|
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 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
|
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
|
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
|
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
|
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
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 50383077915
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.21 |
| 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 |
$2.21
|
| 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
|
$2.45
|
|
|
Service Code
|
NDC 50383077915
|
| Hospital Charge Code |
150920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.21 |
| 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 |
$2.21
|
| 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 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 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
|
|
|
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 |
$2.21 |
| 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 |
$2.21
|
| 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 |
$2.21 |
| 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 |
$2.21
|
| 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
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.51 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: BCBS Trust/PPO |
$314.60
|
| Rate for Payer: BCN Commercial |
$297.84
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.53 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$100.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.44
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: BCBS MAPPO |
$96.35
|
| Rate for Payer: BCBS Trust/PPO |
$316.84
|
| Rate for Payer: BCN Commercial |
$299.65
|
| Rate for Payer: BCN Medicare Advantage |
$96.35
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: PACE Senior Care Partners |
$91.53
|
| Rate for Payer: PACE SWMI |
$96.35
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: PHP Medicare Advantage |
$96.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Medicare |
$97.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.22
|
| Rate for Payer: Railroad Medicare Medicare |
$96.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.35
|
| Rate for Payer: UHC Exchange |
$96.35
|
| Rate for Payer: UHC Medicare Advantage |
$96.35
|
| Rate for Payer: VA VA |
$96.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.51 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: BCBS Trust/PPO |
$314.60
|
| Rate for Payer: BCN Commercial |
$297.84
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.53 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$100.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.44
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: BCBS MAPPO |
$96.35
|
| Rate for Payer: BCBS Trust/PPO |
$316.84
|
| Rate for Payer: BCN Commercial |
$299.65
|
| Rate for Payer: BCN Medicare Advantage |
$96.35
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Nomi Health Commercial |
$316.03
|
| Rate for Payer: PACE Senior Care Partners |
$91.53
|
| Rate for Payer: PACE SWMI |
$96.35
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: PHP Medicare Advantage |
$96.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health HMO/PPO |
$335.30
|
| Rate for Payer: Priority Health Medicare |
$97.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.22
|
| Rate for Payer: Railroad Medicare Medicare |
$96.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.15
|
| Rate for Payer: UHC Core |
$321.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.35
|
| Rate for Payer: UHC Exchange |
$96.35
|
| Rate for Payer: UHC Medicare Advantage |
$96.35
|
| Rate for Payer: VA VA |
$96.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$65.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.31
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS MAPPO |
$63.45
|
| Rate for Payer: BCBS Trust/PPO |
$208.65
|
| Rate for Payer: BCN Commercial |
$197.33
|
| Rate for Payer: BCN Medicare Advantage |
$63.45
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.45
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PACE Senior Care Partners |
$60.28
|
| Rate for Payer: PACE SWMI |
$63.45
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: PHP Medicare Advantage |
$63.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Medicare |
$64.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: Railroad Medicare Medicare |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.45
|
| Rate for Payer: UHC Exchange |
$63.45
|
| Rate for Payer: UHC Medicare Advantage |
$63.45
|
| Rate for Payer: VA VA |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.18
|
| Rate for Payer: BCN Commercial |
$196.14
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: BCBS Trust/PPO |
$262.81
|
| Rate for Payer: BCN Commercial |
$248.80
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: Priority Health HMO/PPO |
$280.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.32
|
| Rate for Payer: UHC Core |
$268.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.46 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna Medicare |
$83.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.61
|
| Rate for Payer: BCBS Complete |
$128.78
|
| Rate for Payer: BCBS MAPPO |
$80.49
|
| Rate for Payer: BCBS Trust/PPO |
$264.68
|
| Rate for Payer: BCN Commercial |
$250.32
|
| Rate for Payer: BCN Medicare Advantage |
$80.49
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: PACE Senior Care Partners |
$76.46
|
| Rate for Payer: PACE SWMI |
$80.49
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: Priority Health HMO/PPO |
$280.10
|
| Rate for Payer: Priority Health Medicare |
$81.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.71
|
| Rate for Payer: Railroad Medicare Medicare |
$80.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.32
|
| Rate for Payer: UHC Core |
$268.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.49
|
| Rate for Payer: UHC Exchange |
$80.49
|
| Rate for Payer: UHC Medicare Advantage |
$80.49
|
| Rate for Payer: VA VA |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.75
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.12
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Nomi Health Commercial |
$15.08
|
| Rate for Payer: PACE Senior Care Partners |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.95
|
| Rate for Payer: Priority Health HMO/PPO |
$16.00
|
| Rate for Payer: Priority Health Medicare |
$4.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.18
|
| Rate for Payer: UHC Core |
$15.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.60
|
| Rate for Payer: VA VA |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
