Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LAMOTRIGINE 25 MG TABLET

Facility

$131.60

Service Code	NDC 51672413001
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$52.64
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna Medicare	$65.80
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: BCBS Complete	$52.64
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.12
Rate for Payer: Cofinity Medicare Advantage	$92.12
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health Cigna Priority Health	$85.54
Rate for Payer: Priority Health SBD	$82.91

LAMOTRIGINE 25 MG TABLET

Facility

$321.95

Service Code	NDC 00904700761
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$202.83
Max. Negotiated Rate	$289.75
Rate for Payer: Aetna Commercial	$273.66
Rate for Payer: Aetna New Business (MI Preferred)	$209.27
Rate for Payer: Cash Price	$257.56
Rate for Payer: Cofinity Commercial	$225.37
Rate for Payer: Cofinity Commercial	$276.88
Rate for Payer: Cofinity Medicare Advantage	$225.37
Rate for Payer: Encore Health Key Benefits Commercial	$257.56
Rate for Payer: Healthscope Commercial	$289.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.66
Rate for Payer: PHP Commercial	$273.66
Rate for Payer: Priority Health Cigna Priority Health	$209.27
Rate for Payer: Priority Health SBD	$202.83

LAMOTRIGINE 25 MG TABLET

Facility

$321.95

Service Code	NDC 00904700761
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$128.78
Max. Negotiated Rate	$289.75
Rate for Payer: Aetna Commercial	$273.66
Rate for Payer: Aetna Medicare	$160.97
Rate for Payer: Aetna New Business (MI Preferred)	$209.27
Rate for Payer: BCBS Complete	$128.78
Rate for Payer: Cash Price	$257.56
Rate for Payer: Cofinity Commercial	$225.37
Rate for Payer: Cofinity Commercial	$276.88
Rate for Payer: Cofinity Medicare Advantage	$225.37
Rate for Payer: Encore Health Key Benefits Commercial	$257.56
Rate for Payer: Healthscope Commercial	$289.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.66
Rate for Payer: PHP Commercial	$273.66
Rate for Payer: Priority Health Cigna Priority Health	$209.27
Rate for Payer: Priority Health SBD	$202.83

LAMOTRIGINE 25 MG TABLET

Facility

$131.60

Service Code	NDC 51672413001
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$82.91
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.12
Rate for Payer: Cofinity Medicare Advantage	$92.12
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health Cigna Priority Health	$85.54
Rate for Payer: Priority Health SBD	$82.91

LAMOTRIGINE 25 MG TABLET

Facility

$3.62

Service Code	NDC 68084031811
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.26
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.35
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Cofinity Medicare Advantage	$2.53
Rate for Payer: Encore Health Key Benefits Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.08
Rate for Payer: PHP Commercial	$3.08
Rate for Payer: Priority Health Cigna Priority Health	$2.35
Rate for Payer: Priority Health SBD	$2.28

LAMOTRIGINE 25 MG TABLET

Facility

$361.90

Service Code	NDC 68084031801
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

LAMOTRIGINE 25 MG TABLET

Facility

$361.90

Service Code	NDC 68084031801
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$144.76
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$180.95
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: BCBS Complete	$144.76
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$42,933.38

Service Code	HCPCS J1930
Hospital Charge Code	87861
Hospital Revenue Code	636
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$38,640.04
Rate for Payer: Aetna Commercial	$36,493.37
Rate for Payer: Aetna Medicare	$35.41
Rate for Payer: Aetna New Business (MI Preferred)	$27,906.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.56
Rate for Payer: Amish Plain Church Group Commercial	$42.56
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: BCBS MAPPO	$34.05
Rate for Payer: BCN Medicare Advantage	$34.05
Rate for Payer: Cash Price	$34,346.70
Rate for Payer: Cash Price	$34,346.70
Rate for Payer: Cofinity Commercial	$36,922.71
Rate for Payer: Cofinity Commercial	$30,053.37
Rate for Payer: Cofinity Medicare Advantage	$30,053.37
Rate for Payer: Encore Health Key Benefits Commercial	$34,346.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.05
Rate for Payer: Healthscope Commercial	$38,640.04
Rate for Payer: Mclaren Medicaid	$18.25
Rate for Payer: Mclaren Medicare	$34.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.75
Rate for Payer: Meridian Medicaid	$19.16
Rate for Payer: MI Amish Medical Board Commercial	$39.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36,493.37
Rate for Payer: PACE Medicare	$32.35
Rate for Payer: PACE SWMI	$34.05
Rate for Payer: PHP Commercial	$36,493.37
Rate for Payer: PHP Medicare Advantage	$34.05
Rate for Payer: Priority Health Choice Medicaid	$18.25
Rate for Payer: Priority Health Cigna Priority Health	$27,906.70
Rate for Payer: Priority Health Medicare	$34.05
Rate for Payer: Priority Health SBD	$27,048.03
Rate for Payer: Railroad Medicare Medicare	$34.05
Rate for Payer: UHC All Payor (Choice/PPO)	$95.85
Rate for Payer: UHC Dual Complete DSNP	$34.05
Rate for Payer: UHC Medicare Advantage	$34.05
Rate for Payer: UHCCP Medicaid	$19.17
Rate for Payer: VA VA	$34.05

LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$42,933.38

Service Code	HCPCS J1930
Hospital Charge Code	87861
Hospital Revenue Code	636
Min. Negotiated Rate	$27,048.03
Max. Negotiated Rate	$38,640.04
Rate for Payer: Aetna Commercial	$36,493.37
Rate for Payer: Aetna New Business (MI Preferred)	$27,906.70
Rate for Payer: Cash Price	$34,346.70
Rate for Payer: Cofinity Commercial	$30,053.37
Rate for Payer: Cofinity Commercial	$36,922.71
Rate for Payer: Cofinity Medicare Advantage	$30,053.37
Rate for Payer: Encore Health Key Benefits Commercial	$34,346.70
Rate for Payer: Healthscope Commercial	$38,640.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36,493.37
Rate for Payer: PHP Commercial	$36,493.37
Rate for Payer: Priority Health Cigna Priority Health	$27,906.70
Rate for Payer: Priority Health SBD	$27,048.03

LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE

Facility

$27,335.12

Service Code	HCPCS J1930
Hospital Charge Code	88570
Hospital Revenue Code	636
Min. Negotiated Rate	$17,221.13
Max. Negotiated Rate	$24,601.61
Rate for Payer: Aetna Commercial	$23,234.85
Rate for Payer: Aetna New Business (MI Preferred)	$17,767.83
Rate for Payer: Cash Price	$21,868.10
Rate for Payer: Cofinity Commercial	$19,134.58
Rate for Payer: Cofinity Commercial	$23,508.20
Rate for Payer: Cofinity Medicare Advantage	$19,134.58
Rate for Payer: Encore Health Key Benefits Commercial	$21,868.10
Rate for Payer: Healthscope Commercial	$24,601.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23,234.85
Rate for Payer: PHP Commercial	$23,234.85
Rate for Payer: Priority Health Cigna Priority Health	$17,767.83
Rate for Payer: Priority Health SBD	$17,221.13

LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE

Facility

$27,335.12

Service Code	HCPCS J1930
Hospital Charge Code	88570
Hospital Revenue Code	636
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$24,601.61
Rate for Payer: Aetna Commercial	$23,234.85
Rate for Payer: Aetna Medicare	$35.41
Rate for Payer: Aetna New Business (MI Preferred)	$17,767.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.56
Rate for Payer: Amish Plain Church Group Commercial	$42.56
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: BCBS MAPPO	$34.05
Rate for Payer: BCN Medicare Advantage	$34.05
Rate for Payer: Cash Price	$21,868.10
Rate for Payer: Cash Price	$21,868.10
Rate for Payer: Cofinity Commercial	$19,134.58
Rate for Payer: Cofinity Commercial	$23,508.20
Rate for Payer: Cofinity Medicare Advantage	$19,134.58
Rate for Payer: Encore Health Key Benefits Commercial	$21,868.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.05
Rate for Payer: Healthscope Commercial	$24,601.61
Rate for Payer: Mclaren Medicaid	$18.25
Rate for Payer: Mclaren Medicare	$34.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.75
Rate for Payer: Meridian Medicaid	$19.16
Rate for Payer: MI Amish Medical Board Commercial	$39.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23,234.85
Rate for Payer: PACE Medicare	$32.35
Rate for Payer: PACE SWMI	$34.05
Rate for Payer: PHP Commercial	$23,234.85
Rate for Payer: PHP Medicare Advantage	$34.05
Rate for Payer: Priority Health Choice Medicaid	$18.25
Rate for Payer: Priority Health Cigna Priority Health	$17,767.83
Rate for Payer: Priority Health Medicare	$34.05
Rate for Payer: Priority Health SBD	$17,221.13
Rate for Payer: Railroad Medicare Medicare	$34.05
Rate for Payer: UHC All Payor (Choice/PPO)	$95.85
Rate for Payer: UHC Dual Complete DSNP	$34.05
Rate for Payer: UHC Medicare Advantage	$34.05
Rate for Payer: UHCCP Medicaid	$19.17
Rate for Payer: VA VA	$34.05

LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE

Facility

$21,080.81

Service Code	HCPCS J1930
Hospital Charge Code	87860
Hospital Revenue Code	636
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$18,972.73
Rate for Payer: Aetna Commercial	$17,918.69
Rate for Payer: Aetna Medicare	$35.41
Rate for Payer: Aetna New Business (MI Preferred)	$13,702.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$42.56
Rate for Payer: Amish Plain Church Group Commercial	$42.56
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: BCBS MAPPO	$34.05
Rate for Payer: BCN Medicare Advantage	$34.05
Rate for Payer: Cash Price	$16,864.65
Rate for Payer: Cash Price	$16,864.65
Rate for Payer: Cofinity Commercial	$18,129.50
Rate for Payer: Cofinity Commercial	$14,756.57
Rate for Payer: Cofinity Medicare Advantage	$14,756.57
Rate for Payer: Encore Health Key Benefits Commercial	$16,864.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$34.05
Rate for Payer: Healthscope Commercial	$18,972.73
Rate for Payer: Mclaren Medicaid	$18.25
Rate for Payer: Mclaren Medicare	$34.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.75
Rate for Payer: Meridian Medicaid	$19.16
Rate for Payer: MI Amish Medical Board Commercial	$39.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17,918.69
Rate for Payer: PACE Medicare	$32.35
Rate for Payer: PACE SWMI	$34.05
Rate for Payer: PHP Commercial	$17,918.69
Rate for Payer: PHP Medicare Advantage	$34.05
Rate for Payer: Priority Health Choice Medicaid	$18.25
Rate for Payer: Priority Health Cigna Priority Health	$13,702.53
Rate for Payer: Priority Health Medicare	$34.05
Rate for Payer: Priority Health SBD	$13,280.91
Rate for Payer: Railroad Medicare Medicare	$34.05
Rate for Payer: UHC All Payor (Choice/PPO)	$95.85
Rate for Payer: UHC Dual Complete DSNP	$34.05
Rate for Payer: UHC Medicare Advantage	$34.05
Rate for Payer: UHCCP Medicaid	$19.17
Rate for Payer: VA VA	$34.05

LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE

Facility

$21,080.81

Service Code	HCPCS J1930
Hospital Charge Code	87860
Hospital Revenue Code	636
Min. Negotiated Rate	$13,280.91
Max. Negotiated Rate	$18,972.73
Rate for Payer: Aetna Commercial	$17,918.69
Rate for Payer: Aetna New Business (MI Preferred)	$13,702.53
Rate for Payer: Cash Price	$16,864.65
Rate for Payer: Cofinity Commercial	$14,756.57
Rate for Payer: Cofinity Commercial	$18,129.50
Rate for Payer: Cofinity Medicare Advantage	$14,756.57
Rate for Payer: Encore Health Key Benefits Commercial	$16,864.65
Rate for Payer: Healthscope Commercial	$18,972.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17,918.69
Rate for Payer: PHP Commercial	$17,918.69
Rate for Payer: Priority Health Cigna Priority Health	$13,702.53
Rate for Payer: Priority Health SBD	$13,280.91

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$21.74

Service Code	NDC 68382077230
Hospital Charge Code	34595
Hospital Revenue Code	637
Min. Negotiated Rate	$8.70
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 Commercial	$15.22
Rate for Payer: Cofinity Commercial	$18.70
Rate for Payer: Cofinity Medicare Advantage	$15.22
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: PHP Commercial	$18.48
Rate for Payer: Priority Health Cigna Priority Health	$14.13
Rate for Payer: Priority Health SBD	$13.70

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$31.05

Service Code	NDC 00378698232
Hospital Charge Code	34595
Hospital Revenue Code	637
Min. Negotiated Rate	$12.42
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 Commercial	$21.73
Rate for Payer: Cofinity Commercial	$26.70
Rate for Payer: Cofinity Medicare Advantage	$21.73
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: PHP Commercial	$26.39
Rate for Payer: Priority Health Cigna Priority Health	$20.18
Rate for Payer: Priority Health SBD	$19.56

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$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 Commercial	$21.73
Rate for Payer: Cofinity Commercial	$26.70
Rate for Payer: Cofinity Medicare Advantage	$21.73
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: PHP Commercial	$26.39
Rate for Payer: Priority Health Cigna Priority Health	$20.18
Rate for Payer: Priority Health SBD	$19.56

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$1,552.34

Service Code	NDC 00378698285
Hospital Charge Code	34595
Hospital Revenue Code	637
Min. Negotiated Rate	$620.94
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 Commercial	$1,086.64
Rate for Payer: Cofinity Commercial	$1,335.01
Rate for Payer: Cofinity Medicare Advantage	$1,086.64
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: PHP Commercial	$1,319.49
Rate for Payer: Priority Health Cigna Priority Health	$1,009.02
Rate for Payer: Priority Health SBD	$977.97

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$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 Commercial	$2,173.27
Rate for Payer: Cofinity Commercial	$2,670.02
Rate for Payer: Cofinity Medicare Advantage	$2,173.27
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: PHP Commercial	$2,638.97
Rate for Payer: Priority Health Cigna Priority Health	$2,018.04
Rate for Payer: Priority Health SBD	$1,955.94

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$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 Commercial	$1,521.37
Rate for Payer: Cofinity Commercial	$1,869.11
Rate for Payer: Cofinity Medicare Advantage	$1,521.37
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: PHP Commercial	$1,847.37
Rate for Payer: Priority Health Cigna Priority Health	$1,412.70
Rate for Payer: Priority Health SBD	$1,369.23

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$2,173.38

Service Code	NDC 68382077277
Hospital Charge Code	34595
Hospital Revenue Code	637
Min. Negotiated Rate	$869.35
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 Commercial	$1,521.37
Rate for Payer: Cofinity Commercial	$1,869.11
Rate for Payer: Cofinity Medicare Advantage	$1,521.37
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: PHP Commercial	$1,847.37
Rate for Payer: Priority Health Cigna Priority Health	$1,412.70
Rate for Payer: Priority Health SBD	$1,369.23

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$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 Commercial	$1,086.64
Rate for Payer: Cofinity Commercial	$1,335.01
Rate for Payer: Cofinity Medicare Advantage	$1,086.64
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: PHP Commercial	$1,319.49
Rate for Payer: Priority Health Cigna Priority Health	$1,009.02
Rate for Payer: Priority Health SBD	$977.97

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$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 Commercial	$15.22
Rate for Payer: Cofinity Commercial	$18.70
Rate for Payer: Cofinity Medicare Advantage	$15.22
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: PHP Commercial	$18.48
Rate for Payer: Priority Health Cigna Priority Health	$14.13
Rate for Payer: Priority Health SBD	$13.70

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET

Facility

$3,104.67

Service Code	NDC 00378698288
Hospital Charge Code	34595
Hospital Revenue Code	637
Min. Negotiated Rate	$1,241.87
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 Commercial	$2,173.27
Rate for Payer: Cofinity Commercial	$2,670.02
Rate for Payer: Cofinity Medicare Advantage	$2,173.27
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: PHP Commercial	$2,638.97
Rate for Payer: Priority Health Cigna Priority Health	$2,018.04
Rate for Payer: Priority Health SBD	$1,955.94

LANTHANUM 500 MG CHEWABLE TABLET

Facility

$1,301.70

Service Code	NDC 69097093498
Hospital Charge Code	39975
Hospital Revenue Code	637
Min. Negotiated Rate	$520.68
Max. Negotiated Rate	$1,171.53
Rate for Payer: Aetna Commercial	$1,106.44
Rate for Payer: Aetna Medicare	$650.85
Rate for Payer: Aetna New Business (MI Preferred)	$846.11
Rate for Payer: BCBS Complete	$520.68
Rate for Payer: Cash Price	$1,041.36
Rate for Payer: Cofinity Commercial	$1,119.46
Rate for Payer: Cofinity Commercial	$911.19
Rate for Payer: Cofinity Medicare Advantage	$911.19
Rate for Payer: Encore Health Key Benefits Commercial	$1,041.36
Rate for Payer: Healthscope Commercial	$1,171.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,106.44
Rate for Payer: PHP Commercial	$1,106.44
Rate for Payer: Priority Health Cigna Priority Health	$846.11
Rate for Payer: Priority Health SBD	$820.07

LANTHANUM 500 MG CHEWABLE TABLET

Facility

$1,301.70

Service Code	NDC 69097093498
Hospital Charge Code	39975
Hospital Revenue Code	637
Min. Negotiated Rate	$820.07
Max. Negotiated Rate	$1,171.53
Rate for Payer: Aetna Commercial	$1,106.44
Rate for Payer: Aetna New Business (MI Preferred)	$846.11
Rate for Payer: Cash Price	$1,041.36
Rate for Payer: Cofinity Commercial	$1,119.46
Rate for Payer: Cofinity Commercial	$911.19
Rate for Payer: Cofinity Medicare Advantage	$911.19
Rate for Payer: Encore Health Key Benefits Commercial	$1,041.36
Rate for Payer: Healthscope Commercial	$1,171.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,106.44
Rate for Payer: PHP Commercial	$1,106.44
Rate for Payer: Priority Health Cigna Priority Health	$846.11
Rate for Payer: Priority Health SBD	$820.07

Know your out-of-pocket cost for care.

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