|
GLIPIZIDE 2.5 MG CUSTOM TABLET
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 09900000356
|
| Hospital Charge Code |
158688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.72
|
| Rate for Payer: BCN Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
GLIPIZIDE 2.5 MG CUSTOM TABLET
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 09900000356
|
| Hospital Charge Code |
158688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: Meridian Medicaid |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.86
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.75
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.38
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Mclaren Medicaid |
$0.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.54
|
| Rate for Payer: Meridian Medicaid |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.80
|
| Rate for Payer: Priority Health Medicare |
$0.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.82
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicaid |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: UHCCP Medicaid |
$0.36
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: Aetna Medicare |
$53.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.42
|
| Rate for Payer: BCBS Complete |
$38.16
|
| Rate for Payer: BCBS MAPPO |
$51.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.48
|
| Rate for Payer: BCN Commercial |
$169.48
|
| Rate for Payer: BCN Medicare Advantage |
$51.54
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.54
|
| Rate for Payer: Healthscope Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Mclaren Medicaid |
$36.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.11
|
| Rate for Payer: Meridian Medicaid |
$38.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PACE Senior Care Partners |
$48.96
|
| Rate for Payer: PACE SWMI |
$51.54
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: PHP Medicare Advantage |
$51.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.35
|
| Rate for Payer: Priority Health Medicare |
$52.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.41
|
| Rate for Payer: UHC Core |
$172.14
|
| Rate for Payer: UHC Exchange |
$51.54
|
| Rate for Payer: UHC Medicaid |
$36.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.54
|
| Rate for Payer: UHCCP Medicaid |
$36.34
|
| Rate for Payer: VA VA |
$51.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna Medicare |
$59.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.95
|
| Rate for Payer: BCBS Complete |
$42.03
|
| Rate for Payer: BCBS MAPPO |
$56.76
|
| Rate for Payer: BCBS Trust/PPO |
$186.66
|
| Rate for Payer: BCN Commercial |
$186.66
|
| Rate for Payer: BCN Medicare Advantage |
$56.76
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.76
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.29
|
| Rate for Payer: Mclaren Medicaid |
$40.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.60
|
| Rate for Payer: Meridian Medicaid |
$42.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PACE Senior Care Partners |
$53.92
|
| Rate for Payer: PACE SWMI |
$56.76
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: PHP Medicare Advantage |
$56.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.53
|
| Rate for Payer: Priority Health Medicare |
$57.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.03
|
| Rate for Payer: Railroad Medicare Medicare |
$56.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.80
|
| Rate for Payer: UHC Core |
$189.59
|
| Rate for Payer: UHC Exchange |
$56.76
|
| Rate for Payer: UHC Medicaid |
$40.03
|
| Rate for Payer: UHC Medicare Advantage |
$56.76
|
| Rate for Payer: UHCCP Medicaid |
$40.03
|
| Rate for Payer: VA VA |
$56.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.29
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.66
|
| 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: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.82
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 60505014100
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$60.17
|
| Rate for Payer: BCN Commercial |
$60.17
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 60505014100
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.89
|
| Rate for Payer: BCN Commercial |
$59.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Mclaren Medicaid |
$12.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Meridian Medicaid |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.84
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$227.05
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.03 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: BCBS Trust/PPO |
$187.52
|
| Rate for Payer: BCN Commercial |
$187.52
|
| Rate for Payer: Cash Price |
$181.64
|
| 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: Lakeland Regional Health Systems Commercial |
$170.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.80
|
| Rate for Payer: UHC Core |
$189.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.29
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.48 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$175.23
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: Cash Price |
$164.92
|
| 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: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$179.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.41
|
| Rate for Payer: UHC Core |
$172.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 59651027001
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$75.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.06
|
| Rate for Payer: BCBS Complete |
$53.94
|
| Rate for Payer: BCBS MAPPO |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$239.56
|
| Rate for Payer: BCN Commercial |
$239.56
|
| Rate for Payer: BCN Medicare Advantage |
$72.85
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Mclaren Medicaid |
$51.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.49
|
| Rate for Payer: Meridian Medicaid |
$53.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PACE Senior Care Partners |
$69.21
|
| Rate for Payer: PACE SWMI |
$72.85
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Medicare |
$73.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: Railroad Medicare Medicare |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: UHC Exchange |
$72.85
|
| Rate for Payer: UHC Medicaid |
$51.37
|
| Rate for Payer: UHC Medicare Advantage |
$72.85
|
| Rate for Payer: UHCCP Medicaid |
$51.37
|
| Rate for Payer: VA VA |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$316.80
|
|
|
Service Code
|
NDC 00049017807
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.49 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$269.28
|
| Rate for Payer: BCBS Trust/PPO |
$261.65
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: Cash Price |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.44
|
| Rate for Payer: Healthscope Commercial |
$285.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.28
|
| Rate for Payer: Nomi Health Commercial |
$259.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.60
|
| Rate for Payer: PHP Commercial |
$269.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.78
|
| Rate for Payer: UHC Core |
$264.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.60
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 59651078201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.12 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$98.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.97
|
| Rate for Payer: BCBS Complete |
$70.47
|
| Rate for Payer: BCBS MAPPO |
$95.17
|
| Rate for Payer: BCBS Trust/PPO |
$312.97
|
| Rate for Payer: BCN Commercial |
$312.97
|
| Rate for Payer: BCN Medicare Advantage |
$95.17
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.17
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Mclaren Medicaid |
$67.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.93
|
| Rate for Payer: Meridian Medicaid |
$70.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PACE Senior Care Partners |
$90.42
|
| Rate for Payer: PACE SWMI |
$95.17
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Medicare |
$96.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.97
|
| Rate for Payer: Railroad Medicare Medicare |
$95.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: UHC Exchange |
$95.17
|
| Rate for Payer: UHC Medicaid |
$67.12
|
| Rate for Payer: UHC Medicare Advantage |
$95.17
|
| Rate for Payer: UHCCP Medicaid |
$67.12
|
| Rate for Payer: VA VA |
$95.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 59762054201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.36
|
| Rate for Payer: BCBS Complete |
$52.93
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$235.08
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: Meridian Medicaid |
$52.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.46
|
| Rate for Payer: PACE Senior Care Partners |
$67.91
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.02
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicaid |
$50.41
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 59651027001
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.81 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: BCBS Trust/PPO |
$240.67
|
| Rate for Payer: BCN Commercial |
$240.67
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 59762054201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$236.17
|
| Rate for Payer: BCN Commercial |
$236.17
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.46
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 59651078201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.97 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: BCBS Trust/PPO |
$314.42
|
| Rate for Payer: BCN Commercial |
$314.42
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$316.80
|
|
|
Service Code
|
NDC 00049017807
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$269.28
|
| Rate for Payer: Aetna Medicare |
$82.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.00
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCBS Trust/PPO |
$260.44
|
| Rate for Payer: BCN Commercial |
$260.44
|
| Rate for Payer: BCN Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$285.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.60
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.28
|
| Rate for Payer: Nomi Health Commercial |
$259.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.60
|
| Rate for Payer: PACE Senior Care Partners |
$75.24
|
| Rate for Payer: PACE SWMI |
$79.20
|
| Rate for Payer: PHP Commercial |
$269.28
|
| Rate for Payer: PHP Medicare Advantage |
$79.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.62
|
| Rate for Payer: Priority Health Medicare |
$79.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.49
|
| Rate for Payer: Railroad Medicare Medicare |
$79.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.78
|
| Rate for Payer: UHC Core |
$264.53
|
| Rate for Payer: UHC Exchange |
$79.20
|
| Rate for Payer: UHC Medicaid |
$55.85
|
| Rate for Payer: UHC Medicare Advantage |
$79.20
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.60
|
|
|
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 |
$134.00 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: BCBS Trust/PPO |
$159.01
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$154.02
|
| 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: Lakeland Regional Health Systems Commercial |
$144.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$157.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: PHP Commercial |
$163.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.43
|
| Rate for Payer: UHC Core |
$160.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.40
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
NDC 59651078030
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: BCBS Trust/PPO |
$40.18
|
| Rate for Payer: BCN Commercial |
$40.18
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Nomi Health Commercial |
$39.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$40.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
|
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 |
$4.47 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.30
|
| Rate for Payer: BCN Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$5.14
|
| 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: Lakeland Regional Health Systems Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.82
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$147.60
|
|
|
Service Code
|
NDC 60687048021
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.02 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: Aetna Commercial |
$125.46
|
| Rate for Payer: Aetna Medicare |
$38.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.12
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS MAPPO |
$36.90
|
| Rate for Payer: BCBS Trust/PPO |
$121.34
|
| Rate for Payer: BCN Commercial |
$121.34
|
| Rate for Payer: BCN Medicare Advantage |
$36.90
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Cofinity Commercial |
$126.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.90
|
| Rate for Payer: Healthscope Commercial |
$132.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.70
|
| Rate for Payer: Mclaren Medicaid |
$26.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.74
|
| Rate for Payer: Meridian Medicaid |
$27.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$121.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.70
|
| Rate for Payer: PACE Senior Care Partners |
$35.05
|
| Rate for Payer: PACE SWMI |
$36.90
|
| Rate for Payer: PHP Commercial |
$125.46
|
| Rate for Payer: PHP Medicare Advantage |
$36.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.41
|
| Rate for Payer: Priority Health Medicare |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.73
|
| Rate for Payer: Railroad Medicare Medicare |
$36.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.89
|
| Rate for Payer: UHC Core |
$123.25
|
| Rate for Payer: UHC Exchange |
$36.90
|
| Rate for Payer: UHC Medicaid |
$26.02
|
| Rate for Payer: UHC Medicare Advantage |
$36.90
|
| Rate for Payer: UHCCP Medicaid |
$26.02
|
| Rate for Payer: VA VA |
$36.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.70
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
NDC 59651026830
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: BCBS Trust/PPO |
$115.29
|
| Rate for Payer: BCN Commercial |
$115.29
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.84
|
| Rate for Payer: UHC Core |
$116.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
NDC 59651026830
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: Aetna Medicare |
$36.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.62
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS MAPPO |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$114.76
|
| Rate for Payer: BCN Commercial |
$114.76
|
| Rate for Payer: BCN Medicare Advantage |
$34.90
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.90
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: Mclaren Medicaid |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.64
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PACE Senior Care Partners |
$33.15
|
| Rate for Payer: PACE SWMI |
$34.90
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: PHP Medicare Advantage |
$34.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Medicare |
$35.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: Railroad Medicare Medicare |
$34.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.84
|
| Rate for Payer: UHC Core |
$116.56
|
| Rate for Payer: UHC Exchange |
$34.90
|
| Rate for Payer: UHC Medicaid |
$24.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.90
|
| Rate for Payer: UHCCP Medicaid |
$24.61
|
| Rate for Payer: VA VA |
$34.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
|
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 |
$33.94 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$163.65
|
| Rate for Payer: Aetna Medicare |
$50.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.17
|
| Rate for Payer: BCBS Complete |
$35.64
|
| Rate for Payer: BCBS MAPPO |
$48.13
|
| Rate for Payer: BCBS Trust/PPO |
$158.28
|
| Rate for Payer: BCN Commercial |
$158.28
|
| Rate for Payer: BCN Medicare Advantage |
$48.13
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.13
|
| Rate for Payer: Healthscope Commercial |
$173.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.40
|
| Rate for Payer: Mclaren Medicaid |
$33.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.54
|
| Rate for Payer: Meridian Medicaid |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$157.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: PACE Senior Care Partners |
$45.73
|
| Rate for Payer: PACE SWMI |
$48.13
|
| Rate for Payer: PHP Commercial |
$163.65
|
| Rate for Payer: PHP Medicare Advantage |
$48.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.50
|
| Rate for Payer: Priority Health Medicare |
$48.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: Railroad Medicare Medicare |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.43
|
| Rate for Payer: UHC Core |
$160.76
|
| Rate for Payer: UHC Exchange |
$48.13
|
| Rate for Payer: UHC Medicaid |
$33.94
|
| Rate for Payer: UHC Medicare Advantage |
$48.13
|
| Rate for Payer: UHCCP Medicaid |
$33.94
|
| Rate for Payer: VA VA |
$48.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.40
|
|
