|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.96 |
| 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 |
$82.46
|
| Rate for Payer: BCBS MAPPO |
$51.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.48
|
| Rate for Payer: BCN Commercial |
$160.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| 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 Cigna Priority Health |
$134.00
|
| Rate for Payer: Priority Health HMO/PPO |
$179.35
|
| Rate for Payer: Priority Health Medicare |
$52.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.12
|
| 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 Dual Complete DSNP |
$51.54
|
| Rate for Payer: UHC Exchange |
$51.54
|
| Rate for Payer: UHC Medicare Advantage |
$51.54
|
| Rate for Payer: VA VA |
$51.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| 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: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| 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
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$180.96
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.29
|
| Rate for Payer: Priority Health HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.94
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.19
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
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 |
$189.41 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: BCBS Trust/PPO |
$237.87
|
| Rate for Payer: BCN Commercial |
$225.19
|
| 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: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.24
|
| 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
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 59651027001
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.21 |
| 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 |
$116.56
|
| Rate for Payer: BCBS MAPPO |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$239.56
|
| Rate for Payer: BCN Commercial |
$226.56
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| 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 Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Medicare |
$73.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.24
|
| 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 Dual Complete DSNP |
$72.85
|
| Rate for Payer: UHC Exchange |
$72.85
|
| Rate for Payer: UHC Medicare Advantage |
$72.85
|
| 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 |
$205.92 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$269.28
|
| Rate for Payer: BCBS Trust/PPO |
$258.60
|
| Rate for Payer: BCN Commercial |
$244.82
|
| 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: PHP Commercial |
$269.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.92
|
| Rate for Payer: Priority Health HMO/PPO |
$275.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.26
|
| 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
|
$324.30
|
|
|
Service Code
|
NDC 59651078201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.34
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCBS Trust/PPO |
$266.61
|
| Rate for Payer: BCN Commercial |
$252.14
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PACE Senior Care Partners |
$77.02
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Medicare |
$81.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.28
|
| Rate for Payer: Railroad Medicare Medicare |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.08
|
| Rate for Payer: UHC Exchange |
$81.08
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
| Rate for Payer: VA VA |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
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 |
$75.24 |
| 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 |
$126.72
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCBS Trust/PPO |
$260.44
|
| Rate for Payer: BCN Commercial |
$246.31
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.28
|
| Rate for Payer: Nomi Health Commercial |
$259.78
|
| 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 Cigna Priority Health |
$205.92
|
| Rate for Payer: Priority Health HMO/PPO |
$275.62
|
| Rate for Payer: Priority Health Medicare |
$79.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.26
|
| 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 Dual Complete DSNP |
$79.20
|
| Rate for Payer: UHC Exchange |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$79.20
|
| Rate for Payer: VA VA |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.60
|
|
|
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 |
$67.91 |
| 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 |
$114.38
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$222.33
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| 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 Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| 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 Dual Complete DSNP |
$71.49
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| 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
|
$285.95
|
|
|
Service Code
|
NDC 59762054201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$233.42
|
| Rate for Payer: BCN Commercial |
$220.98
|
| 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: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| 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
|
$324.30
|
|
|
Service Code
|
NDC 59651078201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: BCBS Trust/PPO |
$264.73
|
| Rate for Payer: BCN Commercial |
$250.62
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$141.56
|
|
|
Service Code
|
NDC 68084029521
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna Commercial |
$120.33
|
| Rate for Payer: BCBS Trust/PPO |
$115.56
|
| Rate for Payer: BCN Commercial |
$109.40
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: Cofinity Commercial |
$121.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.25
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.33
|
| Rate for Payer: Nomi Health Commercial |
$116.08
|
| Rate for Payer: PHP Commercial |
$120.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health HMO/PPO |
$123.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.57
|
| Rate for Payer: UHC Core |
$118.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.17
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 68084029511
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.89
|
| Rate for Payer: BCBS MAPPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: BCN Medicare Advantage |
$1.18
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: PACE Senior Care Partners |
$1.12
|
| Rate for Payer: PACE SWMI |
$1.18
|
| Rate for Payer: PHP Commercial |
$4.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4.11
|
| Rate for Payer: Priority Health Medicare |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.15
|
| Rate for Payer: UHC Core |
$3.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.18
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: VA VA |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.54
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$162.44
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.59 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Aetna Commercial |
$138.07
|
| Rate for Payer: BCBS Trust/PPO |
$132.60
|
| Rate for Payer: BCN Commercial |
$125.53
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.95
|
| Rate for Payer: Healthscope Commercial |
$146.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.07
|
| Rate for Payer: Nomi Health Commercial |
$133.20
|
| Rate for Payer: PHP Commercial |
$138.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.59
|
| Rate for Payer: Priority Health HMO/PPO |
$141.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.95
|
| Rate for Payer: UHC Core |
$135.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.83
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 60687048011
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
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 |
$90.73 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: BCBS Trust/PPO |
$113.95
|
| Rate for Payer: BCN Commercial |
$107.88
|
| 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: PHP Commercial |
$118.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.73
|
| Rate for Payer: Priority Health HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.53
|
| 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
|
$162.44
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Aetna Commercial |
$138.07
|
| Rate for Payer: Aetna Medicare |
$42.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.76
|
| Rate for Payer: BCBS Complete |
$64.98
|
| Rate for Payer: BCBS MAPPO |
$40.61
|
| Rate for Payer: BCBS Trust/PPO |
$133.54
|
| Rate for Payer: BCN Commercial |
$126.30
|
| Rate for Payer: BCN Medicare Advantage |
$40.61
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: Cofinity Commercial |
$139.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.61
|
| Rate for Payer: Healthscope Commercial |
$146.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.07
|
| Rate for Payer: Nomi Health Commercial |
$133.20
|
| Rate for Payer: PACE Senior Care Partners |
$38.58
|
| Rate for Payer: PACE SWMI |
$40.61
|
| Rate for Payer: PHP Commercial |
$138.07
|
| Rate for Payer: PHP Medicare Advantage |
$40.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.59
|
| Rate for Payer: Priority Health HMO/PPO |
$141.32
|
| Rate for Payer: Priority Health Medicare |
$41.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.83
|
| Rate for Payer: Railroad Medicare Medicare |
$40.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.95
|
| Rate for Payer: UHC Core |
$135.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.61
|
| Rate for Payer: UHC Exchange |
$40.61
|
| Rate for Payer: UHC Medicare Advantage |
$40.61
|
| Rate for Payer: VA VA |
$40.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.83
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 60687048011
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.54
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.23
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PACE Senior Care Partners |
$1.17
|
| Rate for Payer: PACE SWMI |
$1.23
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Medicare Advantage |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$1.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.23
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UHC Medicare Advantage |
$1.23
|
| Rate for Payer: VA VA |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$147.60
|
|
|
Service Code
|
NDC 60687048021
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: Aetna Commercial |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$120.49
|
| Rate for Payer: BCN Commercial |
$114.07
|
| 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: Healthscope Commercial |
$132.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$121.03
|
| Rate for Payer: PHP Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.94
|
| Rate for Payer: Priority Health HMO/PPO |
$128.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.89
|
| Rate for Payer: UHC Core |
$123.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.70
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$4.61
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.69
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.21
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.29
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$4.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$1.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.77
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
|
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 |
$35.05 |
| 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 |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$36.90
|
| Rate for Payer: BCBS Trust/PPO |
$121.34
|
| Rate for Payer: BCN Commercial |
$114.76
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$121.03
|
| 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 Cigna Priority Health |
$95.94
|
| Rate for Payer: Priority Health HMO/PPO |
$128.41
|
| Rate for Payer: Priority Health Medicare |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.89
|
| 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 Dual Complete DSNP |
$36.90
|
| Rate for Payer: UHC Exchange |
$36.90
|
| Rate for Payer: UHC Medicare Advantage |
$36.90
|
| 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
|
$4.72
|
|
|
Service Code
|
NDC 68084029511
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.15
|
| Rate for Payer: UHC Core |
$3.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.54
|
|
|
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 |
$33.15 |
| 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 |
$55.84
|
| Rate for Payer: BCBS MAPPO |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$114.76
|
| Rate for Payer: BCN Commercial |
$108.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| 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 Cigna Priority Health |
$90.73
|
| Rate for Payer: Priority Health HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Medicare |
$35.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.53
|
| 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 Dual Complete DSNP |
$34.90
|
| Rate for Payer: UHC Exchange |
$34.90
|
| Rate for Payer: UHC Medicare Advantage |
$34.90
|
| 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
|
$141.56
|
|
|
Service Code
|
NDC 68084029521
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna Commercial |
$120.33
|
| Rate for Payer: Aetna Medicare |
$36.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.24
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: BCBS MAPPO |
$35.39
|
| Rate for Payer: BCBS Trust/PPO |
$116.38
|
| Rate for Payer: BCN Commercial |
$110.06
|
| Rate for Payer: BCN Medicare Advantage |
$35.39
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: Cofinity Commercial |
$121.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.39
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.33
|
| Rate for Payer: Nomi Health Commercial |
$116.08
|
| Rate for Payer: PACE Senior Care Partners |
$33.62
|
| Rate for Payer: PACE SWMI |
$35.39
|
| Rate for Payer: PHP Commercial |
$120.33
|
| Rate for Payer: PHP Medicare Advantage |
$35.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health HMO/PPO |
$123.16
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.85
|
| Rate for Payer: Railroad Medicare Medicare |
$35.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.57
|
| Rate for Payer: UHC Core |
$118.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.39
|
| Rate for Payer: UHC Exchange |
$35.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.39
|
| Rate for Payer: VA VA |
$35.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.17
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$4.42
|
| Rate for Payer: BCN Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: PHP Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.77
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
