|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 51079-499-01
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 0904-7008-61
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.92
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 51079-499-20
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 60687-693-11
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna American Axle |
$2.36
|
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health SBD |
$2.29
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$117.03
|
|
|
Service Code
|
NDC 13668-048-60
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.49 |
| Max. Negotiated Rate |
$105.33 |
| Rate for Payer: Aetna American Axle |
$76.07
|
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.07
|
| Rate for Payer: Cash Price |
$93.62
|
| Rate for Payer: Cofinity Commercial |
$100.65
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.62
|
| Rate for Payer: Healthscope Commercial |
$105.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.48
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.92
|
| Rate for Payer: Priority Health SBD |
$73.73
|
| Rate for Payer: UMR Bronson Commercial |
$51.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.77
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$115.62
|
|
|
Service Code
|
NDC 59746-247-60
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$104.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.28
|
| Rate for Payer: PHP Commercial |
$98.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.93
|
| Rate for Payer: Priority Health SBD |
$72.84
|
| Rate for Payer: UMR Bronson Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.72
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$115.62
|
|
|
Service Code
|
NDC 51672-4132-4
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$104.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.28
|
| Rate for Payer: PHP Commercial |
$98.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.93
|
| Rate for Payer: Priority Health SBD |
$72.84
|
| Rate for Payer: UMR Bronson Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.72
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$132.81
|
|
|
Service Code
|
NDC 68382-009-14
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna American Axle |
$86.33
|
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.33
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.89
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.97
|
| Rate for Payer: Priority Health SBD |
$83.67
|
| Rate for Payer: UMR Bronson Commercial |
$58.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$362.90
|
|
|
Service Code
|
NDC 60687-693-01
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.68 |
| Max. Negotiated Rate |
$326.61 |
| Rate for Payer: Aetna American Axle |
$235.88
|
| Rate for Payer: Aetna Commercial |
$308.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.88
|
| Rate for Payer: Cash Price |
$290.32
|
| Rate for Payer: Cofinity Commercial |
$254.03
|
| Rate for Payer: Cofinity Commercial |
$312.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.32
|
| Rate for Payer: Healthscope Commercial |
$326.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.46
|
| Rate for Payer: PHP Commercial |
$308.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.03
|
| Rate for Payer: Priority Health SBD |
$228.63
|
| Rate for Payer: UMR Bronson Commercial |
$159.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.18
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 65862-229-60
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.12
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.34
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
IP
|
$3,886.48
|
|
|
Service Code
|
NDC 0173-0527-00
|
| Hospital Charge Code |
103880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,710.05 |
| Max. Negotiated Rate |
$3,497.83 |
| Rate for Payer: Aetna American Axle |
$2,526.21
|
| Rate for Payer: Aetna Commercial |
$3,303.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,526.21
|
| Rate for Payer: Cash Price |
$3,109.18
|
| Rate for Payer: Cofinity Commercial |
$2,720.54
|
| Rate for Payer: Cofinity Commercial |
$3,342.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,109.18
|
| Rate for Payer: Healthscope Commercial |
$3,497.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,720.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,914.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,303.51
|
| Rate for Payer: PHP Commercial |
$3,303.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.54
|
| Rate for Payer: Priority Health SBD |
$2,448.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,710.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,914.86
|
|
|
LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 68462-229-01
|
| Hospital Charge Code |
103880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna American Axle |
$253.18
|
| Rate for Payer: Aetna Commercial |
$331.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.08
|
| Rate for Payer: PHP Commercial |
$331.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.65
|
| Rate for Payer: Priority Health SBD |
$245.38
|
| Rate for Payer: UMR Bronson Commercial |
$171.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 65862-362-01
|
| Hospital Charge Code |
103880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.50
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.71
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UMR Bronson Commercial |
$204.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 68462-228-01
|
| Hospital Charge Code |
104568
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.02
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna American Axle |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.63
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna American Axle |
$27,906.70
|
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$156.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,346.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,053.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,200.04
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,493.37
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,053.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.23
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health Narrow Network |
$120.18
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: UMR Bronson Commercial |
$15,885.35
|
| Rate for Payer: VA VA |
$48.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,200.04
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,890.69 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna American Axle |
$27,906.70
|
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,346.70
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,053.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,200.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,493.37
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,053.37
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
| Rate for Payer: UMR Bronson Commercial |
$18,890.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,200.04
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna American Axle |
$17,767.83
|
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$156.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,868.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,134.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,501.34
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,234.85
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,134.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.23
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health Narrow Network |
$120.18
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: UMR Bronson Commercial |
$10,113.99
|
| Rate for Payer: VA VA |
$48.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,501.34
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,027.45 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna American Axle |
$17,767.83
|
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,868.10
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,134.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,501.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,234.85
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,134.58
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
| Rate for Payer: UMR Bronson Commercial |
$12,027.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,501.34
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna American Axle |
$13,702.53
|
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$156.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,864.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,756.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,810.61
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,918.69
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,756.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.23
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health Narrow Network |
$120.18
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: UMR Bronson Commercial |
$7,799.90
|
| Rate for Payer: VA VA |
$48.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,810.61
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,275.56 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna American Axle |
$13,702.53
|
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,864.65
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,756.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,810.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,918.69
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,756.57
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
| Rate for Payer: UMR Bronson Commercial |
$9,275.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,810.61
|
|
|
LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764-046-13
|
| Hospital Charge Code |
27692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,094.91 |
| Max. Negotiated Rate |
$4,285.04 |
| Rate for Payer: Aetna American Axle |
$3,094.75
|
| Rate for Payer: Aetna Commercial |
$4,046.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,094.75
|
| Rate for Payer: Cash Price |
$3,808.93
|
| Rate for Payer: Cofinity Commercial |
$3,332.81
|
| Rate for Payer: Cofinity Commercial |
$4,094.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,808.93
|
| Rate for Payer: Healthscope Commercial |
$4,285.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,332.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,570.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,046.99
|
| Rate for Payer: PHP Commercial |
$4,046.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.81
|
| Rate for Payer: Priority Health SBD |
$2,999.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,094.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,570.87
|
|
|
LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$889.44
|
|
|
Service Code
|
NDC 0781-2148-01
|
| Hospital Charge Code |
27692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.35 |
| Max. Negotiated Rate |
$800.50 |
| Rate for Payer: Aetna American Axle |
$578.14
|
| Rate for Payer: Aetna Commercial |
$756.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.14
|
| Rate for Payer: Cash Price |
$711.55
|
| Rate for Payer: Cofinity Commercial |
$622.61
|
| Rate for Payer: Cofinity Commercial |
$764.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.55
|
| Rate for Payer: Healthscope Commercial |
$800.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$622.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.02
|
| Rate for Payer: PHP Commercial |
$756.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.61
|
| Rate for Payer: Priority Health SBD |
$560.35
|
| Rate for Payer: UMR Bronson Commercial |
$391.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.08
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764-544-11
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,094.91 |
| Max. Negotiated Rate |
$4,285.04 |
| Rate for Payer: Aetna American Axle |
$3,094.75
|
| Rate for Payer: Aetna Commercial |
$4,046.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,094.75
|
| Rate for Payer: Cash Price |
$3,808.93
|
| Rate for Payer: Cofinity Commercial |
$3,332.81
|
| Rate for Payer: Cofinity Commercial |
$4,094.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,808.93
|
| Rate for Payer: Healthscope Commercial |
$4,285.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,332.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,570.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,046.99
|
| Rate for Payer: PHP Commercial |
$4,046.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.81
|
| Rate for Payer: Priority Health SBD |
$2,999.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,094.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,570.87
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$47.62
|
|
|
Service Code
|
NDC 64764-544-30
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.33
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
