|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$26.65
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$23.98 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: BCBS Trust/PPO |
$20.60
|
| Rate for Payer: BCN Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$22.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.32
|
| Rate for Payer: Healthscope Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.65
|
| Rate for Payer: PHP Commercial |
$22.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.45
|
| Rate for Payer: UHC Core |
$22.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.99
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$71.82
|
| Rate for Payer: BCBS Trust/PPO |
$65.30
|
| Rate for Payer: BCBS Trust/PPO |
$121.33
|
| Rate for Payer: BCBS Trust/PPO |
$35.55
|
| Rate for Payer: BCBS Trust/PPO |
$45.60
|
| Rate for Payer: BCN Commercial |
$121.33
|
| Rate for Payer: BCN Commercial |
$35.55
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: BCN Commercial |
$65.30
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$72.67
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Healthscope Commercial |
$76.05
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.82
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: PHP Commercial |
$71.82
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.36
|
| Rate for Payer: UHC Core |
$131.10
|
| Rate for Payer: UHC Core |
$38.41
|
| Rate for Payer: UHC Core |
$70.56
|
| Rate for Payer: UHC Core |
$49.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,182.04
|
|
|
Service Code
|
NDC 0131-2478-60
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,550.63 |
| Max. Negotiated Rate |
$3,763.84 |
| Rate for Payer: Aetna Commercial |
$3,554.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,231.88
|
| Rate for Payer: BCN Commercial |
$3,231.88
|
| Rate for Payer: Cash Price |
$3,345.63
|
| Rate for Payer: Cofinity Commercial |
$3,596.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.63
|
| Rate for Payer: Healthscope Commercial |
$3,763.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,554.73
|
| Rate for Payer: PHP Commercial |
$3,554.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,927.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,638.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,550.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,680.20
|
| Rate for Payer: UHC Core |
$3,492.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.53
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$3,801.53
|
|
|
Service Code
|
NDC 0131-2478-35
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,318.55 |
| Max. Negotiated Rate |
$3,421.38 |
| Rate for Payer: Aetna Commercial |
$3,231.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,937.82
|
| Rate for Payer: BCN Commercial |
$2,937.82
|
| Rate for Payer: Cash Price |
$3,041.22
|
| Rate for Payer: Cofinity Commercial |
$3,269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.22
|
| Rate for Payer: Healthscope Commercial |
$3,421.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,231.30
|
| Rate for Payer: PHP Commercial |
$3,231.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,307.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,318.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,345.35
|
| Rate for Payer: UHC Core |
$3,174.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.15
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$2,431.57
|
|
|
Service Code
|
NDC 0131-2477-35
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,483.01 |
| Max. Negotiated Rate |
$2,188.41 |
| Rate for Payer: Aetna Commercial |
$2,066.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.12
|
| Rate for Payer: BCN Commercial |
$1,879.12
|
| Rate for Payer: Cash Price |
$1,945.26
|
| Rate for Payer: Cofinity Commercial |
$2,091.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.26
|
| Rate for Payer: Healthscope Commercial |
$2,188.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,823.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,066.83
|
| Rate for Payer: PHP Commercial |
$2,066.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,115.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,483.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,139.78
|
| Rate for Payer: UHC Core |
$2,030.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,823.68
|
|
|
LACTASE 9,000 UNIT CHEWABLE TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 45093032
|
| Hospital Charge Code |
109806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| Rate for Payer: BCN Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.45
|
| Rate for Payer: UHC Core |
$62.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 4910040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.63 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: BCBS Trust/PPO |
$484.82
|
| Rate for Payer: BCN Commercial |
$484.82
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.08
|
| Rate for Payer: UHC Core |
$523.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.52
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
NDC 0121-4577-40
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.39
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.58
|
| Rate for Payer: UHC Core |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 50383-779-15
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.89
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 50383-779-17
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.89
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
NDC 0121-4577-15
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.39
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.58
|
| Rate for Payer: UHC Core |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 68084-319-11
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.49 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.65
|
| Rate for Payer: BCN Commercial |
$299.65
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 68084-319-01
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.49 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.65
|
| Rate for Payer: BCN Commercial |
$299.65
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 0904-7008-61
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.93 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: BCBS Trust/PPO |
$192.50
|
| Rate for Payer: BCN Commercial |
$192.50
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.21
|
| Rate for Payer: UHC Core |
$208.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Commercial |
$14.21
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.63
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.18
|
| Rate for Payer: UHC Core |
$15.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$18.22
|
|
|
Service Code
|
NDC 0378-6981-32
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.08
|
| Rate for Payer: BCN Commercial |
$14.08
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.49
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.03
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,821.88
|
|
|
Service Code
|
NDC 0378-6981-88
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,111.16 |
| Max. Negotiated Rate |
$1,639.69 |
| Rate for Payer: Aetna Commercial |
$1,548.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,407.95
|
| Rate for Payer: BCN Commercial |
$1,407.95
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cofinity Commercial |
$1,566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,457.50
|
| Rate for Payer: Healthscope Commercial |
$1,639.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,366.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,548.60
|
| Rate for Payer: PHP Commercial |
$1,548.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,585.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,111.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,603.25
|
| Rate for Payer: UHC Core |
$1,521.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,366.41
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
NDC 0378-6982-32
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$11.88
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,536.61
|
|
|
Service Code
|
NDC 0378-6982-88
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$937.18 |
| Max. Negotiated Rate |
$1,382.95 |
| Rate for Payer: Aetna Commercial |
$1,306.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,187.49
|
| Rate for Payer: BCN Commercial |
$1,187.49
|
| Rate for Payer: Cash Price |
$1,229.29
|
| Rate for Payer: Cofinity Commercial |
$1,321.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.29
|
| Rate for Payer: Healthscope Commercial |
$1,382.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.12
|
| Rate for Payer: PHP Commercial |
$1,306.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,336.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$937.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.22
|
| Rate for Payer: UHC Core |
$1,283.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.46
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$781.06
|
|
|
Service Code
|
NDC 65628-080-03
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.37 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Aetna Commercial |
$663.90
|
| Rate for Payer: BCBS Trust/PPO |
$603.60
|
| Rate for Payer: BCN Commercial |
$603.60
|
| Rate for Payer: Cash Price |
$624.85
|
| Rate for Payer: Cofinity Commercial |
$671.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.85
|
| Rate for Payer: Healthscope Commercial |
$702.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.90
|
| Rate for Payer: PHP Commercial |
$663.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.33
|
| Rate for Payer: UHC Core |
$652.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.80
|
|
