|
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
|
$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
|
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 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
|
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 |
$41.23
|
| 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 |
$35.41
|
| 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 |
$41.23
|
| 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 |
$41.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.23
|
| 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 |
$40.45
|
| 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 |
$32.49
|
| 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 |
$131.09
|
| 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 |
$35.41
|
|
|
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 |
$10.93 |
| 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 |
$41.23
|
| 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 |
$35.77
|
| 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 |
$35.41
|
| 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 |
$12.07
|
| 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 |
$41.23
|
| 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 |
$10.93
|
| 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 |
$41.23
|
| 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 |
$30.23
|
| 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 |
$40.45
|
| 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 |
$32.49
|
| 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 |
$131.09
|
| 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 |
$35.41
|
| 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
|
|
|
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 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
|
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 |
$3,506.89 |
| 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 |
$3,506.89
|
| 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
|
OP
|
$3,896.55
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$925.43 |
| Max. Negotiated Rate |
$3,506.89 |
| 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 |
$3,506.89
|
| 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 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
|
$2,492.40
|
|
|
Service Code
|
NDC 00131247735
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$591.95 |
| 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 |
$654.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.57
|
| 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 |
$591.95
|
| 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
|
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
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 00450093032
|
| Hospital Charge Code |
109806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna Medicare |
$19.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.24
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS MAPPO |
$18.59
|
| Rate for Payer: BCBS Trust/PPO |
$61.14
|
| Rate for Payer: BCN Commercial |
$57.82
|
| Rate for Payer: BCN Medicare Advantage |
$18.59
|
| 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: Health Alliance Plan Medicare Advantage |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Nomi Health Commercial |
$60.98
|
| Rate for Payer: PACE Senior Care Partners |
$17.66
|
| Rate for Payer: PACE SWMI |
$18.59
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: PHP Medicare Advantage |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO |
$64.70
|
| Rate for Payer: Priority Health Medicare |
$18.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.83
|
| Rate for Payer: Railroad Medicare Medicare |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.45
|
| Rate for Payer: UHC Core |
$62.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.59
|
| Rate for Payer: UHC Exchange |
$18.59
|
| Rate for Payer: UHC Medicare Advantage |
$18.59
|
| Rate for Payer: VA VA |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.78
|
|
|
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
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
