|
glucose 50% IV Sol 50 mL [HMC]
|
Facility
|
OP
|
$59.12
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
3801302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$56.16 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.65
|
| Rate for Payer: WPPA Medicare Advantage |
$35.47
|
|
|
Glucose-6-Phosphate Dehydrogenase Qn QST
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
3552955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.70
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Glucose-6-Phosphate Dehydrogenase Qn QST
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
3552955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$77.72
|
| Rate for Payer: Humana Medicare Advantage |
$27.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.70
|
| Rate for Payer: WPPA Medicare Advantage |
$39.60
|
|
|
Glucose CSF
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3550445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Glucose CSF
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3550445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$8.64
|
| Rate for Payer: Humana Medicare Advantage |
$14.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.93
|
| Rate for Payer: WPPA Medicare Advantage |
$20.40
|
|
|
.Glucose Fasting
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
3550425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$48.72
|
| Rate for Payer: Humana Medicare Advantage |
$22.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.87
|
| Rate for Payer: WPPA Medicare Advantage |
$32.40
|
|
|
.Glucose Fasting
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
3550425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Glucose Level
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3550445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Glucose Level
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3550445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$8.64
|
| Rate for Payer: Humana Medicare Advantage |
$14.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.93
|
| Rate for Payer: WPPA Medicare Advantage |
$20.40
|
|
|
Glucose, Pleural Fluid QST
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3550775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$14.27
|
| Rate for Payer: Humana Medicare Advantage |
$22.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.93
|
| Rate for Payer: WPPA Medicare Advantage |
$31.80
|
|
|
Glucose, Pleural Fluid QST
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3550775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.35
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Glucose POCT
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3556416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$4.42
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.20
|
| Rate for Payer: WPPA Medicare Advantage |
$25.80
|
|
|
Glucose POCT
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3556416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.85
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glyBURIDE 5 mg Tab [HMC]
|
Facility
|
IP
|
$7.33
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3805534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.96
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glyBURIDE 5 mg Tab [HMC]
|
Facility
|
OP
|
$7.33
|
|
|
Service Code
|
NDC 23155005801
|
| Hospital Charge Code |
3805534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Humana Medicare Advantage |
$3.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.93
|
| Rate for Payer: WPPA Medicare Advantage |
$4.40
|
|
|
glycerin pediatric Supp [HMC]
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3801757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.11
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glycerin pediatric Supp [HMC]
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
NDC 00132008112
|
| Hospital Charge Code |
3801757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.11 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Humana Medicare Advantage |
$2.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.15
|
| Rate for Payer: WPPA Medicare Advantage |
$3.23
|
|
|
glycopyrrolate 0.2 mg/mL 2 mL Inj Sol [HMC]
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
NDC 71839012425
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.73
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glycopyrrolate 0.2 mg/mL 2 mL Inj Sol [HMC]
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
NDC 71839012425
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Humana Medicare Advantage |
$17.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.73
|
| Rate for Payer: WPPA Medicare Advantage |
$25.09
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
OP
|
$28.16
|
|
|
Service Code
|
NDC 43547064025
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Aetna Commercial |
$25.34
|
| Rate for Payer: Humana Medicare Advantage |
$11.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.26
|
| Rate for Payer: WPPA Medicare Advantage |
$16.90
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
IP
|
$46.19
|
|
|
Service Code
|
NDC 70069001225
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$41.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.88
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
OP
|
$41.94
|
|
|
Service Code
|
NDC 16729047108
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$39.84 |
| Rate for Payer: Aetna Commercial |
$37.75
|
| Rate for Payer: Humana Medicare Advantage |
$17.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.78
|
| Rate for Payer: WPPA Medicare Advantage |
$25.16
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
OP
|
$46.19
|
|
|
Service Code
|
NDC 70069001225
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$41.57
|
| Rate for Payer: Humana Medicare Advantage |
$19.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.48
|
| Rate for Payer: WPPA Medicare Advantage |
$27.71
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
IP
|
$41.94
|
|
|
Service Code
|
NDC 16729047108
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$37.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.84
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
glycopyrrolate 0.2 mg/mL Sol [HMC]
|
Facility
|
IP
|
$28.16
|
|
|
Service Code
|
NDC 43547064025
|
| Hospital Charge Code |
3807761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$25.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.75
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
