|
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
|
|
|
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
|
$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 |
$27.95 |
| 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 |
$27.95
|
| 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
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698132
|
| Hospital Charge Code |
34594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$27.95 |
| 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 |
$27.95
|
| 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
|
IP
|
$31.05
|
|
|
Service Code
|
NDC 00378698232
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$27.95 |
| 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 |
$27.95
|
| 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 |
$543.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,786.74
|
| Rate for Payer: BCN Commercial |
$1,689.80
|
| Rate for Payer: BCN Medicare Advantage |
$543.35
|
| 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 |
$543.35
|
| 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 |
$543.35
|
| Rate for Payer: PHP Commercial |
$1,847.37
|
| Rate for Payer: PHP Medicare Advantage |
$543.35
|
| 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 |
$543.35
|
| 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 |
$543.35
|
| Rate for Payer: UHC Exchange |
$543.35
|
| Rate for Payer: UHC Medicare Advantage |
$543.35
|
| Rate for Payer: VA VA |
$543.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.04
|
|
|
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 |
$27.95 |
| 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 |
$27.95
|
| 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
|
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 |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$16.90
|
| Rate for Payer: BCN Medicare Advantage |
$5.43
|
| 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 |
$5.43
|
| 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 |
$5.43
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.43
|
| 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 |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.13
|
| Rate for Payer: UHC Core |
$18.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.43
|
| Rate for Payer: UHC Exchange |
$5.43
|
| Rate for Payer: UHC Medicare Advantage |
$5.43
|
| Rate for Payer: VA VA |
$5.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
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
|
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
|
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
|
$4,429.45
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 49651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$4,429.45
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.27
|
| Rate for Payer: BCBS Complete |
$10.58
|
| Rate for Payer: BCBS MAPPO |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$21.75
|
| Rate for Payer: BCN Commercial |
$20.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.62
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: Nomi Health Commercial |
$21.70
|
| Rate for Payer: PACE Senior Care Partners |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.62
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: PHP Medicare Advantage |
$6.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health HMO/PPO |
$23.02
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.28
|
| Rate for Payer: UHC Core |
$22.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.62
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$6.62
|
| Rate for Payer: VA VA |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$18.63
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health HMO/PPO |
$16.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.39
|
| Rate for Payer: UHC Core |
$15.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.60
|
| Rate for Payer: BCN Commercial |
$20.45
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: Nomi Health Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health HMO/PPO |
$23.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.28
|
| Rate for Payer: UHC Core |
$22.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Medicare |
$4.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.82
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.32
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$15.28
|
| Rate for Payer: PACE Senior Care Partners |
$4.42
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health HMO/PPO |
$16.21
|
| Rate for Payer: Priority Health Medicare |
$4.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.48
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.39
|
| Rate for Payer: UHC Core |
$15.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Exchange |
$4.66
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$155.35
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.55
|
| Rate for Payer: BCBS Complete |
$62.14
|
| Rate for Payer: BCBS MAPPO |
$38.84
|
| Rate for Payer: BCBS Trust/PPO |
$127.71
|
| Rate for Payer: BCN Commercial |
$120.78
|
| Rate for Payer: BCN Medicare Advantage |
$38.84
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.84
|
| Rate for Payer: Healthscope Commercial |
$139.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Nomi Health Commercial |
$127.39
|
| Rate for Payer: PACE Senior Care Partners |
$36.90
|
| Rate for Payer: PACE SWMI |
$38.84
|
| Rate for Payer: PHP Commercial |
$132.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.98
|
| Rate for Payer: Priority Health HMO/PPO |
$135.15
|
| Rate for Payer: Priority Health Medicare |
$39.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.08
|
| Rate for Payer: Railroad Medicare Medicare |
$38.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.71
|
| Rate for Payer: UHC Core |
$129.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.84
|
| Rate for Payer: UHC Exchange |
$38.84
|
| Rate for Payer: UHC Medicare Advantage |
$38.84
|
| Rate for Payer: VA VA |
$38.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.51
|
|
