|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$4,398.05
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$775.38 |
| Max. Negotiated Rate |
$3,958.24 |
| Rate for Payer: Aetna Commercial |
$3,738.34
|
| Rate for Payer: Aetna Medicare |
$1,143.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,374.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,374.39
|
| Rate for Payer: BCBS Complete |
$814.08
|
| Rate for Payer: BCBS MAPPO |
$1,099.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,615.64
|
| Rate for Payer: BCN Commercial |
$3,615.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.51
|
| Rate for Payer: Cash Price |
$3,518.44
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.51
|
| Rate for Payer: Healthscope Commercial |
$3,958.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,298.54
|
| Rate for Payer: Mclaren Medicaid |
$775.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.49
|
| Rate for Payer: Meridian Medicaid |
$814.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,264.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,209.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.34
|
| Rate for Payer: Nomi Health Commercial |
$3,606.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,298.54
|
| Rate for Payer: PACE Senior Care Partners |
$1,044.54
|
| Rate for Payer: PACE SWMI |
$1,099.51
|
| Rate for Payer: PHP Commercial |
$3,738.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$775.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,826.30
|
| Rate for Payer: Priority Health Medicare |
$1,110.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,061.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,099.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,870.28
|
| Rate for Payer: UHC Core |
$3,672.37
|
| Rate for Payer: UHC Exchange |
$1,099.51
|
| Rate for Payer: UHC Medicaid |
$775.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.51
|
| Rate for Payer: UHCCP Medicaid |
$775.38
|
| Rate for Payer: VA VA |
$1,099.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,298.54
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,398.05
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,061.04 |
| Max. Negotiated Rate |
$3,958.24 |
| Rate for Payer: Aetna Commercial |
$3,738.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,632.35
|
| Rate for Payer: BCN Commercial |
$3,632.35
|
| Rate for Payer: Cash Price |
$3,518.44
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.44
|
| Rate for Payer: Healthscope Commercial |
$3,958.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.34
|
| Rate for Payer: Nomi Health Commercial |
$3,606.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,298.54
|
| Rate for Payer: PHP Commercial |
$3,738.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,826.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,061.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,870.28
|
| Rate for Payer: UHC Core |
$3,672.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,298.54
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$3,997.78
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$704.81 |
| Max. Negotiated Rate |
$3,598.00 |
| Rate for Payer: Aetna Commercial |
$3,398.11
|
| Rate for Payer: Aetna Medicare |
$1,039.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,249.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,249.31
|
| Rate for Payer: BCBS Complete |
$739.99
|
| Rate for Payer: BCBS MAPPO |
$999.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,286.57
|
| Rate for Payer: BCN Commercial |
$3,286.57
|
| Rate for Payer: BCN Medicare Advantage |
$999.45
|
| Rate for Payer: Cash Price |
$3,198.22
|
| Rate for Payer: Cofinity Commercial |
$3,438.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.45
|
| Rate for Payer: Healthscope Commercial |
$3,598.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.34
|
| Rate for Payer: Mclaren Medicaid |
$704.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.42
|
| Rate for Payer: Meridian Medicaid |
$739.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,149.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,099.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.11
|
| Rate for Payer: Nomi Health Commercial |
$3,278.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,998.34
|
| Rate for Payer: PACE Senior Care Partners |
$949.47
|
| Rate for Payer: PACE SWMI |
$999.45
|
| Rate for Payer: PHP Commercial |
$3,398.11
|
| Rate for Payer: PHP Medicare Advantage |
$999.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$704.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,478.07
|
| Rate for Payer: Priority Health Medicare |
$1,009.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,782.45
|
| Rate for Payer: Railroad Medicare Medicare |
$999.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,518.05
|
| Rate for Payer: UHC Core |
$3,338.15
|
| Rate for Payer: UHC Exchange |
$999.45
|
| Rate for Payer: UHC Medicaid |
$704.81
|
| Rate for Payer: UHC Medicare Advantage |
$999.45
|
| Rate for Payer: UHCCP Medicaid |
$704.81
|
| Rate for Payer: VA VA |
$999.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.34
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$2,557.22
|
|
|
Service Code
|
NDC 00131247735
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$450.84 |
| Max. Negotiated Rate |
$2,301.50 |
| Rate for Payer: Aetna Commercial |
$2,173.64
|
| Rate for Payer: Aetna Medicare |
$664.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$799.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$799.13
|
| Rate for Payer: BCBS Complete |
$473.34
|
| Rate for Payer: BCBS MAPPO |
$639.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.29
|
| Rate for Payer: BCN Commercial |
$2,102.29
|
| Rate for Payer: BCN Medicare Advantage |
$639.30
|
| Rate for Payer: Cash Price |
$2,045.78
|
| Rate for Payer: Cofinity Commercial |
$2,199.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$639.30
|
| Rate for Payer: Healthscope Commercial |
$2,301.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,917.91
|
| Rate for Payer: Mclaren Medicaid |
$450.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$671.27
|
| Rate for Payer: Meridian Medicaid |
$473.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$735.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$703.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.64
|
| Rate for Payer: Nomi Health Commercial |
$2,096.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.91
|
| Rate for Payer: PACE Senior Care Partners |
$607.34
|
| Rate for Payer: PACE SWMI |
$639.30
|
| Rate for Payer: PHP Commercial |
$2,173.64
|
| Rate for Payer: PHP Medicare Advantage |
$639.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$450.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,224.78
|
| Rate for Payer: Priority Health Medicare |
$645.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,779.83
|
| Rate for Payer: Railroad Medicare Medicare |
$639.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,250.35
|
| Rate for Payer: UHC Core |
$2,135.28
|
| Rate for Payer: UHC Exchange |
$639.30
|
| Rate for Payer: UHC Medicaid |
$450.84
|
| Rate for Payer: UHC Medicare Advantage |
$639.30
|
| Rate for Payer: UHCCP Medicaid |
$450.84
|
| Rate for Payer: VA VA |
$639.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,917.91
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$292.90
|
|
|
Service Code
|
NDC 00904724468
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna Commercial |
$248.97
|
| Rate for Payer: Aetna Medicare |
$76.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.53
|
| Rate for Payer: BCBS Complete |
$54.22
|
| Rate for Payer: BCBS MAPPO |
$73.22
|
| Rate for Payer: BCBS Trust/PPO |
$240.79
|
| Rate for Payer: BCN Commercial |
$240.79
|
| Rate for Payer: BCN Medicare Advantage |
$73.22
|
| Rate for Payer: Cash Price |
$234.32
|
| Rate for Payer: Cofinity Commercial |
$251.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.22
|
| Rate for Payer: Healthscope Commercial |
$263.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.68
|
| Rate for Payer: Mclaren Medicaid |
$51.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.89
|
| Rate for Payer: Meridian Medicaid |
$54.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.97
|
| Rate for Payer: Nomi Health Commercial |
$240.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.68
|
| Rate for Payer: PACE Senior Care Partners |
$69.56
|
| Rate for Payer: PACE SWMI |
$73.22
|
| Rate for Payer: PHP Commercial |
$248.97
|
| Rate for Payer: PHP Medicare Advantage |
$73.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.82
|
| Rate for Payer: Priority Health Medicare |
$73.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.86
|
| Rate for Payer: Railroad Medicare Medicare |
$73.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.75
|
| Rate for Payer: UHC Core |
$244.57
|
| Rate for Payer: UHC Exchange |
$73.22
|
| Rate for Payer: UHC Medicaid |
$51.64
|
| Rate for Payer: UHC Medicare Advantage |
$73.22
|
| Rate for Payer: UHCCP Medicaid |
$51.64
|
| Rate for Payer: VA VA |
$73.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.68
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$292.90
|
|
|
Service Code
|
NDC 00904724468
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.86 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna Commercial |
$248.97
|
| Rate for Payer: BCBS Trust/PPO |
$241.91
|
| Rate for Payer: BCN Commercial |
$241.91
|
| Rate for Payer: Cash Price |
$234.32
|
| Rate for Payer: Cofinity Commercial |
$251.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.32
|
| Rate for Payer: Healthscope Commercial |
$263.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.97
|
| Rate for Payer: Nomi Health Commercial |
$240.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.68
|
| Rate for Payer: PHP Commercial |
$248.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.75
|
| Rate for Payer: UHC Core |
$244.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.68
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$2,557.22
|
|
|
Service Code
|
NDC 00131247735
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,779.83 |
| Max. Negotiated Rate |
$2,301.50 |
| Rate for Payer: Aetna Commercial |
$2,173.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,112.01
|
| Rate for Payer: BCN Commercial |
$2,112.01
|
| Rate for Payer: Cash Price |
$2,045.78
|
| Rate for Payer: Cofinity Commercial |
$2,199.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.78
|
| Rate for Payer: Healthscope Commercial |
$2,301.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,917.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.64
|
| Rate for Payer: Nomi Health Commercial |
$2,096.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.91
|
| Rate for Payer: PHP Commercial |
$2,173.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,224.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,779.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,250.35
|
| Rate for Payer: UHC Core |
$2,135.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,917.91
|
|
|
LACTASE 9,000 UNIT CHEWABLE TABLET
|
Facility
|
OP
|
$79.97
|
|
|
Service Code
|
NDC 00450093032
|
| Hospital Charge Code |
109806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Aetna Commercial |
$67.97
|
| Rate for Payer: Aetna Medicare |
$20.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.99
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$65.74
|
| Rate for Payer: BCN Commercial |
$65.74
|
| Rate for Payer: BCN Medicare Advantage |
$19.99
|
| Rate for Payer: Cash Price |
$63.98
|
| Rate for Payer: Cofinity Commercial |
$68.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.99
|
| Rate for Payer: Healthscope Commercial |
$71.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.98
|
| Rate for Payer: Mclaren Medicaid |
$14.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.99
|
| Rate for Payer: Meridian Medicaid |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.97
|
| Rate for Payer: Nomi Health Commercial |
$65.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.99
|
| Rate for Payer: PACE SWMI |
$19.99
|
| Rate for Payer: PHP Commercial |
$67.97
|
| Rate for Payer: PHP Medicare Advantage |
$19.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.57
|
| Rate for Payer: Priority Health Medicare |
$20.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.37
|
| Rate for Payer: UHC Core |
$66.77
|
| Rate for Payer: UHC Exchange |
$19.99
|
| Rate for Payer: UHC Medicaid |
$14.10
|
| Rate for Payer: UHC Medicare Advantage |
$19.99
|
| Rate for Payer: UHCCP Medicaid |
$14.10
|
| Rate for Payer: VA VA |
$19.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.98
|
|
|
LACTASE 9,000 UNIT CHEWABLE TABLET
|
Facility
|
IP
|
$79.97
|
|
|
Service Code
|
NDC 00450093032
|
| Hospital Charge Code |
109806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Aetna Commercial |
$67.97
|
| Rate for Payer: BCBS Trust/PPO |
$66.05
|
| Rate for Payer: BCN Commercial |
$66.05
|
| Rate for Payer: Cash Price |
$63.98
|
| Rate for Payer: Cofinity Commercial |
$68.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$71.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.97
|
| Rate for Payer: Nomi Health Commercial |
$65.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.98
|
| Rate for Payer: PHP Commercial |
$67.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.37
|
| Rate for Payer: UHC Core |
$66.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.98
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| 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 Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| 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 |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| 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 |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| 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 |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| 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 |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| 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 |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| 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 |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| 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 |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
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 |
$46.76 |
| 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 |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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
|
OP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna Medicare |
$101.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.95
|
| Rate for Payer: BCBS Complete |
$72.23
|
| Rate for Payer: BCBS MAPPO |
$97.56
|
| Rate for Payer: BCBS Trust/PPO |
$320.82
|
| Rate for Payer: BCN Commercial |
$320.82
|
| Rate for Payer: BCN Medicare Advantage |
$97.56
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.56
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Mclaren Medicaid |
$68.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.44
|
| Rate for Payer: Meridian Medicaid |
$72.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Nomi Health Commercial |
$320.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.68
|
| Rate for Payer: PACE Senior Care Partners |
$92.68
|
| Rate for Payer: PACE SWMI |
$97.56
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: PHP Medicare Advantage |
$97.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.51
|
| Rate for Payer: Priority Health Medicare |
$98.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.61
|
| Rate for Payer: Railroad Medicare Medicare |
$97.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.41
|
| Rate for Payer: UHC Core |
$325.85
|
| Rate for Payer: UHC Exchange |
$97.56
|
| Rate for Payer: UHC Medicaid |
$68.80
|
| Rate for Payer: UHC Medicare Advantage |
$97.56
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
| Rate for Payer: VA VA |
$97.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 49100038164
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.23
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.44
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.61 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: BCBS Trust/PPO |
$322.30
|
| Rate for Payer: BCN Commercial |
$322.30
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Nomi Health Commercial |
$320.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.68
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.41
|
| Rate for Payer: UHC Core |
$325.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 49100038164
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.21
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Mclaren Medicaid |
$0.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: Meridian Medicaid |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PACE Senior Care Partners |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.40
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.44
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicaid |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.69
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.77
|
|
|
Service Code
|
NDC 00116400541
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.12
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.69
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.78
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Nomi Health Commercial |
$5.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.08
|
| Rate for Payer: PACE Senior Care Partners |
$1.61
|
| Rate for Payer: PACE SWMI |
$1.69
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: PHP Medicare Advantage |
$1.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.89
|
| Rate for Payer: Priority Health Medicare |
$1.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.96
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: UHC Exchange |
$1.69
|
| Rate for Payer: UHC Medicaid |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.69
|
| Rate for Payer: UHCCP Medicaid |
$1.19
|
| Rate for Payer: VA VA |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCN Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
