|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
NDC 45963043864
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Advantage |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.32
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.34
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00121057716
|
| 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 Advantage |
$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 Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| 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
|
OP
|
$66.51
|
|
|
Service Code
|
NDC 64980059295
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$59.86 |
| Rate for Payer: Aetna American Axle |
$43.23
|
| Rate for Payer: Aetna Commercial |
$56.53
|
| Rate for Payer: Aetna Medicare |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.23
|
| Rate for Payer: BCBS Complete |
$26.60
|
| Rate for Payer: Cash Price |
$53.21
|
| Rate for Payer: Cofinity Advantage |
$46.56
|
| Rate for Payer: Cofinity Commercial |
$57.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.21
|
| Rate for Payer: Healthscope Commercial |
$59.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.88
|
| Rate for Payer: PHP Commercial |
$56.53
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.23
|
| Rate for Payer: UHC Core |
$34.65
|
| Rate for Payer: UHC Exchange |
$26.14
|
| Rate for Payer: UMR Bronson Commercial |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$49.01
|
|
|
Service Code
|
NDC 45963043965
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$44.11 |
| Rate for Payer: Aetna American Axle |
$31.86
|
| Rate for Payer: Aetna Commercial |
$41.66
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.86
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$39.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.76
|
| Rate for Payer: PHP Commercial |
$41.66
|
| Rate for Payer: Priority Health SBD |
$30.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Core |
$25.53
|
| Rate for Payer: UHC Exchange |
$19.26
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.76
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$84.01
|
|
|
Service Code
|
NDC 00121087332
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna American Axle |
$54.61
|
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.61
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cofinity Advantage |
$58.81
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$75.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.01
|
| Rate for Payer: PHP Commercial |
$71.41
|
| Rate for Payer: Priority Health SBD |
$52.93
|
| Rate for Payer: UMR Bronson Commercial |
$36.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.01
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00121057716
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.07
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$66.51
|
|
|
Service Code
|
NDC 64980059295
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$59.86 |
| Rate for Payer: Aetna American Axle |
$43.23
|
| Rate for Payer: Aetna Commercial |
$56.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.23
|
| Rate for Payer: Cash Price |
$53.21
|
| Rate for Payer: Cofinity Advantage |
$46.56
|
| Rate for Payer: Cofinity Commercial |
$57.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.21
|
| Rate for Payer: Healthscope Commercial |
$59.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.88
|
| Rate for Payer: PHP Commercial |
$56.53
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UMR Bronson Commercial |
$29.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.91
|
|
|
Service Code
|
NDC 60432003708
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna American Axle |
$9.69
|
| Rate for Payer: Aetna Commercial |
$12.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: Cash Price |
$11.93
|
| Rate for Payer: Cofinity Advantage |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.93
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.18
|
| Rate for Payer: PHP Commercial |
$12.67
|
| Rate for Payer: Priority Health SBD |
$9.39
|
| Rate for Payer: UMR Bronson Commercial |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.18
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$84.01
|
|
|
Service Code
|
NDC 00121087332
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna American Axle |
$54.61
|
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.61
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cofinity Advantage |
$58.81
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$75.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.01
|
| Rate for Payer: PHP Commercial |
$71.41
|
| Rate for Payer: Priority Health SBD |
$52.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.61
|
| Rate for Payer: UHC Core |
$43.77
|
| Rate for Payer: UHC Exchange |
$33.02
|
| Rate for Payer: UMR Bronson Commercial |
$31.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.01
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
NDC 45963043864
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Advantage |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.32
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$94.51
|
|
|
Service Code
|
NDC 00116400532
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.06 |
| Rate for Payer: Aetna American Axle |
$61.43
|
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.43
|
| 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: 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: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$49.01
|
|
|
Service Code
|
NDC 45963043965
|
| 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 Advantage |
$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 Commercial |
$41.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.76
|
| Rate for Payer: PHP Commercial |
$41.66
|
| 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 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.91
|
|
|
Service Code
|
NDC 60432003708
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna American Axle |
$9.69
|
| Rate for Payer: Aetna Commercial |
$12.67
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: BCBS Complete |
$5.96
|
| Rate for Payer: Cash Price |
$11.93
|
| Rate for Payer: Cofinity Advantage |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.93
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.18
|
| Rate for Payer: PHP Commercial |
$12.67
|
| Rate for Payer: Priority Health SBD |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.69
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Exchange |
$5.86
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.18
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.77
|
|
|
Service Code
|
NDC 00116400541
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna American Axle |
$4.40
|
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.40
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Advantage |
$4.74
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.08
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: Priority Health SBD |
$4.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna American Axle |
$4.59
|
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.59
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Advantage |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health SBD |
$4.45
|
| Rate for Payer: UMR Bronson Commercial |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$5.06
|
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.06
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Advantage |
$5.45
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: Priority Health SBD |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna American Axle |
$3.93
|
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Advantage |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Exchange |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.77
|
|
|
Service Code
|
NDC 00116400541
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna American Axle |
$4.40
|
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.40
|
| Rate for Payer: BCBS Complete |
$2.71
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Advantage |
$4.74
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.08
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: Priority Health SBD |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.40
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: UHC Exchange |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$5.06
|
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.06
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Advantage |
$5.45
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: Priority Health SBD |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.05
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UMR Bronson Commercial |
$2.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 66689003801
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.28
|
| Rate for Payer: UHC Core |
$2.63
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 66689003850
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.28
|
| Rate for Payer: UHC Core |
$2.63
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna American Axle |
$4.59
|
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.59
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Advantage |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health SBD |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 66689003850
|
| 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 Advantage |
$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 Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: PHP Commercial |
$4.28
|
| 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
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna American Axle |
$3.93
|
| Rate for Payer: Aetna Commercial |
$5.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Advantage |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.54
|
| Rate for Payer: PHP Commercial |
$5.14
|
| Rate for Payer: Priority Health SBD |
$3.81
|
| Rate for Payer: UMR Bronson Commercial |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 66689003801
|
| 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 Advantage |
$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 Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: PHP Commercial |
$4.28
|
| 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
|
|
