|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$4,235.32
|
|
|
Service Code
|
NDC 00131248035
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,863.54 |
| Max. Negotiated Rate |
$3,811.79 |
| Rate for Payer: Aetna American Axle |
$2,752.96
|
| Rate for Payer: Aetna Commercial |
$3,600.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,752.96
|
| Rate for Payer: Cash Price |
$3,388.26
|
| Rate for Payer: Cofinity Advantage |
$2,964.72
|
| Rate for Payer: Cofinity Commercial |
$3,642.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,388.26
|
| Rate for Payer: Healthscope Commercial |
$3,811.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,964.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,176.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,600.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,176.49
|
| Rate for Payer: PHP Commercial |
$3,600.02
|
| Rate for Payer: Priority Health SBD |
$2,668.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,863.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,176.49
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$671.78
|
|
|
Service Code
|
NDC 60687069857
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$604.60 |
| Rate for Payer: Aetna American Axle |
$436.66
|
| Rate for Payer: Aetna Commercial |
$571.01
|
| Rate for Payer: Aetna Medicare |
$335.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.66
|
| Rate for Payer: BCBS Complete |
$268.71
|
| Rate for Payer: Cash Price |
$537.42
|
| Rate for Payer: Cofinity Advantage |
$470.25
|
| Rate for Payer: Cofinity Commercial |
$577.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.42
|
| Rate for Payer: Healthscope Commercial |
$604.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$537.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$503.83
|
| Rate for Payer: PHP Commercial |
$571.01
|
| Rate for Payer: Priority Health SBD |
$423.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.66
|
| Rate for Payer: UHC Core |
$350.00
|
| Rate for Payer: UHC Exchange |
$264.01
|
| Rate for Payer: UMR Bronson Commercial |
$248.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.83
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$158.46
|
|
|
Service Code
|
NDC 62332017160
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna American Axle |
$103.00
|
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.00
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Advantage |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UMR Bronson Commercial |
$69.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$158.46
|
|
|
Service Code
|
NDC 62332017160
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna American Axle |
$103.00
|
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.00
|
| Rate for Payer: BCBS Complete |
$63.38
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Advantage |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.00
|
| Rate for Payer: UHC Core |
$82.56
|
| Rate for Payer: UHC Exchange |
$62.27
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
OP
|
$119.70
|
|
|
Service Code
|
NDC 00450091060
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna American Axle |
$77.81
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Medicare |
$59.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: BCBS Complete |
$47.88
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.81
|
| Rate for Payer: UHC Core |
$62.36
|
| Rate for Payer: UHC Exchange |
$47.04
|
| Rate for Payer: UMR Bronson Commercial |
$44.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$35.20
|
|
|
Service Code
|
NDC 00450091012
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna American Axle |
$22.88
|
| Rate for Payer: Aetna Commercial |
$29.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.88
|
| Rate for Payer: Cash Price |
$28.16
|
| Rate for Payer: Cofinity Advantage |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.16
|
| Rate for Payer: Healthscope Commercial |
$31.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.40
|
| Rate for Payer: PHP Commercial |
$29.92
|
| Rate for Payer: Priority Health SBD |
$22.18
|
| Rate for Payer: UMR Bronson Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.40
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$119.70
|
|
|
Service Code
|
NDC 00450091060
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna American Axle |
$77.81
|
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UMR Bronson Commercial |
$52.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
OP
|
$75.72
|
|
|
Service Code
|
NDC 00450091032
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna American Axle |
$49.22
|
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: Aetna Medicare |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.22
|
| Rate for Payer: BCBS Complete |
$30.29
|
| Rate for Payer: Cash Price |
$60.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$60.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.79
|
| Rate for Payer: PHP Commercial |
$64.36
|
| Rate for Payer: Priority Health SBD |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.22
|
| Rate for Payer: UHC Core |
$39.45
|
| Rate for Payer: UHC Exchange |
$29.76
|
| Rate for Payer: UMR Bronson Commercial |
$28.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.79
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
NDC 00450091032
|
| 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 Advantage |
$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 Commercial |
$64.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.79
|
| Rate for Payer: PHP Commercial |
$64.36
|
| 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
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
OP
|
$35.20
|
|
|
Service Code
|
NDC 00450091012
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna American Axle |
$22.88
|
| Rate for Payer: Aetna Commercial |
$29.92
|
| Rate for Payer: Aetna Medicare |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.88
|
| Rate for Payer: BCBS Complete |
$14.08
|
| Rate for Payer: Cash Price |
$28.16
|
| Rate for Payer: Cofinity Advantage |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.16
|
| Rate for Payer: Healthscope Commercial |
$31.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.40
|
| Rate for Payer: PHP Commercial |
$29.92
|
| Rate for Payer: Priority Health SBD |
$22.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.88
|
| Rate for Payer: UHC Core |
$18.34
|
| Rate for Payer: UHC Exchange |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.40
|
|
|
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 Advantage |
$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 Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$56.81
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$61.18
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| 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 |
$61.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| 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 |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$32.34
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.78
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$56.81
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Advantage |
$61.18
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: UMR Bronson Commercial |
$31.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| 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 Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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: 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| 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 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 |
$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 |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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 |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 -DKA
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| 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 Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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: 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| 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
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
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 |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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 |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
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) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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 |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| 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 Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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: 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 |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
OP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.39 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna American Axle |
$253.66
|
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna Medicare |
$195.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.66
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Advantage |
$273.17
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.68
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health SBD |
$245.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.66
|
| Rate for Payer: UHC Core |
$203.32
|
| Rate for Payer: UHC Exchange |
$153.36
|
| Rate for Payer: UMR Bronson Commercial |
$144.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 49100038164
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: UHC Exchange |
$1.54
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$390.24
|
|
|
Service Code
|
NDC 49100040007
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.71 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna American Axle |
$253.66
|
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.66
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Advantage |
$273.17
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.68
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health SBD |
$245.85
|
| Rate for Payer: UMR Bronson Commercial |
$171.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 49100038164
|
| Hospital Charge Code |
27974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$94.51
|
|
|
Service Code
|
NDC 00116400532
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$85.06 |
| Rate for Payer: Aetna American Axle |
$61.43
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$47.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.43
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.61
|
| Rate for Payer: Cofinity Advantage |
$66.16
|
| Rate for Payer: Cofinity Commercial |
$81.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.61
|
| Rate for Payer: Healthscope Commercial |
$85.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Core |
$49.24
|
| Rate for Payer: UHC Exchange |
$37.14
|
| Rate for Payer: UMR Bronson Commercial |
$34.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
