|
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
|
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 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 |
$9,250.44
|
| 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 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 |
$5.65 |
| Max. Negotiated Rate |
$6,234.37 |
| Rate for Payer: Aetna Commercial |
$5,610.93
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: ASR ASR |
$6,047.34
|
| Rate for Payer: ASR Commercial |
$6,047.34
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$5,105.33
|
| Rate for Payer: BCN Commercial |
$4,833.51
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| 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 |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$6,234.37
|
| Rate for Payer: Healthscope Whirlpool |
$6,047.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.54
|
| Rate for Payer: Mclaren Commercial |
$5,610.93
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| 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 |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.59
|
| Rate for Payer: PHP Medicaid |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,052.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.18
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,486.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP DNSP |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: VA VA |
$10.54
|
|
|
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
|
|
|
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
|
|
|
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
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 50383006305
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| 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: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: ASR ASR |
$7.55
|
| Rate for Payer: ASR Commercial |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.34
|
| 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: UHC All Payor (Choice/PPO) + Core |
$6.85
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 81033010251
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.19
|
| Rate for Payer: Priority Health Narrow Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
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
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.19
|
| Rate for Payer: Priority Health Narrow Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 81033010205
|
| Hospital Charge Code |
3542
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$6.85
|
| Rate for Payer: ASR Commercial |
$6.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$7.06
|
| Rate for Payer: Healthscope Whirlpool |
$6.85
|
| Rate for Payer: Mclaren Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.21
|
|
|
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 |
$25.46 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: ASR Commercial |
$61.74
|
| Rate for Payer: BCBS Complete |
$25.46
|
| Rate for Payer: BCBS Trust/PPO |
$52.12
|
| Rate for Payer: BCN Commercial |
$49.35
|
| 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 |
$63.65
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| 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: Priority Health Cigna Priority Health |
$41.37
|
| Rate for Payer: 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
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: ASR ASR |
$352.46
|
| Rate for Payer: ASR Commercial |
$352.46
|
| Rate for Payer: BCBS Trust/PPO |
$296.10
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Commercial |
$341.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$363.36
|
| Rate for Payer: Healthscope Whirlpool |
$352.46
|
| Rate for Payer: Mclaren Commercial |
$327.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.76
|
|
|
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 |
$175.37 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$242.82
|
| Rate for Payer: ASR ASR |
$261.71
|
| Rate for Payer: ASR Commercial |
$261.71
|
| Rate for Payer: BCBS Trust/PPO |
$219.86
|
| Rate for Payer: BCN Commercial |
$209.18
|
| 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 |
$269.80
|
| Rate for Payer: Healthscope Whirlpool |
$261.71
|
| 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: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.42
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: ASR ASR |
$3.52
|
| Rate for Payer: ASR Commercial |
$3.52
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.18
|
| Rate for Payer: Priority Health Narrow Network |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Aetna Medicare |
$165.12
|
| Rate for Payer: ASR ASR |
$320.33
|
| Rate for Payer: ASR Commercial |
$320.33
|
| Rate for Payer: BCBS Complete |
$132.10
|
| Rate for Payer: BCBS Trust/PPO |
$270.43
|
| Rate for Payer: BCN Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$310.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$330.24
|
| Rate for Payer: Healthscope Whirlpool |
$320.33
|
| Rate for Payer: Mclaren Commercial |
$297.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: Nomi Health Commercial |
$270.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.36
|
| Rate for Payer: Priority Health Narrow Network |
$231.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.61
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084057211
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: ASR ASR |
$3.52
|
| Rate for Payer: ASR Commercial |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.19
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$363.36
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: Aetna Medicare |
$181.68
|
| Rate for Payer: ASR ASR |
$352.46
|
| Rate for Payer: ASR Commercial |
$352.46
|
| Rate for Payer: BCBS Complete |
$145.34
|
| Rate for Payer: BCBS Trust/PPO |
$297.56
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$290.69
|
| Rate for Payer: Cofinity Commercial |
$341.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.69
|
| Rate for Payer: Healthscope Commercial |
$363.36
|
| Rate for Payer: Healthscope Whirlpool |
$352.46
|
| Rate for Payer: Mclaren Commercial |
$327.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$297.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.38
|
| Rate for Payer: Priority Health Narrow Network |
$254.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.76
|
|
|
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 |
$41.37 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: ASR ASR |
$61.74
|
| Rate for Payer: ASR Commercial |
$61.74
|
| Rate for Payer: BCBS Trust/PPO |
$51.87
|
| Rate for Payer: BCN Commercial |
$49.35
|
| 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 |
$63.65
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| 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: Priority Health Cigna Priority Health |
$41.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.01
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 00904671839
|
| Hospital Charge Code |
170771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.66 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: ASR ASR |
$320.33
|
| Rate for Payer: ASR Commercial |
$320.33
|
| Rate for Payer: BCBS Trust/PPO |
$269.11
|
| Rate for Payer: BCN Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$310.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$330.24
|
| Rate for Payer: Healthscope Whirlpool |
$320.33
|
| Rate for Payer: Mclaren Commercial |
$297.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: Nomi Health Commercial |
$270.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.61
|
|
