|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Commercial |
$20.67
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.60
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$6.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.62
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Commercial |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.01
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$18.91
|
| Rate for Payer: BCN Commercial |
$9.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.08
|
| Rate for Payer: BCN Medicare Advantage |
$3.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.05
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$12.59
|
| Rate for Payer: Nomi Health Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE Senior Care Partners |
$5.78
|
| Rate for Payer: PACE Senior Care Partners |
$2.85
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$3.00
|
| Rate for Payer: PACE SWMI |
$6.08
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$13.05
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Medicare Advantage |
$3.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.08
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health HMO/PPO |
$12.32
|
| Rate for Payer: Priority Health HMO/PPO |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$21.16
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health Medicare |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.46
|
| Rate for Payer: UHC Core |
$12.82
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.00
|
| Rate for Payer: UHC Exchange |
$6.08
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.08
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$6.08
|
| Rate for Payer: VA VA |
$3.00
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.62
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.32
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: Aetna Commercial |
$20.67
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$11.56
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$21.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$12.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: PHP Commercial |
$13.05
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health HMO/PPO |
$21.16
|
| Rate for Payer: Priority Health HMO/PPO |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health HMO/PPO |
$12.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Core |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Aetna Medicare |
$7.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.44
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCBS MAPPO |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$6.76
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: BCN Commercial |
$9.81
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Commercial |
$21.01
|
| Rate for Payer: BCN Commercial |
$8.58
|
| Rate for Payer: BCN Medicare Advantage |
$6.76
|
| Rate for Payer: BCN Medicare Advantage |
$2.76
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$3.16
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$15.70
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE Senior Care Partners |
$3.00
|
| Rate for Payer: PACE Senior Care Partners |
$6.42
|
| Rate for Payer: PACE Senior Care Partners |
$2.62
|
| Rate for Payer: PACE Senior Care Partners |
$4.14
|
| Rate for Payer: PACE SWMI |
$2.76
|
| Rate for Payer: PACE SWMI |
$6.76
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PACE SWMI |
$3.16
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health HMO/PPO |
$9.60
|
| Rate for Payer: Priority Health HMO/PPO |
$10.98
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health HMO/PPO |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health Medicare |
$2.79
|
| Rate for Payer: Priority Health Medicare |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.11
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Core |
$9.21
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Core |
$22.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.76
|
| Rate for Payer: UHC Exchange |
$6.76
|
| Rate for Payer: UHC Exchange |
$2.76
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Exchange |
$3.16
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$3.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.76
|
| Rate for Payer: UHC Medicare Advantage |
$6.76
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$6.76
|
| Rate for Payer: VA VA |
$2.76
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: VA VA |
$3.16
|
| Rate for Payer: VA VA |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$27.02
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.00
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$15.70
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health HMO/PPO |
$9.60
|
| Rate for Payer: Priority Health HMO/PPO |
$23.51
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health HMO/PPO |
$10.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC Core |
$9.21
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Core |
$22.56
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$291.56 |
| Rate for Payer: Aetna Commercial |
$275.36
|
| Rate for Payer: Aetna Medicare |
$84.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.23
|
| Rate for Payer: BCBS Complete |
$129.58
|
| Rate for Payer: BCBS MAPPO |
$80.99
|
| Rate for Payer: BCBS Trust/PPO |
$266.32
|
| Rate for Payer: BCN Commercial |
$251.87
|
| Rate for Payer: BCN Medicare Advantage |
$80.99
|
| Rate for Payer: Cash Price |
$259.16
|
| Rate for Payer: Cofinity Commercial |
$278.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.99
|
| Rate for Payer: Healthscope Commercial |
$291.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.36
|
| Rate for Payer: Nomi Health Commercial |
$265.64
|
| Rate for Payer: PACE Senior Care Partners |
$76.94
|
| Rate for Payer: PACE SWMI |
$80.99
|
| Rate for Payer: PHP Commercial |
$275.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.57
|
| Rate for Payer: Priority Health HMO/PPO |
$281.84
|
| Rate for Payer: Priority Health Medicare |
$81.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.05
|
| Rate for Payer: Railroad Medicare Medicare |
$80.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.08
|
| Rate for Payer: UHC Core |
$270.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.99
|
| Rate for Payer: UHC Exchange |
$80.99
|
| Rate for Payer: UHC Medicare Advantage |
$80.99
|
| Rate for Payer: VA VA |
$80.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.96
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.57 |
| Max. Negotiated Rate |
$291.56 |
| Rate for Payer: Aetna Commercial |
$275.36
|
| Rate for Payer: BCBS Trust/PPO |
$264.44
|
| Rate for Payer: BCN Commercial |
$250.35
|
| Rate for Payer: Cash Price |
$259.16
|
| Rate for Payer: Cofinity Commercial |
$278.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.16
|
| Rate for Payer: Healthscope Commercial |
$291.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.36
|
| Rate for Payer: Nomi Health Commercial |
$265.64
|
| Rate for Payer: PHP Commercial |
$275.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.57
|
| Rate for Payer: Priority Health HMO/PPO |
$281.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.08
|
| Rate for Payer: UHC Core |
$270.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.96
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 68382079801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.64 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: BCBS Trust/PPO |
$358.72
|
| Rate for Payer: BCN Commercial |
$339.61
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Nomi Health Commercial |
$360.35
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health HMO/PPO |
$382.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.72
|
| Rate for Payer: UHC Core |
$366.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 68382079801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna Medicare |
$114.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.33
|
| Rate for Payer: BCBS Complete |
$175.78
|
| Rate for Payer: BCBS MAPPO |
$109.86
|
| Rate for Payer: BCBS Trust/PPO |
$361.27
|
| Rate for Payer: BCN Commercial |
$341.67
|
| Rate for Payer: BCN Medicare Advantage |
$109.86
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Nomi Health Commercial |
$360.35
|
| Rate for Payer: PACE Senior Care Partners |
$104.37
|
| Rate for Payer: PACE SWMI |
$109.86
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: PHP Medicare Advantage |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health HMO/PPO |
$382.32
|
| Rate for Payer: Priority Health Medicare |
$110.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.43
|
| Rate for Payer: Railroad Medicare Medicare |
$109.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.72
|
| Rate for Payer: UHC Core |
$366.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.86
|
| Rate for Payer: UHC Exchange |
$109.86
|
| Rate for Payer: UHC Medicare Advantage |
$109.86
|
| Rate for Payer: VA VA |
$109.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00904710961
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.17
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$172.10
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PACE Senior Care Partners |
$52.57
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Medicare |
$55.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: Railroad Medicare Medicare |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.34
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| Rate for Payer: VA VA |
$55.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PACE Senior Care Partners |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Medicare |
$0.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.81
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00904710961
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.69
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$23.67
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.61
|
| Rate for Payer: PACE Senior Care Partners |
$6.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO |
$25.05
|
| Rate for Payer: Priority Health Medicare |
$7.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.34
|
| Rate for Payer: UHC Core |
$24.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.20
|
| Rate for Payer: UHC Exchange |
$7.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.20
|
| Rate for Payer: VA VA |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$23.50
|
| Rate for Payer: BCN Commercial |
$22.25
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$23.61
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health HMO/PPO |
$25.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.34
|
| Rate for Payer: UHC Core |
$24.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$41.22
|
| Rate for Payer: Aetna Medicare |
$12.09
|
| Rate for Payer: Aetna Medicare |
$40.82
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Aetna Medicare |
$12.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.76
|
| Rate for Payer: BCBS Complete |
$18.89
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$18.60
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS MAPPO |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$39.25
|
| Rate for Payer: BCBS MAPPO |
$11.50
|
| Rate for Payer: BCBS MAPPO |
$11.80
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$129.07
|
| Rate for Payer: BCBS Trust/PPO |
$37.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.23
|
| Rate for Payer: BCBS Trust/PPO |
$39.87
|
| Rate for Payer: BCBS Trust/PPO |
$38.82
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: BCN Commercial |
$122.07
|
| Rate for Payer: BCN Commercial |
$35.76
|
| Rate for Payer: BCN Commercial |
$36.15
|
| Rate for Payer: BCN Commercial |
$36.71
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: BCN Medicare Advantage |
$11.80
|
| Rate for Payer: BCN Medicare Advantage |
$39.25
|
| Rate for Payer: BCN Medicare Advantage |
$11.50
|
| Rate for Payer: BCN Medicare Advantage |
$11.62
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$39.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$41.85
|
| Rate for Payer: Healthscope Commercial |
$43.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.22
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: Nomi Health Commercial |
$38.13
|
| Rate for Payer: Nomi Health Commercial |
$39.77
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: PACE Senior Care Partners |
$37.29
|
| Rate for Payer: PACE Senior Care Partners |
$11.21
|
| Rate for Payer: PACE Senior Care Partners |
$10.92
|
| Rate for Payer: PACE Senior Care Partners |
$11.04
|
| Rate for Payer: PACE Senior Care Partners |
$11.52
|
| Rate for Payer: PACE SWMI |
$39.25
|
| Rate for Payer: PACE SWMI |
$11.80
|
| Rate for Payer: PACE SWMI |
$11.62
|
| Rate for Payer: PACE SWMI |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$41.22
|
| Rate for Payer: PHP Commercial |
$39.52
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Medicare Advantage |
$11.62
|
| Rate for Payer: PHP Medicare Advantage |
$11.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: PHP Medicare Advantage |
$39.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health HMO/PPO |
$136.59
|
| Rate for Payer: Priority Health HMO/PPO |
$40.46
|
| Rate for Payer: Priority Health HMO/PPO |
$42.20
|
| Rate for Payer: Priority Health HMO/PPO |
$41.08
|
| Rate for Payer: Priority Health HMO/PPO |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health Medicare |
$11.74
|
| Rate for Payer: Priority Health Medicare |
$11.62
|
| Rate for Payer: Priority Health Medicare |
$11.92
|
| Rate for Payer: Priority Health Medicare |
$39.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11.80
|
| Rate for Payer: Railroad Medicare Medicare |
$11.62
|
| Rate for Payer: Railroad Medicare Medicare |
$39.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.92
|
| Rate for Payer: UHC Core |
$38.41
|
| Rate for Payer: UHC Core |
$40.50
|
| Rate for Payer: UHC Core |
$38.83
|
| Rate for Payer: UHC Core |
$39.43
|
| Rate for Payer: UHC Core |
$131.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.62
|
| Rate for Payer: UHC Exchange |
$11.62
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Exchange |
$39.25
|
| Rate for Payer: UHC Exchange |
$11.80
|
| Rate for Payer: UHC Exchange |
$11.50
|
| Rate for Payer: UHC Medicare Advantage |
$11.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.62
|
| Rate for Payer: UHC Medicare Advantage |
$39.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.80
|
| Rate for Payer: VA VA |
$39.25
|
| Rate for Payer: VA VA |
$11.80
|
| Rate for Payer: VA VA |
$11.50
|
| Rate for Payer: VA VA |
$12.12
|
| Rate for Payer: VA VA |
$11.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.88
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.50
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Aetna Commercial |
$41.22
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: BCBS Trust/PPO |
$38.55
|
| Rate for Payer: BCBS Trust/PPO |
$39.59
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCBS Trust/PPO |
$37.55
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$36.49
|
| Rate for Payer: BCN Commercial |
$35.94
|
| Rate for Payer: BCN Commercial |
$121.33
|
| Rate for Payer: BCN Commercial |
$35.55
|
| Rate for Payer: BCN Commercial |
$37.48
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$39.99
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$41.85
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$43.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Nomi Health Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: Nomi Health Commercial |
$38.13
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: Nomi Health Commercial |
$39.77
|
| Rate for Payer: PHP Commercial |
$39.52
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$41.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health HMO/PPO |
$136.59
|
| Rate for Payer: Priority Health HMO/PPO |
$42.20
|
| Rate for Payer: Priority Health HMO/PPO |
$40.46
|
| Rate for Payer: Priority Health HMO/PPO |
$41.08
|
| Rate for Payer: Priority Health HMO/PPO |
$40.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.55
|
| Rate for Payer: UHC Core |
$131.10
|
| Rate for Payer: UHC Core |
$38.41
|
| Rate for Payer: UHC Core |
$39.43
|
| Rate for Payer: UHC Core |
$40.50
|
| Rate for Payer: UHC Core |
$38.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.42
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$3,896.55
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$925.43 |
| Max. Negotiated Rate |
$3,506.90 |
| Rate for Payer: Aetna Commercial |
$3,312.07
|
| Rate for Payer: Aetna Medicare |
$1,013.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,217.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,217.67
|
| Rate for Payer: BCBS Complete |
$1,558.62
|
| Rate for Payer: BCBS MAPPO |
$974.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,203.35
|
| Rate for Payer: BCN Commercial |
$3,029.57
|
| Rate for Payer: BCN Medicare Advantage |
$974.14
|
| Rate for Payer: Cash Price |
$3,117.24
|
| Rate for Payer: Cofinity Commercial |
$3,351.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.14
|
| Rate for Payer: Healthscope Commercial |
$3,506.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,120.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.07
|
| Rate for Payer: Nomi Health Commercial |
$3,195.17
|
| Rate for Payer: PACE Senior Care Partners |
$925.43
|
| Rate for Payer: PACE SWMI |
$974.14
|
| Rate for Payer: PHP Commercial |
$3,312.07
|
| Rate for Payer: PHP Medicare Advantage |
$974.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,532.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3,390.00
|
| Rate for Payer: Priority Health Medicare |
$983.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,610.69
|
| Rate for Payer: Railroad Medicare Medicare |
$974.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,428.96
|
| Rate for Payer: UHC Core |
$3,253.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.14
|
| Rate for Payer: UHC Exchange |
$974.14
|
| Rate for Payer: UHC Medicare Advantage |
$974.14
|
| Rate for Payer: VA VA |
$974.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.41
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$3,896.55
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,532.76 |
| Max. Negotiated Rate |
$3,506.90 |
| Rate for Payer: Aetna Commercial |
$3,312.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,180.75
|
| Rate for Payer: BCN Commercial |
$3,011.25
|
| Rate for Payer: Cash Price |
$3,117.24
|
| Rate for Payer: Cofinity Commercial |
$3,351.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.24
|
| Rate for Payer: Healthscope Commercial |
$3,506.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.07
|
| Rate for Payer: Nomi Health Commercial |
$3,195.17
|
| Rate for Payer: PHP Commercial |
$3,312.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,532.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3,390.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,610.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,428.96
|
| Rate for Payer: UHC Core |
$3,253.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.41
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,286.60
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,786.29 |
| Max. Negotiated Rate |
$3,857.94 |
| Rate for Payer: Aetna Commercial |
$3,643.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,499.15
|
| Rate for Payer: BCN Commercial |
$3,312.68
|
| Rate for Payer: Cash Price |
$3,429.28
|
| Rate for Payer: Cofinity Commercial |
$3,686.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,429.28
|
| Rate for Payer: Healthscope Commercial |
$3,857.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.61
|
| Rate for Payer: Nomi Health Commercial |
$3,515.01
|
| Rate for Payer: PHP Commercial |
$3,643.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.29
|
| Rate for Payer: Priority Health HMO/PPO |
$3,729.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,872.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,772.21
|
| Rate for Payer: UHC Core |
$3,579.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.95
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$4,286.60
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,018.07 |
| Max. Negotiated Rate |
$3,857.94 |
| Rate for Payer: Aetna Commercial |
$3,643.61
|
| Rate for Payer: Aetna Medicare |
$1,114.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,339.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,339.56
|
| Rate for Payer: BCBS Complete |
$1,714.64
|
| Rate for Payer: BCBS MAPPO |
$1,071.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,524.01
|
| Rate for Payer: BCN Commercial |
$3,332.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.65
|
| Rate for Payer: Cash Price |
$3,429.28
|
| Rate for Payer: Cofinity Commercial |
$3,686.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,429.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.65
|
| Rate for Payer: Healthscope Commercial |
$3,857.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,232.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.61
|
| Rate for Payer: Nomi Health Commercial |
$3,515.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,018.07
|
| Rate for Payer: PACE SWMI |
$1,071.65
|
| Rate for Payer: PHP Commercial |
$3,643.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.29
|
| Rate for Payer: Priority Health HMO/PPO |
$3,729.34
|
| Rate for Payer: Priority Health Medicare |
$1,082.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,872.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,071.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,772.21
|
| Rate for Payer: UHC Core |
$3,579.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.65
|
| Rate for Payer: UHC Exchange |
$1,071.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.65
|
| Rate for Payer: VA VA |
$1,071.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.95
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$2,492.40
|
|
|
Service Code
|
NDC 00131247735
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$591.94 |
| Max. Negotiated Rate |
$2,243.16 |
| Rate for Payer: Aetna Commercial |
$2,118.54
|
| Rate for Payer: Aetna Medicare |
$648.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$778.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$778.88
|
| Rate for Payer: BCBS Complete |
$996.96
|
| Rate for Payer: BCBS MAPPO |
$623.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.00
|
| Rate for Payer: BCN Commercial |
$1,937.84
|
| Rate for Payer: BCN Medicare Advantage |
$623.10
|
| Rate for Payer: Cash Price |
$1,993.92
|
| Rate for Payer: Cofinity Commercial |
$2,143.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,993.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.10
|
| Rate for Payer: Healthscope Commercial |
$2,243.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,118.54
|
| Rate for Payer: Nomi Health Commercial |
$2,043.77
|
| Rate for Payer: PACE Senior Care Partners |
$591.94
|
| Rate for Payer: PACE SWMI |
$623.10
|
| Rate for Payer: PHP Commercial |
$2,118.54
|
| Rate for Payer: PHP Medicare Advantage |
$623.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.06
|
| Rate for Payer: Priority Health HMO/PPO |
$2,168.39
|
| Rate for Payer: Priority Health Medicare |
$629.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,669.91
|
| Rate for Payer: Railroad Medicare Medicare |
$623.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,193.31
|
| Rate for Payer: UHC Core |
$2,081.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.10
|
| Rate for Payer: UHC Exchange |
$623.10
|
| Rate for Payer: UHC Medicare Advantage |
$623.10
|
| Rate for Payer: VA VA |
$623.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.30
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$2,492.40
|
|
|
Service Code
|
NDC 00131247735
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,620.06 |
| Max. Negotiated Rate |
$2,243.16 |
| Rate for Payer: Aetna Commercial |
$2,118.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.55
|
| Rate for Payer: BCN Commercial |
$1,926.13
|
| Rate for Payer: Cash Price |
$1,993.92
|
| Rate for Payer: Cofinity Commercial |
$2,143.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,993.92
|
| Rate for Payer: Healthscope Commercial |
$2,243.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,869.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,118.54
|
| Rate for Payer: Nomi Health Commercial |
$2,043.77
|
| Rate for Payer: PHP Commercial |
$2,118.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.06
|
| Rate for Payer: Priority Health HMO/PPO |
$2,168.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,669.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,193.31
|
| Rate for Payer: UHC Core |
$2,081.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,869.30
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$289.16
|
|
|
Service Code
|
NDC 00904724468
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$245.79
|
| Rate for Payer: Aetna Medicare |
$75.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.36
|
| Rate for Payer: BCBS Complete |
$115.66
|
| Rate for Payer: BCBS MAPPO |
$72.29
|
| Rate for Payer: BCBS Trust/PPO |
$237.72
|
| Rate for Payer: BCN Commercial |
$224.82
|
| Rate for Payer: BCN Medicare Advantage |
$72.29
|
| Rate for Payer: Cash Price |
$231.33
|
| Rate for Payer: Cofinity Commercial |
$248.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.29
|
| Rate for Payer: Healthscope Commercial |
$260.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.79
|
| Rate for Payer: Nomi Health Commercial |
$237.11
|
| Rate for Payer: PACE Senior Care Partners |
$68.68
|
| Rate for Payer: PACE SWMI |
$72.29
|
| Rate for Payer: PHP Commercial |
$245.79
|
| Rate for Payer: PHP Medicare Advantage |
$72.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.95
|
| Rate for Payer: Priority Health HMO/PPO |
$251.57
|
| Rate for Payer: Priority Health Medicare |
$73.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.74
|
| Rate for Payer: Railroad Medicare Medicare |
$72.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.46
|
| Rate for Payer: UHC Core |
$241.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.29
|
| Rate for Payer: UHC Exchange |
$72.29
|
| Rate for Payer: UHC Medicare Advantage |
$72.29
|
| Rate for Payer: VA VA |
$72.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.87
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$289.16
|
|
|
Service Code
|
NDC 00904724468
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$245.79
|
| Rate for Payer: BCBS Trust/PPO |
$236.04
|
| Rate for Payer: BCN Commercial |
$223.46
|
| Rate for Payer: Cash Price |
$231.33
|
| Rate for Payer: Cofinity Commercial |
$248.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.33
|
| Rate for Payer: Healthscope Commercial |
$260.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.79
|
| Rate for Payer: Nomi Health Commercial |
$237.11
|
| Rate for Payer: PHP Commercial |
$245.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.95
|
| Rate for Payer: Priority Health HMO/PPO |
$251.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.46
|
| Rate for Payer: UHC Core |
$241.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.87
|
|
|
LACTASE 9,000 UNIT CHEWABLE TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 00450093032
|
| Hospital Charge Code |
109806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: BCBS Trust/PPO |
$60.71
|
| Rate for Payer: BCN Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO |
$64.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.45
|
| Rate for Payer: UHC Core |
$62.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
