|
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
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 51079081001
|
| Hospital Charge Code |
10117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.70
|
| 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: MI Amish Medical Board Commercial |
$1.65
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.81
|
| Rate for Payer: Priority Health Narrow Network |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$192.53
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Aetna Commercial |
$173.28
|
| Rate for Payer: ASR ASR |
$186.75
|
| Rate for Payer: BCBS Trust/PPO |
$158.10
|
| Rate for Payer: BCN Commercial |
$158.10
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$180.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$186.75
|
| Rate for Payer: Healthscope Whirlpool |
$192.53
|
| Rate for Payer: Mclaren Commercial |
$173.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$157.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.42
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: ASR ASR |
$6.23
|
| Rate for Payer: BCBS Complete |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$6.23
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.62
|
| Rate for Payer: Priority Health Narrow Network |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.65
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$6.42
|
|
|
Service Code
|
NDC 60687076811
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: ASR ASR |
$6.23
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$6.23
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.46
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.65
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$192.53
|
|
|
Service Code
|
NDC 60687076821
|
| Hospital Charge Code |
37648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Aetna Commercial |
$173.28
|
| Rate for Payer: Aetna Medicare |
$71.24
|
| Rate for Payer: ASR ASR |
$186.75
|
| Rate for Payer: BCBS Complete |
$77.01
|
| Rate for Payer: BCBS Trust/PPO |
$158.74
|
| Rate for Payer: BCN Commercial |
$158.74
|
| Rate for Payer: Cash Price |
$154.02
|
| Rate for Payer: Cofinity Commercial |
$180.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.02
|
| Rate for Payer: Healthscope Commercial |
$186.75
|
| Rate for Payer: Healthscope Whirlpool |
$192.53
|
| Rate for Payer: Mclaren Commercial |
$173.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$157.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.69
|
| Rate for Payer: Priority Health Narrow Network |
$134.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.42
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 68084011111
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: ASR ASR |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Healthscope Whirlpool |
$4.69
|
| Rate for Payer: Mclaren Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.13
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$213.85
|
|
|
Service Code
|
NDC 59651026901
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna Medicare |
$79.12
|
| Rate for Payer: ASR ASR |
$207.43
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: BCBS Trust/PPO |
$176.32
|
| Rate for Payer: BCN Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$207.43
|
| Rate for Payer: Healthscope Whirlpool |
$213.85
|
| Rate for Payer: Mclaren Commercial |
$192.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Nomi Health Commercial |
$175.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$187.38
|
| Rate for Payer: Priority Health Narrow Network |
$149.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.19
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 591084401
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.38 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: ASR ASR |
$248.81
|
| Rate for Payer: BCBS Trust/PPO |
$210.64
|
| Rate for Payer: BCN Commercial |
$210.64
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$241.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: Healthscope Whirlpool |
$256.50
|
| Rate for Payer: Mclaren Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.72
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 59651026901
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: ASR ASR |
$207.43
|
| Rate for Payer: BCBS Trust/PPO |
$175.61
|
| Rate for Payer: BCN Commercial |
$175.61
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$201.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$207.43
|
| Rate for Payer: Healthscope Whirlpool |
$213.85
|
| Rate for Payer: Mclaren Commercial |
$192.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Nomi Health Commercial |
$175.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.19
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 591084401
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Medicare |
$94.91
|
| Rate for Payer: ASR ASR |
$248.81
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: BCBS Trust/PPO |
$211.48
|
| Rate for Payer: BCN Commercial |
$211.48
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$241.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: Healthscope Whirlpool |
$256.50
|
| Rate for Payer: Mclaren Commercial |
$230.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$224.75
|
| Rate for Payer: Priority Health Narrow Network |
$179.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.72
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 68084011111
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: ASR ASR |
$4.55
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Healthscope Whirlpool |
$4.69
|
| Rate for Payer: Mclaren Commercial |
$4.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.11
|
| Rate for Payer: Priority Health Narrow Network |
$3.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.13
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$481.14
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$481.14 |
| Rate for Payer: Aetna Commercial |
$433.03
|
| Rate for Payer: Aetna Commercial |
$433.04
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.75
|
| Rate for Payer: ASR ASR |
$466.71
|
| Rate for Payer: ASR ASR |
$466.73
|
| Rate for Payer: BCBS Complete |
$74.14
|
| Rate for Payer: BCBS Complete |
$74.14
|
| Rate for Payer: BCBS MAPPO |
$135.00
|
| Rate for Payer: BCBS MAPPO |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$396.72
|
| Rate for Payer: BCBS Trust/PPO |
$396.70
|
| Rate for Payer: BCN Commercial |
$396.72
|
| Rate for Payer: BCN Commercial |
$396.70
|
| Rate for Payer: BCN Medicare Advantage |
$135.00
|
| Rate for Payer: BCN Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cofinity Commercial |
$452.28
|
| Rate for Payer: Cofinity Commercial |
$452.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.00
|
| Rate for Payer: Healthscope Commercial |
$466.71
|
| Rate for Payer: Healthscope Commercial |
$466.73
|
| Rate for Payer: Healthscope Whirlpool |
$481.14
|
| Rate for Payer: Healthscope Whirlpool |
$481.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.00
|
| Rate for Payer: Mclaren Commercial |
$433.04
|
| Rate for Payer: Mclaren Commercial |
$433.03
|
| Rate for Payer: Mclaren Medicaid |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$135.00
|
| Rate for Payer: Mclaren Medicare |
$135.00
|
| Rate for Payer: Mclaren Medicare |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.75
|
| Rate for Payer: Meridian Medicaid |
$74.14
|
| Rate for Payer: Meridian Medicaid |
$74.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.99
|
| Rate for Payer: Nomi Health Commercial |
$394.55
|
| Rate for Payer: Nomi Health Commercial |
$394.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.87
|
| Rate for Payer: PACE Medicare |
$128.25
|
| Rate for Payer: PACE Medicare |
$128.25
|
| Rate for Payer: PACE SWMI |
$135.00
|
| Rate for Payer: PACE SWMI |
$135.00
|
| Rate for Payer: PHP Commercial |
$148.50
|
| Rate for Payer: PHP Commercial |
$148.50
|
| Rate for Payer: PHP Medicaid |
$72.36
|
| Rate for Payer: PHP Medicaid |
$72.36
|
| Rate for Payer: PHP Medicare Advantage |
$135.00
|
| Rate for Payer: PHP Medicare Advantage |
$135.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$148.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$148.66
|
| Rate for Payer: Priority Health Medicare |
$135.00
|
| Rate for Payer: Priority Health Medicare |
$135.00
|
| Rate for Payer: Priority Health Narrow Network |
$118.93
|
| Rate for Payer: Priority Health Narrow Network |
$118.93
|
| Rate for Payer: Railroad Medicare Medicare |
$135.00
|
| Rate for Payer: Railroad Medicare Medicare |
$135.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.00
|
| Rate for Payer: UHC Exchange |
$209.25
|
| Rate for Payer: UHC Exchange |
$209.25
|
| Rate for Payer: UHC Medicaid |
$70.61
|
| Rate for Payer: UHC Medicaid |
$70.61
|
| Rate for Payer: UHCCP DNSP |
$135.00
|
| Rate for Payer: UHCCP DNSP |
$135.00
|
| Rate for Payer: UHCCP Medicaid |
$70.61
|
| Rate for Payer: UHCCP Medicaid |
$70.61
|
| Rate for Payer: VA VA |
$135.00
|
| Rate for Payer: VA VA |
$135.00
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$481.14
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$360.86 |
| Max. Negotiated Rate |
$481.14 |
| Rate for Payer: Aetna Commercial |
$433.03
|
| Rate for Payer: Aetna Commercial |
$433.04
|
| Rate for Payer: ASR ASR |
$466.71
|
| Rate for Payer: ASR ASR |
$466.73
|
| Rate for Payer: BCBS Trust/PPO |
$395.12
|
| Rate for Payer: BCBS Trust/PPO |
$395.13
|
| Rate for Payer: BCN Commercial |
$395.12
|
| Rate for Payer: BCN Commercial |
$395.13
|
| Rate for Payer: Cash Price |
$384.93
|
| Rate for Payer: Cash Price |
$384.92
|
| Rate for Payer: Cofinity Commercial |
$452.29
|
| Rate for Payer: Cofinity Commercial |
$452.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.93
|
| Rate for Payer: Healthscope Commercial |
$466.71
|
| Rate for Payer: Healthscope Commercial |
$466.73
|
| Rate for Payer: Healthscope Whirlpool |
$481.16
|
| Rate for Payer: Healthscope Whirlpool |
$481.14
|
| Rate for Payer: Mclaren Commercial |
$433.04
|
| Rate for Payer: Mclaren Commercial |
$433.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.97
|
| Rate for Payer: Nomi Health Commercial |
$394.55
|
| Rate for Payer: Nomi Health Commercial |
$394.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.41
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: ASR ASR |
$98.02
|
| Rate for Payer: BCBS Trust/PPO |
$82.98
|
| Rate for Payer: BCN Commercial |
$82.98
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$98.02
|
| Rate for Payer: Healthscope Whirlpool |
$101.05
|
| Rate for Payer: Mclaren Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.92
|
|
|
GLYBURIDE 2.5 MG TABLET
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
10126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.39 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Aetna Medicare |
$37.39
|
| Rate for Payer: ASR ASR |
$98.02
|
| Rate for Payer: BCBS Complete |
$40.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.32
|
| Rate for Payer: BCN Commercial |
$83.32
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$98.02
|
| Rate for Payer: Healthscope Whirlpool |
$101.05
|
| Rate for Payer: Mclaren Commercial |
$90.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.54
|
| Rate for Payer: Priority Health Narrow Network |
$70.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.92
|
|
|
GLYBURIDE 5 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$96.35 |
| Rate for Payer: Aetna Commercial |
$86.72
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: ASR ASR |
$93.46
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.44
|
| Rate for Payer: BCN Commercial |
$79.44
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$93.46
|
| Rate for Payer: Healthscope Whirlpool |
$96.35
|
| Rate for Payer: Mclaren Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.42
|
| Rate for Payer: Priority Health Narrow Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.79
|
|
|
GLYBURIDE 5 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.26 |
| Max. Negotiated Rate |
$96.35 |
| Rate for Payer: Aetna Commercial |
$86.72
|
| Rate for Payer: ASR ASR |
$93.46
|
| Rate for Payer: BCBS Trust/PPO |
$79.12
|
| Rate for Payer: BCN Commercial |
$79.12
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$93.46
|
| Rate for Payer: Healthscope Whirlpool |
$96.35
|
| Rate for Payer: Mclaren Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.79
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$35.81
|
|
|
Service Code
|
NDC 132007912
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: ASR ASR |
$34.74
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS Trust/PPO |
$29.53
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$33.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Healthscope Commercial |
$34.74
|
| Rate for Payer: Healthscope Whirlpool |
$35.81
|
| Rate for Payer: Mclaren Commercial |
$32.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Narrow Network |
$25.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.52
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$37.56
|
| Rate for Payer: ASR ASR |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$34.27
|
| Rate for Payer: BCN Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$39.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Whirlpool |
$41.74
|
| Rate for Payer: Mclaren Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.73
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$35.81
|
|
|
Service Code
|
NDC 132007912
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: ASR ASR |
$34.74
|
| Rate for Payer: BCBS Trust/PPO |
$29.41
|
| Rate for Payer: BCN Commercial |
$29.41
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$33.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Healthscope Commercial |
$34.74
|
| Rate for Payer: Healthscope Whirlpool |
$35.81
|
| Rate for Payer: Mclaren Commercial |
$32.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.52
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$41.74
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$41.74 |
| Rate for Payer: Aetna Commercial |
$37.56
|
| Rate for Payer: Aetna Medicare |
$15.44
|
| Rate for Payer: ASR ASR |
$40.48
|
| Rate for Payer: BCBS Complete |
$16.69
|
| Rate for Payer: BCBS Trust/PPO |
$34.41
|
| Rate for Payer: BCN Commercial |
$34.41
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$39.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Whirlpool |
$41.74
|
| Rate for Payer: Mclaren Commercial |
$37.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.48
|
| Rate for Payer: Nomi Health Commercial |
$34.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Narrow Network |
$29.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.73
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: ASR ASR |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCN Commercial |
$31.83
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$36.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Healthscope Whirlpool |
$38.76
|
| Rate for Payer: Mclaren Commercial |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.95
|
| Rate for Payer: Nomi Health Commercial |
$31.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.11
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
NDC 58980040912
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: ASR ASR |
$37.60
|
| Rate for Payer: BCBS Complete |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.96
|
| Rate for Payer: BCN Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$36.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Healthscope Whirlpool |
$38.76
|
| Rate for Payer: Mclaren Commercial |
$34.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.95
|
| Rate for Payer: Nomi Health Commercial |
$31.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.96
|
| Rate for Payer: Priority Health Narrow Network |
$27.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.11
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$12.01 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$67.85
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR ASR |
$23.45
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: ASR ASR |
$17.78
|
| Rate for Payer: ASR ASR |
$73.13
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCBS Trust/PPO |
$61.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$10.84
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: BCN Commercial |
$9.86
|
| Rate for Payer: BCN Commercial |
$61.91
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Commercial |
$10.84
|
| Rate for Payer: BCN Commercial |
$15.05
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$70.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.31
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$73.13
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Healthscope Whirlpool |
$14.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.33
|
| Rate for Payer: Healthscope Whirlpool |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$24.18
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$75.39
|
| Rate for Payer: Mclaren Commercial |
$21.76
|
| Rate for Payer: Mclaren Commercial |
$67.85
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Mclaren Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.55
|
| Rate for Payer: Nomi Health Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$15.03
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Nomi Health Commercial |
$61.82
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.27
|
|
