|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
NDC 50268035811
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.67
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cofinity Advantage |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health SBD |
$2.58
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$204.73
|
|
|
Service Code
|
NDC 50268035815
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$184.26 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.07
|
| Rate for Payer: Cash Price |
$163.78
|
| Rate for Payer: Cofinity Advantage |
$143.31
|
| Rate for Payer: Cofinity Commercial |
$176.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.78
|
| Rate for Payer: Healthscope Commercial |
$184.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.55
|
| Rate for Payer: PHP Commercial |
$174.02
|
| Rate for Payer: Priority Health SBD |
$128.98
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
NDC 50268035815
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$184.26 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Aetna Medicare |
$102.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.07
|
| Rate for Payer: BCBS Complete |
$81.89
|
| Rate for Payer: Cash Price |
$163.78
|
| Rate for Payer: Cofinity Advantage |
$143.31
|
| Rate for Payer: Cofinity Commercial |
$176.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.78
|
| Rate for Payer: Healthscope Commercial |
$184.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.55
|
| Rate for Payer: PHP Commercial |
$174.02
|
| Rate for Payer: Priority Health SBD |
$128.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.07
|
| Rate for Payer: UHC Core |
$106.66
|
| Rate for Payer: UHC Exchange |
$80.46
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
NDC 50268035811
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cofinity Advantage |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: UHC Exchange |
$1.61
|
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 16729000101
|
| Hospital Charge Code |
16355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.81
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$126.35
|
|
|
Service Code
|
NDC 50268036115
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$107.40
|
| Rate for Payer: Aetna Medicare |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.13
|
| Rate for Payer: BCBS Complete |
$50.54
|
| Rate for Payer: Cash Price |
$101.08
|
| Rate for Payer: Cofinity Advantage |
$88.44
|
| Rate for Payer: Cofinity Commercial |
$108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.08
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.76
|
| Rate for Payer: PHP Commercial |
$107.40
|
| Rate for Payer: Priority Health SBD |
$79.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.13
|
| Rate for Payer: UHC Core |
$65.83
|
| Rate for Payer: UHC Exchange |
$49.66
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.87 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.00
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Advantage |
$144.31
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$185.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health SBD |
$129.87
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: Aetna Medicare |
$103.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.00
|
| Rate for Payer: BCBS Complete |
$82.46
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Advantage |
$144.31
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$185.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health SBD |
$129.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.00
|
| Rate for Payer: UHC Core |
$107.40
|
| Rate for Payer: UHC Exchange |
$81.02
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.53
|
|
|
Service Code
|
NDC 50268036111
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna Commercial |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Advantage |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.90
|
| Rate for Payer: PHP Commercial |
$2.15
|
| Rate for Payer: Priority Health SBD |
$1.59
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$126.35
|
|
|
Service Code
|
NDC 50268036115
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$107.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.13
|
| Rate for Payer: Cash Price |
$101.08
|
| Rate for Payer: Cofinity Advantage |
$88.44
|
| Rate for Payer: Cofinity Commercial |
$108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.08
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.76
|
| Rate for Payer: PHP Commercial |
$107.40
|
| Rate for Payer: Priority Health SBD |
$79.60
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$2.53
|
|
|
Service Code
|
NDC 50268036111
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna Commercial |
$2.15
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Advantage |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.90
|
| Rate for Payer: PHP Commercial |
$2.15
|
| Rate for Payer: Priority Health SBD |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.64
|
| Rate for Payer: UHC Core |
$1.32
|
| Rate for Payer: UHC Exchange |
$0.99
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna Medicare |
$113.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.58
|
| Rate for Payer: BCBS Complete |
$90.82
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Advantage |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health SBD |
$143.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.58
|
| Rate for Payer: UHC Core |
$118.29
|
| Rate for Payer: UHC Exchange |
$89.23
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$227.05
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.04 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.58
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Advantage |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health SBD |
$143.04
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: Priority Health SBD |
$4.04
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: BCBS Complete |
$2.57
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: Priority Health SBD |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: UHC Exchange |
$2.52
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
NDC 00591090030
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Advantage |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.50
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.84
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Exchange |
$30.13
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$192.53
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.66 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: BCBS Complete |
$77.01
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Advantage |
$134.77
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: PHP Commercial |
$163.65
|
| Rate for Payer: Priority Health SBD |
$121.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.14
|
| Rate for Payer: UHC Core |
$100.31
|
| Rate for Payer: UHC Exchange |
$75.66
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$192.53
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.29 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.14
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Advantage |
$134.77
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$173.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: PHP Commercial |
$163.65
|
| Rate for Payer: Priority Health SBD |
$121.29
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
NDC 00591090030
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Advantage |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.50
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health SBD |
$48.30
|
|
|
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 41120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,455.29
|
| Rate for Payer: BCN Commercial |
$3,455.29
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,021.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$919.59 |
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Medicare |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.91
|
| Rate for Payer: BCBS Complete |
$80.36
|
| Rate for Payer: BCBS MAPPO |
$146.33
|
| Rate for Payer: BCBS Trust/PPO |
$413.61
|
| Rate for Payer: BCN Commercial |
$413.61
|
| Rate for Payer: BCN Medicare Advantage |
$146.33
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cofinity Advantage |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.33
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Mclaren Medicaid |
$76.53
|
| Rate for Payer: Mclaren Medicare |
$146.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.65
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: Nomi Health Commercial |
$438.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$766.33
|
| Rate for Payer: PACE Medicare |
$139.01
|
| Rate for Payer: PACE SWMI |
$146.33
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: PHP Medicare Advantage |
$146.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$575.43
|
| Rate for Payer: Priority Health Medicare |
$146.33
|
| Rate for Payer: Priority Health SBD |
$643.72
|
| Rate for Payer: Priority Health Tiered Network |
$460.34
|
| Rate for Payer: Railroad Medicare Medicare |
$146.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.02
|
| Rate for Payer: UHC Core |
$272.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.33
|
| Rate for Payer: UHC Exchange |
$272.02
|
| Rate for Payer: UHC Medicaid |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$76.53
|
| Rate for Payer: VA VA |
$146.33
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,021.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$643.72 |
| Max. Negotiated Rate |
$919.59 |
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cofinity Advantage |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$766.33
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: Priority Health SBD |
$643.72
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$426.98
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.55
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Advantage |
$298.89
|
| Rate for Payer: Cofinity Advantage |
$298.90
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: Priority Health SBD |
$269.00
|
| Rate for Payer: Priority Health SBD |
$269.01
|
|
