|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
NDC 65862089610
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$781.92
|
|
|
Service Code
|
NDC 65628008010
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.31 |
| Max. Negotiated Rate |
$703.73 |
| Rate for Payer: Aetna American Axle |
$508.25
|
| Rate for Payer: Aetna Commercial |
$664.63
|
| Rate for Payer: Aetna Medicare |
$390.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.25
|
| Rate for Payer: BCBS Complete |
$312.77
|
| Rate for Payer: Cash Price |
$625.54
|
| Rate for Payer: Cofinity Advantage |
$547.34
|
| Rate for Payer: Cofinity Commercial |
$672.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$625.54
|
| Rate for Payer: Healthscope Commercial |
$703.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$625.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$664.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$586.44
|
| Rate for Payer: PHP Commercial |
$664.63
|
| Rate for Payer: Priority Health SBD |
$492.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.25
|
| Rate for Payer: UHC Core |
$407.38
|
| Rate for Payer: UHC Exchange |
$307.29
|
| Rate for Payer: UMR Bronson Commercial |
$289.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.44
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.75
|
|
|
Service Code
|
NDC 09900000934
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.60
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.31
|
| Rate for Payer: PHP Commercial |
$21.89
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.74
|
| Rate for Payer: UHC Core |
$13.42
|
| Rate for Payer: UHC Exchange |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.31
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.75
|
|
|
Service Code
|
NDC 09900000934
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cofinity Advantage |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.60
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.31
|
| Rate for Payer: PHP Commercial |
$21.89
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.31
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$781.92
|
|
|
Service Code
|
NDC 65628008010
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.04 |
| Max. Negotiated Rate |
$703.73 |
| Rate for Payer: Aetna American Axle |
$508.25
|
| Rate for Payer: Aetna Commercial |
$664.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.25
|
| Rate for Payer: Cash Price |
$625.54
|
| Rate for Payer: Cofinity Advantage |
$547.34
|
| Rate for Payer: Cofinity Commercial |
$672.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$625.54
|
| Rate for Payer: Healthscope Commercial |
$703.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$664.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$586.44
|
| Rate for Payer: PHP Commercial |
$664.63
|
| Rate for Payer: Priority Health SBD |
$492.61
|
| Rate for Payer: UMR Bronson Commercial |
$344.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.44
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$860.31
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.54 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna American Axle |
$559.20
|
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
| Rate for Payer: UMR Bronson Commercial |
$378.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.23
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$860.31
|
|
|
Service Code
|
NDC 68180081952
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.54 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna American Axle |
$559.20
|
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
| Rate for Payer: UMR Bronson Commercial |
$378.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.23
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,119.88
|
|
|
Service Code
|
NDC 67877025690
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.36 |
| Max. Negotiated Rate |
$1,007.89 |
| Rate for Payer: Aetna American Axle |
$727.92
|
| Rate for Payer: Aetna Commercial |
$951.90
|
| Rate for Payer: Aetna Medicare |
$559.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.92
|
| Rate for Payer: BCBS Complete |
$447.95
|
| Rate for Payer: Cash Price |
$895.90
|
| Rate for Payer: Cofinity Advantage |
$783.92
|
| Rate for Payer: Cofinity Commercial |
$963.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.90
|
| Rate for Payer: Healthscope Commercial |
$1,007.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$895.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.91
|
| Rate for Payer: PHP Commercial |
$951.90
|
| Rate for Payer: Priority Health SBD |
$705.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.92
|
| Rate for Payer: UHC Core |
$583.46
|
| Rate for Payer: UHC Exchange |
$440.11
|
| Rate for Payer: UMR Bronson Commercial |
$414.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.91
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,720.62
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$636.63 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna American Axle |
$1,118.40
|
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna Medicare |
$860.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: BCBS Complete |
$688.25
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,204.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,290.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,376.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.40
|
| Rate for Payer: UHC Core |
$896.44
|
| Rate for Payer: UHC Exchange |
$676.20
|
| Rate for Payer: UMR Bronson Commercial |
$636.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,290.46
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,671.50
|
|
|
Service Code
|
NDC 66993042247
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$735.46 |
| Max. Negotiated Rate |
$1,504.35 |
| Rate for Payer: Aetna American Axle |
$1,086.47
|
| Rate for Payer: Aetna Commercial |
$1,420.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.47
|
| Rate for Payer: Cash Price |
$1,337.20
|
| Rate for Payer: Cofinity Advantage |
$1,170.05
|
| Rate for Payer: Cofinity Commercial |
$1,437.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.20
|
| Rate for Payer: Healthscope Commercial |
$1,504.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.62
|
| Rate for Payer: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health SBD |
$1,053.05
|
| Rate for Payer: UMR Bronson Commercial |
$735.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.62
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3,342.99
|
|
|
Service Code
|
NDC 66993042285
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,236.91 |
| Max. Negotiated Rate |
$3,008.69 |
| Rate for Payer: Aetna American Axle |
$2,172.94
|
| Rate for Payer: Aetna Commercial |
$2,841.54
|
| Rate for Payer: Aetna Medicare |
$1,671.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.94
|
| Rate for Payer: BCBS Complete |
$1,337.20
|
| Rate for Payer: Cash Price |
$2,674.39
|
| Rate for Payer: Cofinity Advantage |
$2,340.09
|
| Rate for Payer: Cofinity Commercial |
$2,874.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.39
|
| Rate for Payer: Healthscope Commercial |
$3,008.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,674.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,507.24
|
| Rate for Payer: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health SBD |
$2,106.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,172.94
|
| Rate for Payer: UHC Core |
$1,741.70
|
| Rate for Payer: UHC Exchange |
$1,313.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.24
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,671.50
|
|
|
Service Code
|
NDC 66993042247
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$618.46 |
| Max. Negotiated Rate |
$1,504.35 |
| Rate for Payer: Aetna American Axle |
$1,086.47
|
| Rate for Payer: Aetna Commercial |
$1,420.78
|
| Rate for Payer: Aetna Medicare |
$835.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.47
|
| Rate for Payer: BCBS Complete |
$668.60
|
| Rate for Payer: Cash Price |
$1,337.20
|
| Rate for Payer: Cofinity Advantage |
$1,170.05
|
| Rate for Payer: Cofinity Commercial |
$1,437.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.20
|
| Rate for Payer: Healthscope Commercial |
$1,504.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,337.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.62
|
| Rate for Payer: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health SBD |
$1,053.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.47
|
| Rate for Payer: UHC Core |
$870.85
|
| Rate for Payer: UHC Exchange |
$656.90
|
| Rate for Payer: UMR Bronson Commercial |
$618.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.62
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,119.88
|
|
|
Service Code
|
NDC 67877025690
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.75 |
| Max. Negotiated Rate |
$1,007.89 |
| Rate for Payer: Aetna American Axle |
$727.92
|
| Rate for Payer: Aetna Commercial |
$951.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.92
|
| Rate for Payer: Cash Price |
$895.90
|
| Rate for Payer: Cofinity Advantage |
$783.92
|
| Rate for Payer: Cofinity Commercial |
$963.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.90
|
| Rate for Payer: Healthscope Commercial |
$1,007.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$783.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$839.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.91
|
| Rate for Payer: PHP Commercial |
$951.90
|
| Rate for Payer: Priority Health SBD |
$705.52
|
| Rate for Payer: UMR Bronson Commercial |
$492.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$839.91
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,859.14
|
|
|
Service Code
|
NDC 54092025245
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$687.88 |
| Max. Negotiated Rate |
$1,673.23 |
| Rate for Payer: Aetna American Axle |
$1,208.44
|
| Rate for Payer: Aetna Commercial |
$1,580.27
|
| Rate for Payer: Aetna Medicare |
$929.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.44
|
| Rate for Payer: BCBS Complete |
$743.66
|
| Rate for Payer: Cash Price |
$1,487.31
|
| Rate for Payer: Cofinity Advantage |
$1,301.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,487.31
|
| Rate for Payer: Healthscope Commercial |
$1,673.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,301.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,394.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,487.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,580.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,394.36
|
| Rate for Payer: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health SBD |
$1,171.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,208.44
|
| Rate for Payer: UHC Core |
$968.61
|
| Rate for Payer: UHC Exchange |
$730.64
|
| Rate for Payer: UMR Bronson Commercial |
$687.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,394.36
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,720.62
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$757.07 |
| Max. Negotiated Rate |
$1,548.56 |
| Rate for Payer: Aetna American Axle |
$1,118.40
|
| Rate for Payer: Aetna Commercial |
$1,462.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,376.50
|
| Rate for Payer: Cofinity Advantage |
$1,204.43
|
| Rate for Payer: Cofinity Commercial |
$1,479.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.50
|
| Rate for Payer: Healthscope Commercial |
$1,548.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,204.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,290.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,462.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,290.46
|
| Rate for Payer: PHP Commercial |
$1,462.53
|
| Rate for Payer: Priority Health SBD |
$1,083.99
|
| Rate for Payer: UMR Bronson Commercial |
$757.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,290.46
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3,342.99
|
|
|
Service Code
|
NDC 66993042285
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,470.92 |
| Max. Negotiated Rate |
$3,008.69 |
| Rate for Payer: Aetna American Axle |
$2,172.94
|
| Rate for Payer: Aetna Commercial |
$2,841.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.94
|
| Rate for Payer: Cash Price |
$2,674.39
|
| Rate for Payer: Cofinity Advantage |
$2,340.09
|
| Rate for Payer: Cofinity Commercial |
$2,874.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.39
|
| Rate for Payer: Healthscope Commercial |
$3,008.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,507.24
|
| Rate for Payer: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health SBD |
$2,106.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.24
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3,718.28
|
|
|
Service Code
|
NDC 54092025290
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,636.04 |
| Max. Negotiated Rate |
$3,346.45 |
| Rate for Payer: Aetna American Axle |
$2,416.88
|
| Rate for Payer: Aetna Commercial |
$3,160.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.88
|
| Rate for Payer: Cash Price |
$2,974.62
|
| Rate for Payer: Cofinity Advantage |
$2,602.80
|
| Rate for Payer: Cofinity Commercial |
$3,197.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,974.62
|
| Rate for Payer: Healthscope Commercial |
$3,346.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,602.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,788.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,160.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,788.71
|
| Rate for Payer: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health SBD |
$2,342.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,636.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,788.71
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3,718.28
|
|
|
Service Code
|
NDC 54092025290
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,375.76 |
| Max. Negotiated Rate |
$3,346.45 |
| Rate for Payer: Aetna American Axle |
$2,416.88
|
| Rate for Payer: Aetna Commercial |
$3,160.54
|
| Rate for Payer: Aetna Medicare |
$1,859.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.88
|
| Rate for Payer: BCBS Complete |
$1,487.31
|
| Rate for Payer: Cash Price |
$2,974.62
|
| Rate for Payer: Cofinity Advantage |
$2,602.80
|
| Rate for Payer: Cofinity Commercial |
$3,197.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,974.62
|
| Rate for Payer: Healthscope Commercial |
$3,346.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,602.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,788.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,974.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,160.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,788.71
|
| Rate for Payer: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health SBD |
$2,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,416.88
|
| Rate for Payer: UHC Core |
$1,937.22
|
| Rate for Payer: UHC Exchange |
$1,461.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,788.71
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,859.14
|
|
|
Service Code
|
NDC 54092025245
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$818.02 |
| Max. Negotiated Rate |
$1,673.23 |
| Rate for Payer: Aetna American Axle |
$1,208.44
|
| Rate for Payer: Aetna Commercial |
$1,580.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.44
|
| Rate for Payer: Cash Price |
$1,487.31
|
| Rate for Payer: Cofinity Advantage |
$1,301.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,487.31
|
| Rate for Payer: Healthscope Commercial |
$1,673.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,301.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,394.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,580.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,394.36
|
| Rate for Payer: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health SBD |
$1,171.26
|
| Rate for Payer: UMR Bronson Commercial |
$818.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,394.36
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$559.94
|
|
|
Service Code
|
NDC 67877025645
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.18 |
| Max. Negotiated Rate |
$503.95 |
| Rate for Payer: Aetna American Axle |
$363.96
|
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Medicare |
$279.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.96
|
| Rate for Payer: BCBS Complete |
$223.98
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cofinity Advantage |
$391.96
|
| Rate for Payer: Cofinity Commercial |
$481.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.95
|
| Rate for Payer: Healthscope Commercial |
$503.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$391.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$419.95
|
| Rate for Payer: PHP Commercial |
$475.95
|
| Rate for Payer: Priority Health SBD |
$352.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.96
|
| Rate for Payer: UHC Core |
$291.73
|
| Rate for Payer: UHC Exchange |
$220.06
|
| Rate for Payer: UMR Bronson Commercial |
$207.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.95
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$860.31
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.31 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna American Axle |
$559.20
|
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna Medicare |
$430.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: BCBS Complete |
$344.12
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.20
|
| Rate for Payer: UHC Core |
$448.22
|
| Rate for Payer: UHC Exchange |
$338.10
|
| Rate for Payer: UMR Bronson Commercial |
$318.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.23
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$860.31
|
|
|
Service Code
|
NDC 68180081952
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.31 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Aetna American Axle |
$559.20
|
| Rate for Payer: Aetna Commercial |
$731.26
|
| Rate for Payer: Aetna Medicare |
$430.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.20
|
| Rate for Payer: BCBS Complete |
$344.12
|
| Rate for Payer: Cash Price |
$688.25
|
| Rate for Payer: Cofinity Advantage |
$602.22
|
| Rate for Payer: Cofinity Commercial |
$739.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.25
|
| Rate for Payer: Healthscope Commercial |
$774.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.23
|
| Rate for Payer: PHP Commercial |
$731.26
|
| Rate for Payer: Priority Health SBD |
$542.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.20
|
| Rate for Payer: UHC Core |
$448.22
|
| Rate for Payer: UHC Exchange |
$338.10
|
| Rate for Payer: UMR Bronson Commercial |
$318.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.23
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$559.94
|
|
|
Service Code
|
NDC 67877025645
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.37 |
| Max. Negotiated Rate |
$503.95 |
| Rate for Payer: Aetna American Axle |
$363.96
|
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.96
|
| Rate for Payer: Cash Price |
$447.95
|
| Rate for Payer: Cofinity Advantage |
$391.96
|
| Rate for Payer: Cofinity Commercial |
$481.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.95
|
| Rate for Payer: Healthscope Commercial |
$503.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$391.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$419.95
|
| Rate for Payer: PHP Commercial |
$475.95
|
| Rate for Payer: Priority Health SBD |
$352.76
|
| Rate for Payer: UMR Bronson Commercial |
$246.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.95
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$37,034.14
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$14,002.33 |
| Max. Negotiated Rate |
$37,034.14 |
| Rate for Payer: Aetna Medicare |
$15,328.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,424.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,424.12
|
| Rate for Payer: BCBS MAPPO |
$14,739.30
|
| Rate for Payer: BCBS Trust/PPO |
$37,034.14
|
| Rate for Payer: BCN Commercial |
$37,034.14
|
| Rate for Payer: BCN Medicare Advantage |
$14,739.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,739.30
|
| Rate for Payer: Mclaren Medicare |
$14,739.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,476.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,950.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,213.23
|
| Rate for Payer: Nomi Health Commercial |
$21,821.64
|
| Rate for Payer: PACE Medicare |
$14,002.33
|
| Rate for Payer: PACE SWMI |
$14,739.30
|
| Rate for Payer: PHP Medicare Advantage |
$14,739.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,272.21
|
| Rate for Payer: Priority Health Medicare |
$14,739.30
|
| Rate for Payer: Priority Health Tiered Network |
$21,817.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14,739.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,573.08
|
| Rate for Payer: UHC Core |
$23,068.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,739.30
|
| Rate for Payer: UHC Exchange |
$18,839.35
|
| Rate for Payer: VA VA |
$14,739.30
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$40,825.13
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$19,522.21 |
| Max. Negotiated Rate |
$40,825.13 |
| Rate for Payer: Aetna Medicare |
$21,371.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,687.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,687.11
|
| Rate for Payer: BCBS MAPPO |
$20,549.69
|
| Rate for Payer: BCBS Trust/PPO |
$40,825.13
|
| Rate for Payer: BCN Commercial |
$40,825.13
|
| Rate for Payer: BCN Medicare Advantage |
$20,549.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,549.69
|
| Rate for Payer: Mclaren Medicare |
$20,549.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,577.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,632.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,604.66
|
| Rate for Payer: Nomi Health Commercial |
$30,784.56
|
| Rate for Payer: PACE Medicare |
$19,522.21
|
| Rate for Payer: PACE SWMI |
$20,549.69
|
| Rate for Payer: PHP Medicare Advantage |
$20,549.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,473.87
|
| Rate for Payer: Priority Health Medicare |
$20,549.69
|
| Rate for Payer: Priority Health Tiered Network |
$30,779.10
|
| Rate for Payer: Railroad Medicare Medicare |
$20,549.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,898.32
|
| Rate for Payer: UHC Core |
$32,543.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,549.69
|
| Rate for Payer: UHC Exchange |
$26,577.34
|
| Rate for Payer: VA VA |
$20,549.69
|
|
