|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.77
|
|
|
Service Code
|
NDC 00116400541
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| 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: Healthscope Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| 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: PHP Commercial |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.96
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.83
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Mclaren Medicaid |
$1.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: Meridian Medicaid |
$1.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PACE Senior Care Partners |
$1.68
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.14
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Commercial |
$4.97
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| 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: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Mclaren Medicaid |
$1.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: Meridian Medicaid |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.66
|
| 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: PACE Senior Care Partners |
$1.44
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.26
|
| Rate for Payer: Priority Health Medicare |
$1.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.32
|
| Rate for Payer: UHC Core |
$5.05
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UHC Medicaid |
$1.07
|
| Rate for Payer: UHC Medicare Advantage |
$1.51
|
| Rate for Payer: UHCCP Medicaid |
$1.07
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.43
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$1.95
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Mclaren Medicaid |
$1.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.04
|
| Rate for Payer: Meridian Medicaid |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Nomi Health Commercial |
$6.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PACE Senior Care Partners |
$1.85
|
| Rate for Payer: PACE SWMI |
$1.95
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.77
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Medicaid |
$1.37
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| Rate for Payer: UHCCP Medicaid |
$1.37
|
| Rate for Payer: VA VA |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.88 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: BCBS Trust/PPO |
$298.89
|
| Rate for Payer: BCN Commercial |
$298.89
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$94.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.09
|
| Rate for Payer: BCBS Complete |
$66.99
|
| Rate for Payer: BCBS MAPPO |
$90.47
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$297.52
|
| Rate for Payer: BCN Medicare Advantage |
$90.47
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.47
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Mclaren Medicaid |
$63.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.00
|
| Rate for Payer: Meridian Medicaid |
$66.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PACE Senior Care Partners |
$85.95
|
| Rate for Payer: PACE SWMI |
$90.47
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: PHP Medicare Advantage |
$90.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$91.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| Rate for Payer: Railroad Medicare Medicare |
$90.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: UHC Exchange |
$90.47
|
| Rate for Payer: UHC Medicaid |
$63.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.47
|
| Rate for Payer: UHCCP Medicaid |
$63.80
|
| Rate for Payer: VA VA |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.88 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: BCBS Trust/PPO |
$298.89
|
| Rate for Payer: BCN Commercial |
$298.89
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.89 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.66
|
| Rate for Payer: BCBS Complete |
$51.33
|
| Rate for Payer: BCBS MAPPO |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$227.97
|
| Rate for Payer: BCN Medicare Advantage |
$69.33
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.33
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Mclaren Medicaid |
$48.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: Meridian Medicaid |
$51.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.33
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: PHP Medicare Advantage |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: Railroad Medicare Medicare |
$69.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UHC Medicaid |
$48.89
|
| Rate for Payer: UHC Medicare Advantage |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$48.89
|
| Rate for Payer: VA VA |
$69.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$94.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.09
|
| Rate for Payer: BCBS Complete |
$66.99
|
| Rate for Payer: BCBS MAPPO |
$90.47
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$297.52
|
| Rate for Payer: BCN Medicare Advantage |
$90.47
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.47
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Mclaren Medicaid |
$63.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.00
|
| Rate for Payer: Meridian Medicaid |
$66.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PACE Senior Care Partners |
$85.95
|
| Rate for Payer: PACE SWMI |
$90.47
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: PHP Medicare Advantage |
$90.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$91.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.88
|
| Rate for Payer: Railroad Medicare Medicare |
$90.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: UHC Exchange |
$90.47
|
| Rate for Payer: UHC Medicaid |
$63.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.47
|
| Rate for Payer: UHCCP Medicaid |
$63.80
|
| Rate for Payer: VA VA |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.00 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: BCBS Trust/PPO |
$229.02
|
| Rate for Payer: BCN Commercial |
$229.02
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.76 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna Medicare |
$83.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.61
|
| Rate for Payer: BCBS Complete |
$59.59
|
| Rate for Payer: BCBS MAPPO |
$80.49
|
| Rate for Payer: BCBS Trust/PPO |
$264.68
|
| Rate for Payer: BCN Commercial |
$264.68
|
| Rate for Payer: BCN Medicare Advantage |
$80.49
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Mclaren Medicaid |
$56.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.51
|
| Rate for Payer: Meridian Medicaid |
$59.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: PACE Senior Care Partners |
$76.46
|
| Rate for Payer: PACE SWMI |
$80.49
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.10
|
| Rate for Payer: Priority Health Medicare |
$81.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.08
|
| Rate for Payer: Railroad Medicare Medicare |
$80.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.32
|
| Rate for Payer: UHC Core |
$268.83
|
| Rate for Payer: UHC Exchange |
$80.49
|
| Rate for Payer: UHC Medicaid |
$56.76
|
| Rate for Payer: UHC Medicare Advantage |
$80.49
|
| Rate for Payer: UHCCP Medicaid |
$56.76
|
| Rate for Payer: VA VA |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: BCBS Trust/PPO |
$265.90
|
| Rate for Payer: BCN Commercial |
$265.90
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.32
|
| Rate for Payer: UHC Core |
$268.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCN Commercial |
$15.19
|
| 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 Commercial |
$15.63
|
| Rate for Payer: Nomi Health Commercial |
$15.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.80
|
| 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
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.75
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.12
|
| Rate for Payer: BCN Commercial |
$15.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| 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: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Mclaren Medicaid |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: Meridian Medicaid |
$3.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Nomi Health Commercial |
$15.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PACE Senior Care Partners |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.00
|
| Rate for Payer: Priority Health Medicare |
$4.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.18
|
| Rate for Payer: UHC Core |
$15.36
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicaid |
$3.24
|
| Rate for Payer: UHC Medicare Advantage |
$4.60
|
| Rate for Payer: UHCCP Medicaid |
$3.24
|
| Rate for Payer: VA VA |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698132
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: BCN Commercial |
$25.64
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698188
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.35 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna Medicare |
$807.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$970.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$970.21
|
| Rate for Payer: BCBS Complete |
$574.67
|
| Rate for Payer: BCBS MAPPO |
$776.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,552.35
|
| Rate for Payer: BCN Commercial |
$2,552.35
|
| Rate for Payer: BCN Medicare Advantage |
$776.17
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$776.17
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Mclaren Medicaid |
$547.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.98
|
| Rate for Payer: Meridian Medicaid |
$574.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$853.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PACE Senior Care Partners |
$737.36
|
| Rate for Payer: PACE SWMI |
$776.17
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: PHP Medicare Advantage |
$776.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$547.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Medicare |
$783.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,160.85
|
| Rate for Payer: Railroad Medicare Medicare |
$776.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: UHC Exchange |
$776.17
|
| Rate for Payer: UHC Medicaid |
$547.35
|
| Rate for Payer: UHC Medicare Advantage |
$776.17
|
| Rate for Payer: UHCCP Medicaid |
$547.35
|
| Rate for Payer: VA VA |
$776.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
NDC 00378698132
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.70
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$25.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Mclaren Medicaid |
$5.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: Meridian Medicaid |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PACE Senior Care Partners |
$7.37
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicaid |
$5.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: UHCCP Medicaid |
$5.47
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698188
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,160.85 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,564.15
|
| Rate for Payer: BCN Commercial |
$2,564.15
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,160.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.17 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: Aetna Medicare |
$565.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.18
|
| Rate for Payer: BCBS Complete |
$402.29
|
| Rate for Payer: BCBS MAPPO |
$543.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,786.74
|
| Rate for Payer: BCN Commercial |
$1,786.74
|
| Rate for Payer: BCN Medicare Advantage |
$543.35
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.35
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.04
|
| Rate for Payer: Mclaren Medicaid |
$383.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.51
|
| Rate for Payer: Meridian Medicaid |
$402.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$624.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$597.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Nomi Health Commercial |
$1,782.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,630.04
|
| Rate for Payer: PACE Senior Care Partners |
$516.18
|
| Rate for Payer: PACE SWMI |
$543.35
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: PHP Medicare Advantage |
$543.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,890.84
|
| Rate for Payer: Priority Health Medicare |
$548.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,512.67
|
| Rate for Payer: Railroad Medicare Medicare |
$543.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.57
|
| Rate for Payer: UHC Core |
$1,814.77
|
| Rate for Payer: UHC Exchange |
$543.35
|
| Rate for Payer: UHC Medicaid |
$383.17
|
| Rate for Payer: UHC Medicare Advantage |
$543.35
|
| Rate for Payer: UHCCP Medicaid |
$383.17
|
| Rate for Payer: VA VA |
$543.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.04
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: BCN Commercial |
$25.64
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.70
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$25.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Mclaren Medicaid |
$5.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: Meridian Medicaid |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.29
|
| Rate for Payer: PACE Senior Care Partners |
$7.37
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicaid |
$5.47
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: UHCCP Medicaid |
$5.47
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,512.67 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,794.99
|
| Rate for Payer: BCN Commercial |
$1,794.99
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Nomi Health Commercial |
$1,782.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,630.04
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,890.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,512.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.57
|
| Rate for Payer: UHC Core |
$1,814.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.04
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,160.85 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,564.15
|
| Rate for Payer: BCN Commercial |
$2,564.15
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,160.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
