|
GLUCOSE
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
40602085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.14
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
GLUCOSE 2HR PP
|
Facility
|
OP
|
$11.88
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
40602685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.75
|
| Rate for Payer: Aetna Government |
$4.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.32
|
| Rate for Payer: Brighton Health Commercial |
$8.91
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$4.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.23
|
| Rate for Payer: Group Health Inc Commercial |
$4.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.75
|
| Rate for Payer: Healthfirst QHP |
$4.75
|
| Rate for Payer: Humana Medicare |
$4.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare Commercial |
$6.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.80
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
|
|
GLUCOSE 2HR PP
|
Facility
|
IP
|
$11.88
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
40602685
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.75
|
|
|
GLUCOSE-BF.
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
40602677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.75
|
| Rate for Payer: Brighton Health Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.14
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
GLUCOSE-BF.
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
40602677
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.93
|
|
|
GLUCOSE, BLD BY MONITOR DEVICE
|
Facility
|
IP
|
$8.20
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
30304032
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.28
|
|
|
GLUCOSE, BLD BY MONITOR DEVICE
|
Facility
|
OP
|
$8.20
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
30304032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.28
|
| Rate for Payer: Aetna Government |
$3.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.30
|
| Rate for Payer: Brighton Health Commercial |
$6.15
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.92
|
| Rate for Payer: Group Health Inc Commercial |
$3.28
|
| Rate for Payer: Group Health Inc Medicare |
$3.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.28
|
| Rate for Payer: Healthfirst QHP |
$3.28
|
| Rate for Payer: Humana Medicare |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.28
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.62
|
| Rate for Payer: Wellcare Medicare |
$2.95
|
|
|
GLUCOSE TOLERANCE 3 HOUR
|
Facility
|
IP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602670
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.87
|
|
|
GLUCOSE TOLERANCE 3 HOUR
|
Facility
|
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
GLUCOSE TOLERANCE 5 HOUR
|
Facility
|
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602335
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
GLUCOSE TOLERANCE 5 HOUR
|
Facility
|
IP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602335
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.87
|
|
|
GLYBURIDE 2.5 MG PO TABS [10126]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 23155005701
|
| Hospital Charge Code |
23155005701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
GLYBURIDE 2.5 MG PO TABS [10126]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 00093834301
|
| Hospital Charge Code |
00093834301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
GLYBURIDE 2.5 MG TAB
|
Facility
|
OP
|
$0.43
|
|
| Hospital Charge Code |
41654040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
GLYBURIDE 2.5 MG TAB
|
Facility
|
OP
|
$0.43
|
|
| Hospital Charge Code |
41644040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
GLYBURIDE 5 MG PO TABS [3489]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
23155005801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
GLYBURIDE 5 MG TAB
|
Facility
|
OP
|
$0.37
|
|
| Hospital Charge Code |
41653535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
GLYBURIDE 5 MG TAB
|
Facility
|
OP
|
$0.37
|
|
| Hospital Charge Code |
41643535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
GLYCERIN (ADULT) 2 G RE SUPP [40994]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 00132007912
|
| Hospital Charge Code |
00132007912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
GLYCERIN ADULT SUPP
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41651492
|
|
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
|
|
|
GLYCERIN ADULT SUPP
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41641492
|
|
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
|
|
|
GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN [41412]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
57896018105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.11
|
| 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 |
$0.09
|
|
|
GLYCERIN PEDIATRIC SUPP
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41643375
|
|
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
|
|
|
GLYCERIN PEDIATRIC SUPP
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
41653375
|
|
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
|
|
|
GLYCINE 1.5% 3000CC
|
Facility
|
OP
|
$29.41
|
|
| Hospital Charge Code |
40509813
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.70
|
| Rate for Payer: Aetna Government |
$14.70
|
| Rate for Payer: Brighton Health Commercial |
$22.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.00
|
| Rate for Payer: Group Health Inc Commercial |
$14.70
|
| Rate for Payer: Group Health Inc Medicare |
$10.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
