|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$282.82
|
|
|
Service Code
|
NDC 0904-7244-68
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.44 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna American Axle |
$183.83
|
| Rate for Payer: Aetna Commercial |
$240.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.83
|
| Rate for Payer: Cash Price |
$226.26
|
| Rate for Payer: Cofinity Commercial |
$197.97
|
| Rate for Payer: Cofinity Commercial |
$243.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.26
|
| Rate for Payer: Healthscope Commercial |
$254.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.40
|
| Rate for Payer: PHP Commercial |
$240.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.97
|
| Rate for Payer: Priority Health SBD |
$178.18
|
| Rate for Payer: UMR Bronson Commercial |
$124.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.12
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$526.18
|
|
|
Service Code
|
NDC 60687-676-57
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.52 |
| Max. Negotiated Rate |
$473.56 |
| Rate for Payer: Aetna American Axle |
$342.02
|
| Rate for Payer: Aetna Commercial |
$447.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.02
|
| Rate for Payer: Cash Price |
$420.94
|
| Rate for Payer: Cofinity Commercial |
$368.33
|
| Rate for Payer: Cofinity Commercial |
$452.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.94
|
| Rate for Payer: Healthscope Commercial |
$473.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.25
|
| Rate for Payer: PHP Commercial |
$447.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.33
|
| Rate for Payer: Priority Health SBD |
$331.49
|
| Rate for Payer: UMR Bronson Commercial |
$231.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.64
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$114.24
|
|
|
Service Code
|
NDC 45091060
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Aetna American Axle |
$74.26
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.26
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.39
|
| Rate for Payer: Healthscope Commercial |
$102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.10
|
| Rate for Payer: PHP Commercial |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.97
|
| Rate for Payer: Priority Health SBD |
$71.97
|
| Rate for Payer: UMR Bronson Commercial |
$50.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.68
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
NDC 45091032
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna American Axle |
$49.22
|
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.22
|
| Rate for Payer: Cash Price |
$60.58
|
| Rate for Payer: Cofinity Commercial |
$53.00
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.58
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.36
|
| Rate for Payer: PHP Commercial |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.00
|
| Rate for Payer: Priority Health SBD |
$47.70
|
| Rate for Payer: UMR Bronson Commercial |
$33.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.79
|
|
|
LACTATED RINGERS EYE BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$56.81
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$69.92
|
| 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 |
$75.16
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$61.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.29
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.55
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| 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 |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| 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
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 4910040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.04 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna American Axle |
$407.78
|
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.15
|
| Rate for Payer: Priority Health SBD |
$395.24
|
| Rate for Payer: UMR Bronson Commercial |
$276.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.52
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 0121-0577-16
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$56.01
|
|
|
Service Code
|
NDC 64980-592-95
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Aetna American Axle |
$36.41
|
| Rate for Payer: Aetna Commercial |
$47.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.41
|
| Rate for Payer: Cash Price |
$44.81
|
| Rate for Payer: Cofinity Commercial |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.81
|
| Rate for Payer: Healthscope Commercial |
$50.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.61
|
| Rate for Payer: PHP Commercial |
$47.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.21
|
| Rate for Payer: Priority Health SBD |
$35.29
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.01
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
NDC 60432-038-16
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna American Axle |
$15.93
|
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.83
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.16
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.51
|
|
|
Service Code
|
NDC 50383-779-32
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Aetna American Axle |
$25.03
|
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.03
|
| Rate for Payer: Cash Price |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.81
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.73
|
| Rate for Payer: PHP Commercial |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$42.01
|
|
|
Service Code
|
NDC 0121-0873-32
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna American Axle |
$27.31
|
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.71
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.41
|
| Rate for Payer: Priority Health SBD |
$26.47
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$49.01
|
|
|
Service Code
|
NDC 45963-439-65
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$44.11 |
| Rate for Payer: Aetna American Axle |
$31.86
|
| Rate for Payer: Aetna Commercial |
$41.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.86
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$34.31
|
| Rate for Payer: Cofinity Commercial |
$42.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.21
|
| Rate for Payer: Healthscope Commercial |
$44.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.66
|
| Rate for Payer: PHP Commercial |
$41.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.31
|
| Rate for Payer: Priority Health SBD |
$30.88
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.76
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 0121-1154-30
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna American Axle |
$4.21
|
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.21
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.51
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.54
|
| Rate for Payer: Priority Health SBD |
$4.08
|
| Rate for Payer: UMR Bronson Commercial |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 66689-038-01
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 66689-038-50
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383-779-30
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383-779-31
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
NDC 0121-1154-40
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna American Axle |
$4.68
|
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.68
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Cofinity Commercial |
$6.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.12
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health SBD |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.40
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; CERVICAL
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,283.57 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,283.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,411.93
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,283.57
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$9,065.30
|
|
|
Service Code
|
CPT 63048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$9,065.30 |
| Rate for Payer: BCBS Trust/PPO |
$9,065.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$206.29
|
|
