|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$44,648.56
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$40,183.70 |
| Rate for Payer: Aetna Commercial |
$37,951.28
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,021.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.65
|
| Rate for Payer: BCBS Complete |
$19.62
|
| Rate for Payer: BCBS MAPPO |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$88.77
|
| Rate for Payer: BCN Commercial |
$88.77
|
| Rate for Payer: BCN Medicare Advantage |
$35.72
|
| Rate for Payer: Cash Price |
$35,718.85
|
| Rate for Payer: Cash Price |
$35,718.85
|
| Rate for Payer: Cofinity Advantage |
$31,253.99
|
| Rate for Payer: Cofinity Commercial |
$38,397.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,718.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40,183.70
|
| Rate for Payer: Mclaren Medicaid |
$18.68
|
| Rate for Payer: Mclaren Medicare |
$35.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.51
|
| Rate for Payer: Meridian Medicaid |
$37.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,951.28
|
| Rate for Payer: Nomi Health Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33,486.42
|
| Rate for Payer: PACE Medicare |
$33.93
|
| Rate for Payer: PACE SWMI |
$35.72
|
| Rate for Payer: PHP Commercial |
$37,951.28
|
| Rate for Payer: PHP Medicare Advantage |
$35.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107.37
|
| Rate for Payer: Priority Health Medicare |
$35.72
|
| Rate for Payer: Priority Health SBD |
$28,128.59
|
| Rate for Payer: Priority Health Tiered Network |
$85.90
|
| Rate for Payer: Railroad Medicare Medicare |
$35.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.39
|
| Rate for Payer: UHC Core |
$58.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.72
|
| Rate for Payer: UHC Exchange |
$58.39
|
| Rate for Payer: UHC Medicaid |
$18.68
|
| Rate for Payer: UHCCP Medicaid |
$18.68
|
| Rate for Payer: VA VA |
$35.72
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$28,430.68
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,911.33 |
| Max. Negotiated Rate |
$25,587.61 |
| Rate for Payer: Aetna Commercial |
$24,166.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,479.94
|
| Rate for Payer: Cash Price |
$22,744.54
|
| Rate for Payer: Cofinity Advantage |
$19,901.48
|
| Rate for Payer: Cofinity Commercial |
$24,450.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,744.54
|
| Rate for Payer: Healthscope Commercial |
$25,587.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,166.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,323.01
|
| Rate for Payer: PHP Commercial |
$24,166.08
|
| Rate for Payer: Priority Health SBD |
$17,911.33
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$28,430.68
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$25,587.61 |
| Rate for Payer: Aetna Commercial |
$24,166.08
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,479.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.65
|
| Rate for Payer: BCBS Complete |
$19.62
|
| Rate for Payer: BCBS MAPPO |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$88.77
|
| Rate for Payer: BCN Commercial |
$88.77
|
| Rate for Payer: BCN Medicare Advantage |
$35.72
|
| Rate for Payer: Cash Price |
$22,744.54
|
| Rate for Payer: Cash Price |
$22,744.54
|
| Rate for Payer: Cofinity Advantage |
$19,901.48
|
| Rate for Payer: Cofinity Commercial |
$24,450.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,744.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$25,587.61
|
| Rate for Payer: Mclaren Medicaid |
$18.68
|
| Rate for Payer: Mclaren Medicare |
$35.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.51
|
| Rate for Payer: Meridian Medicaid |
$37.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,166.08
|
| Rate for Payer: Nomi Health Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,323.01
|
| Rate for Payer: PACE Medicare |
$33.93
|
| Rate for Payer: PACE SWMI |
$35.72
|
| Rate for Payer: PHP Commercial |
$24,166.08
|
| Rate for Payer: PHP Medicare Advantage |
$35.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107.37
|
| Rate for Payer: Priority Health Medicare |
$35.72
|
| Rate for Payer: Priority Health SBD |
$17,911.33
|
| Rate for Payer: Priority Health Tiered Network |
$85.90
|
| Rate for Payer: Railroad Medicare Medicare |
$35.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.39
|
| Rate for Payer: UHC Core |
$58.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.72
|
| Rate for Payer: UHC Exchange |
$58.39
|
| Rate for Payer: UHC Medicaid |
$18.68
|
| Rate for Payer: UHCCP Medicaid |
$18.68
|
| Rate for Payer: VA VA |
$35.72
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$21,923.21
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$19,730.89 |
| Rate for Payer: Aetna Commercial |
$18,634.73
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,250.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.65
|
| Rate for Payer: BCBS Complete |
$19.62
|
| Rate for Payer: BCBS MAPPO |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$88.77
|
| Rate for Payer: BCN Commercial |
$88.77
|
| Rate for Payer: BCN Medicare Advantage |
$35.72
|
| Rate for Payer: Cash Price |
$17,538.57
|
| Rate for Payer: Cash Price |
$17,538.57
|
| Rate for Payer: Cofinity Advantage |
$15,346.25
|
| Rate for Payer: Cofinity Commercial |
$18,853.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,538.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$19,730.89
|
| Rate for Payer: Mclaren Medicaid |
$18.68
|
| Rate for Payer: Mclaren Medicare |
$35.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.51
|
| Rate for Payer: Meridian Medicaid |
$37.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,634.73
|
| Rate for Payer: Nomi Health Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,442.41
|
| Rate for Payer: PACE Medicare |
$33.93
|
| Rate for Payer: PACE SWMI |
$35.72
|
| Rate for Payer: PHP Commercial |
$18,634.73
|
| Rate for Payer: PHP Medicare Advantage |
$35.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107.37
|
| Rate for Payer: Priority Health Medicare |
$35.72
|
| Rate for Payer: Priority Health SBD |
$13,811.62
|
| Rate for Payer: Priority Health Tiered Network |
$85.90
|
| Rate for Payer: Railroad Medicare Medicare |
$35.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.39
|
| Rate for Payer: UHC Core |
$58.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.72
|
| Rate for Payer: UHC Exchange |
$58.39
|
| Rate for Payer: UHC Medicaid |
$18.68
|
| Rate for Payer: UHCCP Medicaid |
$18.68
|
| Rate for Payer: VA VA |
$35.72
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$21,923.21
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,811.62 |
| Max. Negotiated Rate |
$19,730.89 |
| Rate for Payer: Aetna Commercial |
$18,634.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,250.09
|
| Rate for Payer: Cash Price |
$17,538.57
|
| Rate for Payer: Cofinity Advantage |
$15,346.25
|
| Rate for Payer: Cofinity Commercial |
$18,853.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,538.57
|
| Rate for Payer: Healthscope Commercial |
$19,730.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,634.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,442.41
|
| Rate for Payer: PHP Commercial |
$18,634.73
|
| Rate for Payer: Priority Health SBD |
$13,811.62
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,369.23 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.70
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Advantage |
$1,521.37
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,630.04
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: Priority Health SBD |
$1,369.23
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
NDC 65862089610
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health SBD |
$9.94
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare |
$15.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.18
|
| Rate for Payer: UHC Core |
$16.18
|
| Rate for Payer: UHC Exchange |
$12.20
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$1,576.57
|
|
|
Service Code
|
NDC 65862089678
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$619.59 |
| Max. Negotiated Rate |
$1,418.91 |
| Rate for Payer: Aetna Commercial |
$1,340.08
|
| Rate for Payer: Aetna Medicare |
$788.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.77
|
| Rate for Payer: BCBS Complete |
$630.63
|
| Rate for Payer: Cash Price |
$1,261.26
|
| Rate for Payer: Cofinity Advantage |
$1,103.60
|
| Rate for Payer: Cofinity Commercial |
$1,355.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.26
|
| Rate for Payer: Healthscope Commercial |
$1,418.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.43
|
| Rate for Payer: PHP Commercial |
$1,340.08
|
| Rate for Payer: Priority Health SBD |
$993.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.77
|
| Rate for Payer: UHC Core |
$821.39
|
| Rate for Payer: UHC Exchange |
$619.59
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,576.57
|
|
|
Service Code
|
NDC 65862089678
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$993.24 |
| Max. Negotiated Rate |
$1,418.91 |
| Rate for Payer: Aetna Commercial |
$1,340.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.77
|
| Rate for Payer: Cash Price |
$1,261.26
|
| Rate for Payer: Cofinity Advantage |
$1,103.60
|
| Rate for Payer: Cofinity Commercial |
$1,355.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.26
|
| Rate for Payer: Healthscope Commercial |
$1,418.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.43
|
| Rate for Payer: PHP Commercial |
$1,340.08
|
| Rate for Payer: Priority Health SBD |
$993.24
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Advantage |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health SBD |
$19.56
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$854.14 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: Aetna Medicare |
$1,086.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.70
|
| Rate for Payer: BCBS Complete |
$869.35
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Advantage |
$1,521.37
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,738.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,630.04
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: Priority Health SBD |
$1,369.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,412.70
|
| Rate for Payer: UHC Core |
$1,132.33
|
| Rate for Payer: UHC Exchange |
$854.14
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$1,552.34
|
|
|
Service Code
|
NDC 00378698285
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$610.07 |
| Max. Negotiated Rate |
$1,397.11 |
| Rate for Payer: Aetna Commercial |
$1,319.49
|
| Rate for Payer: Aetna Medicare |
$776.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.02
|
| Rate for Payer: BCBS Complete |
$620.94
|
| Rate for Payer: Cash Price |
$1,241.87
|
| Rate for Payer: Cofinity Advantage |
$1,086.64
|
| Rate for Payer: Cofinity Commercial |
$1,335.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.87
|
| Rate for Payer: Healthscope Commercial |
$1,397.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,241.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,164.26
|
| Rate for Payer: PHP Commercial |
$1,319.49
|
| Rate for Payer: Priority Health SBD |
$977.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,009.02
|
| Rate for Payer: UHC Core |
$808.77
|
| Rate for Payer: UHC Exchange |
$610.07
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.13
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Advantage |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health SBD |
$13.70
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,955.94 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.04
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Advantage |
$2,173.27
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health SBD |
$1,955.94
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.13
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Advantage |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.13
|
| Rate for Payer: UHC Core |
$11.33
|
| Rate for Payer: UHC Exchange |
$8.54
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,552.34
|
|
|
Service Code
|
NDC 00378698285
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$977.97 |
| Max. Negotiated Rate |
$1,397.11 |
| Rate for Payer: Aetna Commercial |
$1,319.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.02
|
| Rate for Payer: Cash Price |
$1,241.87
|
| Rate for Payer: Cofinity Advantage |
$1,086.64
|
| Rate for Payer: Cofinity Commercial |
$1,335.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.87
|
| Rate for Payer: Healthscope Commercial |
$1,397.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,164.26
|
| Rate for Payer: PHP Commercial |
$1,319.49
|
| Rate for Payer: Priority Health SBD |
$977.97
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
NDC 65862089610
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.25
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: UHC Exchange |
$6.20
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,220.14 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna Medicare |
$1,552.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.04
|
| Rate for Payer: BCBS Complete |
$1,241.87
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Advantage |
$2,173.27
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,483.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health SBD |
$1,955.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,018.04
|
| Rate for Payer: UHC Core |
$1,617.53
|
| Rate for Payer: UHC Exchange |
$1,220.14
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,720.62
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.20 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna Medicare |
$860.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: BCBS Complete |
$688.25
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,376.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.40
|
| Rate for Payer: UHC Core |
$896.44
|
| Rate for Payer: UHC Exchange |
$676.20
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,720.62
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,083.99 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,720.62
|
|
|
Service Code
|
NDC 68180081942
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,083.99 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,720.62
|
|
|
Service Code
|
NDC 68180081942
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.20 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna Medicare |
$860.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: BCBS Complete |
$688.25
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,376.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.40
|
| Rate for Payer: UHC Core |
$896.44
|
| Rate for Payer: UHC Exchange |
$676.20
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$860.31
|
|
|
Service Code
|
NDC 68180081952
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna Medicare |
$430.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: BCBS Complete |
$344.12
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.20
|
| Rate for Payer: UHC Core |
$448.22
|
| Rate for Payer: UHC Exchange |
$338.10
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$860.31
|
|
|
Service Code
|
NDC 68180081952
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$542.00 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
|
