|
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
|
$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 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
|
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
|
$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
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.46 |
| Max. Negotiated Rate |
$289.76 |
| 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 |
$289.76
|
| 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
|
|
|
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 |
$289.76 |
| 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 |
$289.76
|
| 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
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: BCBS Trust/PPO |
$15.01
|
| Rate for Payer: BCN Commercial |
$14.21
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Nomi Health Commercial |
$15.08
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.95
|
| Rate for Payer: Priority Health HMO/PPO |
$16.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.18
|
| Rate for Payer: UHC Core |
$15.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698188
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,018.04 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,534.34
|
| Rate for Payer: BCN Commercial |
$2,399.29
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
NDC 00378698132
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.70
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$24.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: PACE Senior Care Partners |
$7.37
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.76
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698188
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$737.36 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna Medicare |
$807.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$970.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$970.21
|
| Rate for Payer: BCBS Complete |
$1,241.87
|
| Rate for Payer: BCBS MAPPO |
$776.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,552.35
|
| Rate for Payer: BCN Commercial |
$2,413.88
|
| Rate for Payer: BCN Medicare Advantage |
$776.17
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$776.17
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: PACE Senior Care Partners |
$737.36
|
| Rate for Payer: PACE SWMI |
$776.17
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: PHP Medicare Advantage |
$776.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Medicare |
$783.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.13
|
| Rate for Payer: Railroad Medicare Medicare |
$776.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$776.17
|
| Rate for Payer: UHC Exchange |
$776.17
|
| Rate for Payer: UHC Medicare Advantage |
$776.17
|
| Rate for Payer: VA VA |
$776.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698132
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.18 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: Aetna Medicare |
$565.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.18
|
| Rate for Payer: BCBS Complete |
$869.35
|
| Rate for Payer: BCBS MAPPO |
$543.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,786.74
|
| Rate for Payer: BCN Commercial |
$1,689.80
|
| Rate for Payer: BCN Medicare Advantage |
$543.34
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.34
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$624.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Nomi Health Commercial |
$1,782.17
|
| Rate for Payer: PACE Senior Care Partners |
$516.18
|
| Rate for Payer: PACE SWMI |
$543.34
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: PHP Medicare Advantage |
$543.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,890.84
|
| Rate for Payer: Priority Health Medicare |
$548.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,456.16
|
| Rate for Payer: Railroad Medicare Medicare |
$543.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.57
|
| Rate for Payer: UHC Core |
$1,814.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.34
|
| Rate for Payer: UHC Exchange |
$543.34
|
| Rate for Payer: UHC Medicare Advantage |
$543.34
|
| Rate for Payer: VA VA |
$543.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.04
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Nomi Health Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.13
|
| Rate for Payer: Priority Health HMO/PPO |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.13
|
| Rate for Payer: UHC Core |
$18.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,018.04 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,534.34
|
| Rate for Payer: BCN Commercial |
$2,399.29
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$737.36 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna Medicare |
$807.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$970.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$970.21
|
| Rate for Payer: BCBS Complete |
$1,241.87
|
| Rate for Payer: BCBS MAPPO |
$776.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,552.35
|
| Rate for Payer: BCN Commercial |
$2,413.88
|
| Rate for Payer: BCN Medicare Advantage |
$776.17
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$776.17
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: PACE Senior Care Partners |
$737.36
|
| Rate for Payer: PACE SWMI |
$776.17
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: PHP Medicare Advantage |
$776.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Medicare |
$783.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,080.13
|
| Rate for Payer: Railroad Medicare Medicare |
$776.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$776.17
|
| Rate for Payer: UHC Exchange |
$776.17
|
| Rate for Payer: UHC Medicare Advantage |
$776.17
|
| Rate for Payer: VA VA |
$776.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.79
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$16.90
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Nomi Health Commercial |
$17.83
|
| Rate for Payer: PACE Senior Care Partners |
$5.16
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.13
|
| Rate for Payer: Priority Health HMO/PPO |
$18.91
|
| Rate for Payer: Priority Health Medicare |
$5.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.13
|
| Rate for Payer: UHC Core |
$18.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.44
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UHC Medicare Advantage |
$5.44
|
| Rate for Payer: VA VA |
$5.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.70
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$24.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$25.46
|
| Rate for Payer: PACE Senior Care Partners |
$7.37
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$27.01
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$25.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.76
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.29
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$2,173.38
|
|
|
Service Code
|
NDC 68382077277
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,412.70 |
| Max. Negotiated Rate |
$1,956.04 |
| Rate for Payer: Aetna Commercial |
$1,847.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.13
|
| Rate for Payer: BCN Commercial |
$1,679.59
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cofinity Commercial |
$1,869.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.70
|
| Rate for Payer: Healthscope Commercial |
$1,956.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,847.37
|
| Rate for Payer: Nomi Health Commercial |
$1,782.17
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,890.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,456.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.57
|
| Rate for Payer: UHC Core |
$1,814.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.04
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,339.88
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,132.95 |
| Max. Negotiated Rate |
$4,339.88 |
| Rate for Payer: BCBS Complete |
$4,339.88
|
| Rate for Payer: Mclaren Medicaid |
$4,132.95
|
| Rate for Payer: Meridian Medicaid |
$4,339.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,132.95
|
| Rate for Payer: UHCCP Medicaid |
$4,132.95
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$4,339.88
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,132.95 |
| Max. Negotiated Rate |
$4,339.88 |
| Rate for Payer: BCBS Complete |
$4,339.88
|
| Rate for Payer: Mclaren Medicaid |
$4,132.95
|
| Rate for Payer: Meridian Medicaid |
$4,339.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,132.95
|
| Rate for Payer: UHCCP Medicaid |
$4,132.95
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$4,339.88
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,132.95 |
| Max. Negotiated Rate |
$4,339.88 |
| Rate for Payer: BCBS Complete |
$4,339.88
|
| Rate for Payer: Mclaren Medicaid |
$4,132.95
|
| Rate for Payer: Meridian Medicaid |
$4,339.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,132.95
|
| Rate for Payer: UHCCP Medicaid |
$4,132.95
|
|
