|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$344.85
|
|
|
Service Code
|
NDC 00049017402
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$310.37 |
| Rate for Payer: Aetna American Axle |
$224.15
|
| Rate for Payer: Aetna Commercial |
$293.12
|
| Rate for Payer: Aetna Medicare |
$172.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.15
|
| Rate for Payer: BCBS Complete |
$137.94
|
| Rate for Payer: Cash Price |
$275.88
|
| Rate for Payer: Cofinity Commercial |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.40
|
| 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: PHP Commercial |
$293.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.15
|
| Rate for Payer: Priority Health SBD |
$217.26
|
| Rate for Payer: UMR Bronson Commercial |
$127.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.64
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 59762054101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna American Axle |
$238.29
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.62
|
| 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: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: UMR Bronson Commercial |
$161.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 41120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,021.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.58 |
| Max. Negotiated Rate |
$919.59 |
| Rate for Payer: Aetna American Axle |
$664.15
|
| Rate for Payer: Aetna American Axle |
$646.08
|
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Commercial |
$844.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.08
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cash Price |
$795.18
|
| Rate for Payer: Cofinity Commercial |
$854.81
|
| Rate for Payer: Cofinity Commercial |
$695.78
|
| Rate for Payer: Cofinity Commercial |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$715.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.18
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Healthscope Commercial |
$894.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$715.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$695.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: PHP Commercial |
$844.87
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.08
|
| Rate for Payer: Priority Health SBD |
$643.72
|
| Rate for Payer: Priority Health SBD |
$626.20
|
| Rate for Payer: UMR Bronson Commercial |
$449.58
|
| Rate for Payer: UMR Bronson Commercial |
$437.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.48
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$993.97
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$894.57 |
| Rate for Payer: Aetna American Axle |
$646.08
|
| Rate for Payer: Aetna American Axle |
$664.15
|
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Commercial |
$844.87
|
| Rate for Payer: Aetna Medicare |
$189.75
|
| Rate for Payer: Aetna Medicare |
$189.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.06
|
| Rate for Payer: BCBS Complete |
$102.68
|
| Rate for Payer: BCBS Complete |
$102.68
|
| Rate for Payer: BCBS MAPPO |
$182.45
|
| Rate for Payer: BCBS MAPPO |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$182.45
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cash Price |
$795.18
|
| Rate for Payer: Cash Price |
$795.18
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cofinity Commercial |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Cofinity Commercial |
$695.78
|
| Rate for Payer: Cofinity Commercial |
$854.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$715.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.45
|
| Rate for Payer: Healthscope Commercial |
$894.57
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$695.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$715.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.48
|
| Rate for Payer: Mclaren Medicaid |
$97.79
|
| Rate for Payer: Mclaren Medicaid |
$97.79
|
| Rate for Payer: Mclaren Medicare |
$182.45
|
| Rate for Payer: Mclaren Medicare |
$182.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.57
|
| Rate for Payer: Meridian Medicaid |
$102.68
|
| Rate for Payer: Meridian Medicaid |
$102.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: PACE Medicare |
$173.33
|
| Rate for Payer: PACE Medicare |
$173.33
|
| Rate for Payer: PACE SWMI |
$182.45
|
| Rate for Payer: PACE SWMI |
$182.45
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: PHP Commercial |
$844.87
|
| Rate for Payer: PHP Medicare Advantage |
$182.45
|
| Rate for Payer: PHP Medicare Advantage |
$182.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.08
|
| Rate for Payer: Priority Health Medicare |
$182.45
|
| Rate for Payer: Priority Health Medicare |
$182.45
|
| Rate for Payer: Priority Health SBD |
$643.72
|
| Rate for Payer: Priority Health SBD |
$626.20
|
| Rate for Payer: Railroad Medicare Medicare |
$182.45
|
| Rate for Payer: Railroad Medicare Medicare |
$182.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.45
|
| Rate for Payer: UHC Exchange |
$348.68
|
| Rate for Payer: UHC Exchange |
$348.68
|
| Rate for Payer: UHC Medicare Advantage |
$182.45
|
| Rate for Payer: UHC Medicare Advantage |
$182.45
|
| Rate for Payer: UHCCP Medicaid |
$97.79
|
| Rate for Payer: UHCCP Medicaid |
$97.79
|
| Rate for Payer: UMR Bronson Commercial |
$378.05
|
| Rate for Payer: UMR Bronson Commercial |
$367.77
|
| Rate for Payer: VA VA |
$182.45
|
| Rate for Payer: VA VA |
$182.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.33
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$419.39 |
| Rate for Payer: Aetna American Axle |
$277.55
|
| Rate for Payer: Aetna American Axle |
$277.54
|
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna Medicare |
$154.95
|
| Rate for Payer: Aetna Medicare |
$154.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cofinity Commercial |
$298.89
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$298.90
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Priority Health SBD |
$269.00
|
| Rate for Payer: Priority Health SBD |
$269.01
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Exchange |
$284.73
|
| Rate for Payer: UHC Exchange |
$284.73
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: UMR Bronson Commercial |
$157.98
|
| Rate for Payer: UMR Bronson Commercial |
$157.99
|
| Rate for Payer: VA VA |
$148.99
|
| Rate for Payer: VA VA |
$148.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$426.98
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna American Axle |
$277.54
|
| Rate for Payer: Aetna American Axle |
$277.55
|
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.55
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Cofinity Commercial |
$298.90
|
| Rate for Payer: Cofinity Commercial |
$298.89
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health SBD |
$269.00
|
| Rate for Payer: Priority Health SBD |
$269.01
|
| Rate for Payer: UMR Bronson Commercial |
$187.87
|
| Rate for Payer: UMR Bronson Commercial |
$187.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$744.16
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
192635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$669.74 |
| Rate for Payer: Aetna American Axle |
$483.70
|
| Rate for Payer: Aetna Commercial |
$632.54
|
| Rate for Payer: Aetna Medicare |
$154.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cofinity Commercial |
$639.98
|
| Rate for Payer: Cofinity Commercial |
$520.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$669.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.12
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.54
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PHP Commercial |
$632.54
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Priority Health SBD |
$468.82
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Exchange |
$284.73
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: UMR Bronson Commercial |
$275.34
|
| Rate for Payer: VA VA |
$148.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.12
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$744.16
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
192635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.43 |
| Max. Negotiated Rate |
$669.74 |
| Rate for Payer: Aetna American Axle |
$483.70
|
| Rate for Payer: Aetna Commercial |
$632.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.70
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cofinity Commercial |
$520.91
|
| Rate for Payer: Cofinity Commercial |
$639.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.33
|
| Rate for Payer: Healthscope Commercial |
$669.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.54
|
| Rate for Payer: PHP Commercial |
$632.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health SBD |
$468.82
|
| Rate for Payer: UMR Bronson Commercial |
$327.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.12
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG INJECTION PEN TO GO
|
Facility
|
OP
|
$419.39
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
300446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$419.39 |
| Rate for Payer: Aetna Medicare |
$154.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.24
|
| Rate for Payer: BCBS Complete |
$83.85
|
| Rate for Payer: BCBS MAPPO |
$148.99
|
| Rate for Payer: BCN Medicare Advantage |
$148.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.99
|
| Rate for Payer: Mclaren Medicaid |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$148.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.44
|
| Rate for Payer: Meridian Medicaid |
$83.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.34
|
| Rate for Payer: PACE Medicare |
$141.54
|
| Rate for Payer: PACE SWMI |
$148.99
|
| Rate for Payer: PHP Medicare Advantage |
$148.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$148.99
|
| Rate for Payer: Railroad Medicare Medicare |
$148.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.99
|
| Rate for Payer: UHC Exchange |
$284.73
|
| Rate for Payer: UHC Medicare Advantage |
$148.99
|
| Rate for Payer: UHCCP Medicaid |
$79.86
|
| Rate for Payer: VA VA |
$148.99
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG INJECTION PEN TO GO
|
Facility
|
OP
|
$513.58
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
300446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$513.58 |
| Rate for Payer: Aetna Medicare |
$189.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.06
|
| Rate for Payer: BCBS Complete |
$102.68
|
| Rate for Payer: BCBS MAPPO |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$182.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.45
|
| Rate for Payer: Mclaren Medicaid |
$97.79
|
| Rate for Payer: Mclaren Medicare |
$182.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.57
|
| Rate for Payer: Meridian Medicaid |
$102.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.82
|
| Rate for Payer: PACE Medicare |
$173.33
|
| Rate for Payer: PACE SWMI |
$182.45
|
| Rate for Payer: PHP Medicare Advantage |
$182.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.79
|
| Rate for Payer: Priority Health Medicare |
$182.45
|
| Rate for Payer: Railroad Medicare Medicare |
$182.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.45
|
| Rate for Payer: UHC Exchange |
$348.68
|
| Rate for Payer: UHC Medicare Advantage |
$182.45
|
| Rate for Payer: UHCCP Medicaid |
$97.79
|
| Rate for Payer: VA VA |
$182.45
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
OP
|
$569.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$513.58 |
| Rate for Payer: Aetna American Axle |
$370.35
|
| Rate for Payer: Aetna American Axle |
$370.36
|
| Rate for Payer: Aetna Commercial |
$484.30
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: Aetna Medicare |
$189.75
|
| Rate for Payer: Aetna Medicare |
$189.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.06
|
| Rate for Payer: BCBS Complete |
$102.68
|
| Rate for Payer: BCBS Complete |
$102.68
|
| Rate for Payer: BCBS MAPPO |
$182.45
|
| Rate for Payer: BCBS MAPPO |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$182.45
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Commercial |
$398.84
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$398.85
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.45
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Healthscope Commercial |
$512.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Mclaren Medicaid |
$97.79
|
| Rate for Payer: Mclaren Medicaid |
$97.79
|
| Rate for Payer: Mclaren Medicare |
$182.45
|
| Rate for Payer: Mclaren Medicare |
$182.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.57
|
| Rate for Payer: Meridian Medicaid |
$102.68
|
| Rate for Payer: Meridian Medicaid |
$102.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.30
|
| Rate for Payer: PACE Medicare |
$173.33
|
| Rate for Payer: PACE Medicare |
$173.33
|
| Rate for Payer: PACE SWMI |
$182.45
|
| Rate for Payer: PACE SWMI |
$182.45
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: PHP Commercial |
$484.30
|
| Rate for Payer: PHP Medicare Advantage |
$182.45
|
| Rate for Payer: PHP Medicare Advantage |
$182.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.35
|
| Rate for Payer: Priority Health Medicare |
$182.45
|
| Rate for Payer: Priority Health Medicare |
$182.45
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: Railroad Medicare Medicare |
$182.45
|
| Rate for Payer: Railroad Medicare Medicare |
$182.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.45
|
| Rate for Payer: UHC Exchange |
$348.68
|
| Rate for Payer: UHC Exchange |
$348.68
|
| Rate for Payer: UHC Medicare Advantage |
$182.45
|
| Rate for Payer: UHC Medicare Advantage |
$182.45
|
| Rate for Payer: UHCCP Medicaid |
$97.79
|
| Rate for Payer: UHCCP Medicaid |
$97.79
|
| Rate for Payer: UMR Bronson Commercial |
$210.81
|
| Rate for Payer: UMR Bronson Commercial |
$210.82
|
| Rate for Payer: VA VA |
$182.45
|
| Rate for Payer: VA VA |
$182.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
IP
|
$569.78
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$512.80 |
| Rate for Payer: Aetna American Axle |
$370.36
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.36
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Commercial |
$398.85
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$370.36
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: UMR Bronson Commercial |
$250.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$23.97
|
|
|
Service Code
|
NDC 38396052163
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna American Axle |
$15.58
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.58
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.37
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 38396050763
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 21292000434
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.57
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$24.21
|
|
|
Service Code
|
NDC 38396050208
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$21.79 |
| Rate for Payer: Aetna American Axle |
$15.74
|
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Medicare |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$20.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$21.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.58
|
| Rate for Payer: PHP Commercial |
$20.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.74
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.16
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 38396052363
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 38396052263
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 38396052263
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 21292000434
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$42.54
|
|
|
Service Code
|
NDC 56151161011
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna American Axle |
$27.65
|
| Rate for Payer: Aetna Commercial |
$36.16
|
| Rate for Payer: Aetna Medicare |
$21.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.65
|
| Rate for Payer: BCBS Complete |
$17.02
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cofinity Commercial |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$36.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.03
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.16
|
| Rate for Payer: PHP Commercial |
$36.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.65
|
| Rate for Payer: Priority Health SBD |
$26.80
|
| Rate for Payer: UMR Bronson Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.91
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$23.97
|
|
|
Service Code
|
NDC 38396052163
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna American Axle |
$15.58
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.58
|
| Rate for Payer: BCBS Complete |
$9.59
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.37
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$24.21
|
|
|
Service Code
|
NDC 38396050208
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$21.79 |
| Rate for Payer: Aetna American Axle |
$15.74
|
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$20.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$21.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.58
|
| Rate for Payer: PHP Commercial |
$20.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.74
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.16
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$42.54
|
|
|
Service Code
|
NDC 56151161011
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna American Axle |
$27.65
|
| Rate for Payer: Aetna Commercial |
$36.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.65
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cofinity Commercial |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$36.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.03
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.16
|
| Rate for Payer: PHP Commercial |
$36.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.65
|
| Rate for Payer: Priority Health SBD |
$26.80
|
| Rate for Payer: UMR Bronson Commercial |
$18.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.91
|
|
