|
GLENOSPHERE W/BASEPLTE 25MM
|
Facility
|
IP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,250.00 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,250.00
|
|
|
GLIADIN IGG/IGA AB PROF, EIA
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
GLIADIN IGG/IGA AB PROF, EIA
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729243
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
GLIDEWIRE, .018 300CM 45D
|
Facility
|
OP
|
$478.13
|
|
| Hospital Charge Code |
64906161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.35 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$262.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$239.06
|
| Rate for Payer: Aetna Government |
$239.06
|
| Rate for Payer: Brighton Health Commercial |
$358.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$382.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$325.13
|
| Rate for Payer: Group Health Inc Commercial |
$239.06
|
| Rate for Payer: Group Health Inc Medicare |
$167.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.06
|
|
|
GLIDEWIRE, .035, 180CM STF
|
Facility
|
OP
|
$127.54
|
|
| Hospital Charge Code |
64906162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$102.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.77
|
| Rate for Payer: Aetna Government |
$63.77
|
| Rate for Payer: Brighton Health Commercial |
$95.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.73
|
| Rate for Payer: Group Health Inc Commercial |
$63.77
|
| Rate for Payer: Group Health Inc Medicare |
$44.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.77
|
|
|
GLIDEWIRE/CATH
|
Facility
|
OP
|
$463.00
|
|
| Hospital Charge Code |
40203082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.50
|
| Rate for Payer: Aetna Government |
$231.50
|
| Rate for Payer: Brighton Health Commercial |
$347.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$370.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.84
|
| Rate for Payer: Group Health Inc Commercial |
$231.50
|
| Rate for Payer: Group Health Inc Medicare |
$162.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.50
|
|
|
GLIMEPIRIDE 1 MG PO TABS [16355]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 50268035811
|
| Hospital Charge Code |
50268035811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
GLIMEPIRIDE 1 MG PO TABS [16355]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 50268035815
|
| Hospital Charge Code |
50268035815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
GLIMEPIRIDE 1 MG TAB
|
Facility
|
OP
|
$0.04
|
|
| Hospital Charge Code |
41642333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
GLIMEPIRIDE 1 MG TAB
|
Facility
|
OP
|
$0.04
|
|
| Hospital Charge Code |
41652333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
GLIMEPIRIDE 2 MG PO TABS [16356]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 50268035915
|
| Hospital Charge Code |
50268035915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna Government |
$0.44
|
| Rate for Payer: Brighton Health Commercial |
$0.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
GLIMEPIRIDE 2 MG PO TABS [16356]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 16729000201
|
| Hospital Charge Code |
16729000201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
GLIMEPIRIDE 2 MG TAB
|
Facility
|
OP
|
$0.21
|
|
| Hospital Charge Code |
41653870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
GLIMEPIRIDE 2 MG TAB
|
Facility
|
OP
|
$0.21
|
|
| Hospital Charge Code |
41643870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
GLIMEPIRIDE 4 MG PO TABS [16357]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 50268036011
|
| Hospital Charge Code |
50268036011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.61
|
| Rate for Payer: Aetna Government |
$0.61
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.79
|
|
|
GLIMEPIRIDE 4 MG PO TABS [16357]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 50268036015
|
| Hospital Charge Code |
50268036015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.61
|
| Rate for Payer: Aetna Government |
$0.61
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.79
|
|
|
GLIMEPIRIDE 4 MG PO TABS [16357]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 16729000301
|
| Hospital Charge Code |
16729000301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.61
|
| Rate for Payer: Aetna Government |
$0.61
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
GLIMEPIRIDE 4 MG PO TABS [16357]
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 00039022310
|
| Hospital Charge Code |
00039022310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.44
|
| Rate for Payer: Aetna Government |
$2.44
|
| Rate for Payer: Brighton Health Commercial |
$3.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.31
|
| Rate for Payer: Group Health Inc Commercial |
$2.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.17
|
|
|
GLIMEPIRIDE 4 MG TAB
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41653869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
GLIMEPIRIDE 4 MG TAB
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41643869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
GLIPIZIDE 10 MG PO TABS [10116]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 50268036215
|
| Hospital Charge Code |
50268036215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
GLIPIZIDE 10 MG PO TABS [10116]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 60505014200
|
| Hospital Charge Code |
60505014200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
GLIPIZIDE 10 MG PO TABS [10116]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 50268036211
|
| Hospital Charge Code |
50268036211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
GLIPIZIDE 10 MG TAB
|
Facility
|
OP
|
$0.13
|
|
| Hospital Charge Code |
41641532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
GLIPIZIDE 10 MG TAB
|
Facility
|
OP
|
$0.13
|
|
| Hospital Charge Code |
41651532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
