|
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
|
|
|
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 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 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
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
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 INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
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
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
OP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna Medicare |
$101.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.95
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$97.56
|
| Rate for Payer: BCBS Trust/PPO |
$320.82
|
| Rate for Payer: BCN Commercial |
$303.41
|
| Rate for Payer: BCN Medicare Advantage |
$97.56
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.56
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Nomi Health Commercial |
$320.00
|
| Rate for Payer: PACE Senior Care Partners |
$92.68
|
| Rate for Payer: PACE SWMI |
$97.56
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: PHP Medicare Advantage |
$97.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.66
|
| Rate for Payer: Priority Health HMO/PPO |
$339.51
|
| Rate for Payer: Priority Health Medicare |
$98.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.46
|
| Rate for Payer: Railroad Medicare Medicare |
$97.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.41
|
| Rate for Payer: UHC Core |
$325.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.56
|
| Rate for Payer: UHC Exchange |
$97.56
|
| Rate for Payer: UHC Medicare Advantage |
$97.56
|
| Rate for Payer: VA VA |
$97.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.66 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: BCBS Trust/PPO |
$318.55
|
| Rate for Payer: BCN Commercial |
$301.58
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Nomi Health Commercial |
$320.00
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.66
|
| Rate for Payer: Priority Health HMO/PPO |
$339.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.41
|
| Rate for Payer: UHC Core |
$325.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$5.84
|
|
|
Service Code
|
NDC 00116400540
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna Commercial |
$4.96
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$2.34
|
| Rate for Payer: BCBS MAPPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.46
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.96
|
| Rate for Payer: Nomi Health Commercial |
$4.79
|
| Rate for Payer: PACE Senior Care Partners |
$1.39
|
| Rate for Payer: PACE SWMI |
$1.46
|
| Rate for Payer: PHP Commercial |
$4.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.80
|
| Rate for Payer: Priority Health HMO/PPO |
$5.08
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UHC Medicare Advantage |
$1.46
|
| Rate for Payer: VA VA |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.38
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 00121457740
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.17
|
| Rate for Payer: Priority Health HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 00121457715
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.17
|
| Rate for Payer: Priority Health HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$5.84
|
|
|
Service Code
|
NDC 00116400540
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna Commercial |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.51
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.67
|
| Rate for Payer: Healthscope Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.96
|
| Rate for Payer: Nomi Health Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.80
|
| Rate for Payer: Priority Health HMO/PPO |
$5.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.38
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 50383077915
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 50383077917
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.90
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$2.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.13
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 50383077915
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.90
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$2.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.13
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$5.84
|
|
|
Service Code
|
NDC 00116400515
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna Commercial |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.51
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.67
|
| Rate for Payer: Healthscope Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.96
|
| Rate for Payer: Nomi Health Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.80
|
| Rate for Payer: Priority Health HMO/PPO |
$5.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.38
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 50383077917
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 00121457715
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.17
|
| Rate for Payer: Priority Health HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$5.84
|
|
|
Service Code
|
NDC 00116400515
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna Commercial |
$4.96
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$2.34
|
| Rate for Payer: BCBS MAPPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.46
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.96
|
| Rate for Payer: Nomi Health Commercial |
$4.79
|
| Rate for Payer: PACE Senior Care Partners |
$1.39
|
| Rate for Payer: PACE SWMI |
$1.46
|
| Rate for Payer: PHP Commercial |
$4.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.80
|
| Rate for Payer: Priority Health HMO/PPO |
$5.08
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UHC Medicare Advantage |
$1.46
|
| Rate for Payer: VA VA |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.38
|
|
|
LACTULOSE 10 GRAM/15 ML (15 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 00121457740
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$4.98
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.17
|
| Rate for Payer: Priority Health HMO/PPO |
$5.58
|
| Rate for Payer: Priority Health Medicare |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.64
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
