 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: Priority Health Cigna Priority Health |
$4,052.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,486.25
|
|
|
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 |
$5.92 |
| Max. Negotiated Rate |
$6,234.37 |
| Rate for Payer: Aetna Commercial |
$5,610.93
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.80
|
| Rate for Payer: ASR ASR |
$6,047.34
|
| Rate for Payer: ASR Commercial |
$6,047.34
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS MAPPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,105.33
|
| Rate for Payer: BCN Commercial |
$4,833.51
|
| Rate for Payer: BCN Medicare Advantage |
$11.04
|
| 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 |
$4,987.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$6,234.37
|
| Rate for Payer: Healthscope Whirlpool |
$6,047.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.04
|
| Rate for Payer: Mclaren Commercial |
$5,610.93
|
| Rate for Payer: Mclaren Medicaid |
$5.92
|
| Rate for Payer: Mclaren Medicare |
$11.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.59
|
| Rate for Payer: Meridian Medicaid |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: Nomi Health Commercial |
$5,112.18
|
| Rate for Payer: PACE Medicare |
$10.49
|
| Rate for Payer: PACE SWMI |
$11.04
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicaid |
$5.92
|
| Rate for Payer: PHP Medicare Advantage |
$11.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,052.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,462.55
|
| Rate for Payer: Priority Health Medicare |
$11.04
|
| Rate for Payer: Priority Health Narrow Network |
$4,370.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,486.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.04
|
| Rate for Payer: UHC Exchange |
$17.11
|
| Rate for Payer: UHC Medicare Advantage |
$11.04
|
| Rate for Payer: UHCCP DNSP |
$11.04
|
| Rate for Payer: UHCCP Medicaid |
$5.92
|
| Rate for Payer: VA VA |
$11.04
|
|
|
GOLIMUMAB 50 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$15,461.19
|
|
|
Service Code
|
NDC 57894007001
|
| Hospital Charge Code |
97696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,184.48 |
| Max. Negotiated Rate |
$15,461.19 |
| Rate for Payer: Aetna Commercial |
$13,915.07
|
| Rate for Payer: Aetna Medicare |
$7,730.60
|
| Rate for Payer: ASR ASR |
$14,997.35
|
| Rate for Payer: ASR Commercial |
$14,997.35
|
| Rate for Payer: BCBS Complete |
$6,184.48
|
| Rate for Payer: BCBS Trust/PPO |
$12,661.17
|
| Rate for Payer: BCN Commercial |
$11,987.06
|
| Rate for Payer: Cash Price |
$12,368.95
|
| Rate for Payer: Cofinity Commercial |
$14,533.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,368.95
|
| Rate for Payer: Healthscope Commercial |
$15,461.19
|
| Rate for Payer: Healthscope Whirlpool |
$14,997.35
|
| Rate for Payer: Mclaren Commercial |
$13,915.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,142.01
|
| Rate for Payer: Nomi Health Commercial |
$12,678.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,049.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,547.09
|
| Rate for Payer: Priority Health Narrow Network |
$10,838.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,605.85
|
|
|
GOLIMUMAB 50 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$15,461.19
|
|
|
Service Code
|
NDC 57894007001
|
| Hospital Charge Code |
97696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,049.77 |
| Max. Negotiated Rate |
$15,461.19 |
| Rate for Payer: Aetna Commercial |
$13,915.07
|
| Rate for Payer: ASR ASR |
$14,997.35
|
| Rate for Payer: ASR Commercial |
$14,997.35
|
| Rate for Payer: BCBS Trust/PPO |
$12,599.32
|
| Rate for Payer: BCN Commercial |
$11,987.06
|
| Rate for Payer: Cash Price |
$12,368.95
|
| Rate for Payer: Cofinity Commercial |
$14,533.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,368.95
|
| Rate for Payer: Healthscope Commercial |
$15,461.19
|
| Rate for Payer: Healthscope Whirlpool |
$14,997.35
|
| Rate for Payer: Mclaren Commercial |
$13,915.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,142.01
|
| Rate for Payer: Nomi Health Commercial |
$12,678.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,049.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,605.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: ASR ASR |
$7.55
|
| Rate for Payer: ASR Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.37
|
| Rate for Payer: BCN Commercial |
$6.03
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Healthscope Whirlpool |
$7.55
|
| Rate for Payer: Mclaren Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 50383006305
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Healthscope Whirlpool |
$2.58
|
| Rate for Payer: Mclaren Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Nomi Health Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
