|
GLIMEPIRIDE 4 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
|
Service Code
|
NDC 68084032701
|
| Hospital Charge Code |
16357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna American Axle |
$192.50
|
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Advantage |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.12
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| Rate for Payer: UMR Bronson Commercial |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.12
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna American Axle |
$134.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$144.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$76.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$206.15
|
|
|
Service Code
|
NDC 51079081020
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna American Axle |
$134.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$144.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| 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: UMR Bronson Commercial |
$90.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.61
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| 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: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$255.36
|
|
|
Service Code
|
NDC 00591084501
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.36 |
| Max. Negotiated Rate |
$229.82 |
| Rate for Payer: Aetna American Axle |
$165.98
|
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cofinity Advantage |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.52
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: UMR Bronson Commercial |
$112.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.52
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
NDC 68084011211
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.92
|
| Rate for Payer: PHP Commercial |
$3.31
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.92
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 64980028101
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$389.76
|
|
|
Service Code
|
NDC 68084011201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$350.78 |
| Rate for Payer: Aetna American Axle |
$253.34
|
| Rate for Payer: Aetna Commercial |
$331.30
|
| Rate for Payer: Aetna Medicare |
$194.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.34
|
| Rate for Payer: BCBS Complete |
$155.90
|
| Rate for Payer: Cash Price |
$311.81
|
| Rate for Payer: Cofinity Advantage |
$272.83
|
| Rate for Payer: Cofinity Commercial |
$335.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.81
|
| Rate for Payer: Healthscope Commercial |
$350.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.32
|
| Rate for Payer: PHP Commercial |
$331.30
|
| Rate for Payer: Priority Health SBD |
$245.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.34
|
| Rate for Payer: UHC Core |
$203.06
|
| Rate for Payer: UHC Exchange |
$153.18
|
| Rate for Payer: UMR Bronson Commercial |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.32
|
|
|
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 |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.41
|
| Rate for Payer: UHC Core |
$151.82
|
| Rate for Payer: UHC Exchange |
$114.52
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 64980028101
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.73
|
| Rate for Payer: UHC Core |
$116.81
|
| Rate for Payer: UHC Exchange |
$88.11
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$389.76
|
|
|
Service Code
|
NDC 68084011201
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.49 |
| Max. Negotiated Rate |
$350.78 |
| Rate for Payer: Aetna American Axle |
$253.34
|
| Rate for Payer: Aetna Commercial |
$331.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.34
|
| Rate for Payer: Cash Price |
$311.81
|
| Rate for Payer: Cofinity Advantage |
$272.83
|
| Rate for Payer: Cofinity Commercial |
$335.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.81
|
| Rate for Payer: Healthscope Commercial |
$350.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.32
|
| Rate for Payer: PHP Commercial |
$331.30
|
| Rate for Payer: Priority Health SBD |
$245.55
|
| Rate for Payer: UMR Bronson Commercial |
$171.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.32
|
|
|
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 |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 68084011211
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.92
|
| Rate for Payer: PHP Commercial |
$3.31
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: UHC Exchange |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.92
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$255.36
|
|
|
Service Code
|
NDC 00591084501
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$229.82 |
| Rate for Payer: Aetna American Axle |
$165.98
|
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna Medicare |
$127.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: BCBS Complete |
$102.14
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cofinity Advantage |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.52
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.98
|
| Rate for Payer: UHC Core |
$133.04
|
| Rate for Payer: UHC Exchange |
$100.36
|
| Rate for Payer: UMR Bronson Commercial |
$94.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.52
|
|
|
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 |
$33.73 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| 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: UMR Bronson Commercial |
$33.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
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 |
$28.37 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$28.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$72.11
|
|
|
Service Code
|
NDC 59762054001
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$64.90 |
| Rate for Payer: Aetna American Axle |
$46.87
|
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: Cash Price |
$57.69
|
| Rate for Payer: Cofinity Advantage |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.69
|
| Rate for Payer: Healthscope Commercial |
$64.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.29
|
| Rate for Payer: Priority Health SBD |
$45.43
|
| Rate for Payer: UMR Bronson Commercial |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$72.11
|
|
|
Service Code
|
NDC 59762054001
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$64.90 |
| Rate for Payer: Aetna American Axle |
$46.87
|
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: Cash Price |
$57.69
|
| Rate for Payer: Cofinity Advantage |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.69
|
| Rate for Payer: Healthscope Commercial |
$64.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.29
|
| Rate for Payer: Priority Health SBD |
$45.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.87
|
| Rate for Payer: UHC Core |
$37.57
|
| Rate for Payer: UHC Exchange |
$28.34
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 00591084401
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Advantage |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.38
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$366.60
|
|
|
Service Code
|
NDC 59762054101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.64 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna American Axle |
$238.29
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Advantage |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.29
|
| Rate for Payer: UHC Core |
$191.00
|
| Rate for Payer: UHC Exchange |
$144.07
|
| Rate for Payer: UMR Bronson Commercial |
$135.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$344.85
|
|
|
Service Code
|
NDC 00049017402
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.73 |
| Max. Negotiated Rate |
$310.37 |
| Rate for Payer: Aetna American Axle |
$224.15
|
| Rate for Payer: Aetna Commercial |
$293.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.15
|
| Rate for Payer: Cash Price |
$275.88
|
| Rate for Payer: Cofinity Advantage |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$310.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.64
|
| Rate for Payer: PHP Commercial |
$293.12
|
| Rate for Payer: Priority Health SBD |
$217.26
|
| Rate for Payer: UMR Bronson Commercial |
$151.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.64
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$232.65
|
|
|
Service Code
|
NDC 59651078101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.08 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna American Axle |
$151.22
|
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: Aetna Medicare |
$116.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.22
|
| Rate for Payer: BCBS Complete |
$93.06
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Advantage |
$162.85
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.49
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health SBD |
$146.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.22
|
| Rate for Payer: UHC Core |
$121.21
|
| Rate for Payer: UHC Exchange |
$91.43
|
| Rate for Payer: UMR Bronson Commercial |
$86.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$232.65
|
|
|
Service Code
|
NDC 59651078101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna American Axle |
$151.22
|
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.22
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Advantage |
$162.85
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.49
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health SBD |
$146.57
|
| Rate for Payer: UMR Bronson Commercial |
$102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 00591084401
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Advantage |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.38
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.72
|
| Rate for Payer: UHC Core |
$133.64
|
| Rate for Payer: UHC Exchange |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$94.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
