|
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 |
$185.54 |
| 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 Commercial |
$144.30
|
| Rate for Payer: Cofinity Commercial |
$177.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$185.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: PHP Commercial |
$175.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.00
|
| 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 |
$1.04
|
| 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 Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.45
|
| 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: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| 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 Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.45
|
| 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: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| 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
|
OP
|
$361.95
|
|
|
Service Code
|
NDC 10370074601
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.92 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna American Axle |
$235.27
|
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna Medicare |
$180.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: BCBS Complete |
$144.78
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$253.36
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.66
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.27
|
| Rate for Payer: Priority Health SBD |
$228.03
|
| Rate for Payer: UMR Bronson Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.46
|
|
|
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 |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.73
|
| 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 |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| 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
|
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 Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| 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: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| 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
|
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 Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| 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: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| 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
|
$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 Commercial |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.75
|
| 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: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: UMR Bronson Commercial |
$94.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.52
|
|
|
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 Commercial |
$272.83
|
| Rate for Payer: Cofinity Commercial |
$335.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.83
|
| 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: PHP Commercial |
$331.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.34
|
| 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
|
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 Commercial |
$272.83
|
| Rate for Payer: Cofinity Commercial |
$335.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.83
|
| 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: PHP Commercial |
$331.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.34
|
| Rate for Payer: Priority Health SBD |
$245.55
|
| 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
|
$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 |
$3.32
|
| 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 Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.73
|
| 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 |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| 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
|
IP
|
$361.95
|
|
|
Service Code
|
NDC 10370074601
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.26 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna American Axle |
$235.27
|
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$253.36
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.66
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.27
|
| Rate for Payer: Priority Health SBD |
$228.03
|
| Rate for Payer: UMR Bronson Commercial |
$159.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.46
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$228.95
|
|
|
Service Code
|
NDC 64980028101
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna American Axle |
$148.82
|
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna Medicare |
$114.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.82
|
| Rate for Payer: BCBS Complete |
$91.58
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$160.26
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health SBD |
$144.24
|
| Rate for Payer: UMR Bronson Commercial |
$84.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$228.95
|
|
|
Service Code
|
NDC 64980028101
|
| Hospital Charge Code |
37650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna American Axle |
$148.82
|
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.82
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$160.26
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health SBD |
$144.24
|
| Rate for Payer: UMR Bronson Commercial |
$100.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
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 Commercial |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.75
|
| 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: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| 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 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 Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| 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: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| 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
|
$141.56
|
|
|
Service Code
|
NDC 68084029521
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.33
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: Cofinity Commercial |
$121.74
|
| Rate for Payer: Cofinity Commercial |
$99.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.25
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.33
|
| Rate for Payer: PHP Commercial |
$120.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$52.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.17
|
|
|
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 Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| 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: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| 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
|
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 |
$36.06
|
| 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 Commercial |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.48
|
| 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: PHP Commercial |
$61.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.87
|
| Rate for Payer: Priority Health SBD |
$45.43
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
|
|
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 |
$62.29 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: Cofinity Commercial |
$121.74
|
| Rate for Payer: Cofinity Commercial |
$99.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.25
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.33
|
| Rate for Payer: PHP Commercial |
$120.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.17
|
|
|
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 Commercial |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.48
|
| 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: PHP Commercial |
$61.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.87
|
| 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 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 |
$310.36 |
| 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 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 |
$310.36
|
| 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 |
$151.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.64
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 59651078101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 59651078101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
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 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 |
$135.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
