|
GENETIC DISORDERS
|
Facility
|
IP
|
$3,422.29
|
|
|
Service Code
|
APR-DRG 4281
|
| Min. Negotiated Rate |
$3,094.16 |
| Max. Negotiated Rate |
$3,422.29 |
| Rate for Payer: BCBS Complete |
$3,422.29
|
| Rate for Payer: Mclaren Medicaid |
$3,259.32
|
| Rate for Payer: Meridian Medicaid |
$3,422.29
|
| Rate for Payer: PHP Medicaid |
$3,094.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,259.32
|
| Rate for Payer: UHC Medicaid |
$3,259.32
|
| Rate for Payer: UHCCP Medicaid |
$3,259.32
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$23,727.67
|
|
|
Service Code
|
APR-DRG 4284
|
| Min. Negotiated Rate |
$21,452.65 |
| Max. Negotiated Rate |
$23,727.67 |
| Rate for Payer: BCBS Complete |
$23,727.67
|
| Rate for Payer: Mclaren Medicaid |
$22,597.78
|
| Rate for Payer: Meridian Medicaid |
$23,727.67
|
| Rate for Payer: PHP Medicaid |
$21,452.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,597.78
|
| Rate for Payer: UHC Medicaid |
$22,597.78
|
| Rate for Payer: UHCCP Medicaid |
$22,597.78
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$6,422.78
|
|
|
Service Code
|
APR-DRG 4282
|
| Min. Negotiated Rate |
$5,806.96 |
| Max. Negotiated Rate |
$6,422.78 |
| Rate for Payer: BCBS Complete |
$6,422.78
|
| Rate for Payer: Mclaren Medicaid |
$6,116.93
|
| Rate for Payer: Meridian Medicaid |
$6,422.78
|
| Rate for Payer: PHP Medicaid |
$5,806.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,116.93
|
| Rate for Payer: UHC Medicaid |
$6,116.93
|
| Rate for Payer: UHCCP Medicaid |
$6,116.93
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.18 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: ASR ASR |
$112.75
|
| Rate for Payer: BCBS Trust/PPO |
$95.45
|
| Rate for Payer: BCN Commercial |
$95.45
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$109.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$112.75
|
| Rate for Payer: Healthscope Whirlpool |
$116.23
|
| Rate for Payer: Mclaren Commercial |
$104.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Nomi Health Commercial |
$95.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.29
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: ASR ASR |
$17.68
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.97
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Whirlpool |
$18.23
|
| Rate for Payer: Mclaren Commercial |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$14.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.04
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: ASR ASR |
$17.68
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.03
|
| Rate for Payer: BCN Commercial |
$15.03
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Whirlpool |
$18.23
|
| Rate for Payer: Mclaren Commercial |
$16.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$14.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.97
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.04
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$17.82
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS Trust/PPO |
$14.69
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.29
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.15
|
| Rate for Payer: Nomi Health Commercial |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.61
|
| Rate for Payer: Priority Health Narrow Network |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$104.61
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: ASR ASR |
$112.75
|
| Rate for Payer: BCBS Complete |
$46.49
|
| Rate for Payer: BCBS Trust/PPO |
$95.84
|
| Rate for Payer: BCN Commercial |
$95.84
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$109.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$112.75
|
| Rate for Payer: Healthscope Whirlpool |
$116.23
|
| Rate for Payer: Mclaren Commercial |
$104.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Nomi Health Commercial |
$95.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.85
|
| Rate for Payer: Priority Health Narrow Network |
$81.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.29
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Commercial |
$14.63
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.29
|
| Rate for Payer: Healthscope Whirlpool |
$17.82
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.15
|
| Rate for Payer: Nomi Health Commercial |
$14.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.65
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna Commercial |
$31.18
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: ASR ASR |
$45.40
|
| Rate for Payer: ASR ASR |
$33.61
|
| Rate for Payer: ASR ASR |
$326.59
|
| Rate for Payer: ASR ASR |
$20.13
|
| Rate for Payer: BCBS Trust/PPO |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$276.49
|
| Rate for Payer: BCBS Trust/PPO |
$38.44
|
| Rate for Payer: BCN Commercial |
$17.04
|
| Rate for Payer: BCN Commercial |
$38.44
|
| Rate for Payer: BCN Commercial |
$276.49
|
| Rate for Payer: BCN Commercial |
$28.45
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$269.35
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$316.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.60
|
| Rate for Payer: Healthscope Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$34.65
|
| Rate for Payer: Healthscope Whirlpool |
$46.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$336.69
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$42.13
|
| Rate for Payer: Mclaren Commercial |
$303.02
|
| Rate for Payer: Mclaren Commercial |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.64
|
| Rate for Payer: Nomi Health Commercial |
$276.09
|
| Rate for Payer: Nomi Health Commercial |
$38.38
|
| Rate for Payer: Nomi Health Commercial |
$28.41
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.19
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$46.81
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$46.81 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Commercial |
$31.18
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Aetna Medicare |
$12.82
|
| Rate for Payer: Aetna Medicare |
$124.58
|
| Rate for Payer: ASR ASR |
$33.61
|
| Rate for Payer: ASR ASR |
$326.59
|
| Rate for Payer: ASR ASR |
$20.13
|
| Rate for Payer: ASR ASR |
$45.40
|
| Rate for Payer: BCBS Complete |
$13.86
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$18.72
|
| Rate for Payer: BCBS Complete |
$134.68
|
| Rate for Payer: BCBS Trust/PPO |
$277.60
|
| Rate for Payer: BCBS Trust/PPO |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$28.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$38.59
|
| Rate for Payer: BCN Commercial |
$28.57
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$269.35
|
| Rate for Payer: Cash Price |
$269.35
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cofinity Commercial |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$316.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Healthscope Commercial |
$33.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$34.65
|
| Rate for Payer: Healthscope Whirlpool |
$46.81
|
| Rate for Payer: Healthscope Whirlpool |
$336.69
|
| Rate for Payer: Mclaren Commercial |
$31.18
|
| Rate for Payer: Mclaren Commercial |
$303.02
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$42.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.79
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$28.41
|
| Rate for Payer: Nomi Health Commercial |
$38.38
|
| Rate for Payer: Nomi Health Commercial |
$276.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.29
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.04
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
117665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$25.24
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: ASR ASR |
$27.20
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Trust/PPO |
$23.12
|
| Rate for Payer: BCN Commercial |
$23.12
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$26.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$27.20
|
| Rate for Payer: Healthscope Whirlpool |
$28.04
|
| Rate for Payer: Mclaren Commercial |
$25.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Nomi Health Commercial |
$23.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.25
|
| Rate for Payer: Priority Health Narrow Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.68
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.04
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
117665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$25.24
|
| Rate for Payer: ASR ASR |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$23.03
|
| Rate for Payer: BCN Commercial |
$23.03
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$26.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$27.20
|
| Rate for Payer: Healthscope Whirlpool |
$28.04
|
| Rate for Payer: Mclaren Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Nomi Health Commercial |
$23.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.68
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
IP
|
$277.44
|
|
|
Service Code
|
NDC 68084032601
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.08 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: ASR ASR |
$269.12
|
| Rate for Payer: BCBS Trust/PPO |
$227.83
|
| Rate for Payer: BCN Commercial |
$227.83
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$260.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$269.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.44
|
| Rate for Payer: Mclaren Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Nomi Health Commercial |
$227.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.15
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 68084032611
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.43
|
| Rate for Payer: Priority Health Narrow Network |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 16729000201
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.03
|
| Rate for Payer: Aetna Medicare |
$30.43
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$67.82
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Healthscope Whirlpool |
$82.25
|
| Rate for Payer: Mclaren Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.07
|
| Rate for Payer: Priority Health Narrow Network |
$57.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 55111032101
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: ASR ASR |
$68.39
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$58.13
|
| Rate for Payer: BCN Commercial |
$58.13
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$68.39
|
| Rate for Payer: Healthscope Whirlpool |
$70.50
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 16729000201
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.03
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.54
|
| Rate for Payer: BCN Commercial |
$67.54
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Healthscope Whirlpool |
$82.25
|
| Rate for Payer: Mclaren Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
OP
|
$277.44
|
|
|
Service Code
|
NDC 68084032601
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$102.65
|
| Rate for Payer: ASR ASR |
$269.12
|
| Rate for Payer: BCBS Complete |
$110.98
|
| Rate for Payer: BCBS Trust/PPO |
$228.75
|
| Rate for Payer: BCN Commercial |
$228.75
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$260.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$269.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.44
|
| Rate for Payer: Mclaren Commercial |
$249.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Nomi Health Commercial |
$227.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.09
|
| Rate for Payer: Priority Health Narrow Network |
$194.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.15
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 68084032611
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
GLIMEPIRIDE 2 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 55111032101
|
| Hospital Charge Code |
16356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: ASR ASR |
$68.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.89
|
| Rate for Payer: BCN Commercial |
$57.89
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$68.39
|
| Rate for Payer: Healthscope Whirlpool |
$70.50
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
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 |
$206.15 |
| Rate for Payer: Aetna Commercial |
$185.53
|
| Rate for Payer: Aetna Medicare |
$76.28
|
| Rate for Payer: ASR ASR |
$199.97
|
| Rate for Payer: BCBS Complete |
$82.46
|
| Rate for Payer: BCBS Trust/PPO |
$169.97
|
| Rate for Payer: BCN Commercial |
$169.97
|
| Rate for Payer: Cash Price |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$193.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.92
|
| Rate for Payer: Healthscope Commercial |
$199.97
|
| Rate for Payer: Healthscope Whirlpool |
$206.15
|
| Rate for Payer: Mclaren Commercial |
$185.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.23
|
| Rate for Payer: Nomi Health Commercial |
$169.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.63
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.41
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.00
|
| Rate for Payer: Healthscope Whirlpool |
$2.06
|
| Rate for Payer: Mclaren Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna Commercial |
$204.34
|
| Rate for Payer: Aetna Medicare |
$84.01
|
| Rate for Payer: ASR ASR |
$220.24
|
| Rate for Payer: BCBS Complete |
$90.82
|
| Rate for Payer: BCBS Trust/PPO |
$187.20
|
| Rate for Payer: BCN Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Commercial |
$213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$220.24
|
| Rate for Payer: Healthscope Whirlpool |
$227.05
|
| Rate for Payer: Mclaren Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.94
|
| Rate for Payer: Priority Health Narrow Network |
$159.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.80
|
|
|
GLIPIZIDE 5 MG TABLET
|
Facility
|
IP
|
$227.05
|
|
|
Service Code
|
NDC 904663761
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.29 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna Commercial |
$204.34
|
| Rate for Payer: ASR ASR |
$220.24
|
| Rate for Payer: BCBS Trust/PPO |
$186.45
|
| Rate for Payer: BCN Commercial |
$186.45
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Commercial |
$213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$220.24
|
| Rate for Payer: Healthscope Whirlpool |
$227.05
|
| Rate for Payer: Mclaren Commercial |
$204.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.80
|
|
