|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$226.58 |
| Rate for Payer: Aetna American Axle |
$163.64
|
| Rate for Payer: Aetna Commercial |
$213.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.64
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$176.22
|
| Rate for Payer: Cofinity Commercial |
$216.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$226.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: PHP Commercial |
$213.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.64
|
| Rate for Payer: Priority Health SBD |
$158.60
|
| Rate for Payer: UMR Bronson Commercial |
$110.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.81
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$335.35
|
|
|
Service Code
|
NDC 72888012101
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$301.82 |
| Rate for Payer: Aetna American Axle |
$217.98
|
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: Aetna Medicare |
$167.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.98
|
| Rate for Payer: BCBS Complete |
$134.14
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$234.74
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$301.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: PHP Commercial |
$285.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.98
|
| Rate for Payer: Priority Health SBD |
$211.27
|
| Rate for Payer: UMR Bronson Commercial |
$124.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.51
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna American Axle |
$278.00
|
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health SBD |
$269.45
|
| Rate for Payer: UMR Bronson Commercial |
$158.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna American Axle |
$188.96
|
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UMR Bronson Commercial |
$107.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.36 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna American Axle |
$250.09
|
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
| Rate for Payer: UMR Bronson Commercial |
$142.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.19 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna American Axle |
$278.00
|
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health SBD |
$269.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$226.58 |
| Rate for Payer: Aetna American Axle |
$163.64
|
| Rate for Payer: Aetna Commercial |
$213.99
|
| Rate for Payer: Aetna Medicare |
$125.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.64
|
| Rate for Payer: BCBS Complete |
$100.70
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$176.22
|
| Rate for Payer: Cofinity Commercial |
$216.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$226.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: PHP Commercial |
$213.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.64
|
| Rate for Payer: Priority Health SBD |
$158.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.81
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna American Axle |
$188.96
|
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UMR Bronson Commercial |
$127.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna American Axle |
$250.09
|
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
| Rate for Payer: UMR Bronson Commercial |
$169.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$335.35
|
|
|
Service Code
|
NDC 72888012101
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.55 |
| Max. Negotiated Rate |
$301.82 |
| Rate for Payer: Aetna American Axle |
$217.98
|
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.98
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$234.74
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$301.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: PHP Commercial |
$285.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.98
|
| Rate for Payer: Priority Health SBD |
$211.27
|
| Rate for Payer: UMR Bronson Commercial |
$147.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.51
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$35.69
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna American Axle |
$23.20
|
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.14
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: Priority Health SBD |
$22.48
|
| Rate for Payer: UMR Bronson Commercial |
$15.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna American Axle |
$5.98
|
| Rate for Payer: Aetna American Axle |
$23.20
|
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$17.84
|
| Rate for Payer: Aetna Medicare |
$14.46
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Complete |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$24.59
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: Priority Health SBD |
$22.48
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$13.21
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: UMR Bronson Commercial |
$10.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.90
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna American Axle |
$150.15
|
| Rate for Payer: Aetna American Axle |
$362.67
|
| Rate for Payer: Aetna American Axle |
$102.05
|
| Rate for Payer: Aetna American Axle |
$30.69
|
| Rate for Payer: Aetna American Axle |
$208.00
|
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna American Axle |
$27.62
|
| Rate for Payer: Aetna American Axle |
$70.85
|
| Rate for Payer: Aetna American Axle |
$76.05
|
| Rate for Payer: Aetna Commercial |
$474.27
|
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$446.37
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$479.85
|
| Rate for Payer: Cofinity Commercial |
$390.57
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$33.05
|
| Rate for Payer: Cofinity Commercial |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$29.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$502.16
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$474.27
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.67
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$351.51
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$73.71
|
| Rate for Payer: Priority Health SBD |
$26.78
|
| Rate for Payer: Priority Health SBD |
$29.75
|
| Rate for Payer: UMR Bronson Commercial |
$18.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.78
|
| Rate for Payer: UMR Bronson Commercial |
$245.50
|
| Rate for Payer: UMR Bronson Commercial |
$51.48
|
| Rate for Payer: UMR Bronson Commercial |
$69.08
|
| Rate for Payer: UMR Bronson Commercial |
$47.96
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$101.64
|
| Rate for Payer: UMR Bronson Commercial |
$140.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.50
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna American Axle |
$27.62
|
| Rate for Payer: Aetna American Axle |
$362.67
|
| Rate for Payer: Aetna American Axle |
$102.05
|
| Rate for Payer: Aetna American Axle |
$150.15
|
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna American Axle |
$70.85
|
| Rate for Payer: Aetna American Axle |
$76.05
|
| Rate for Payer: Aetna American Axle |
$208.00
|
| Rate for Payer: Aetna American Axle |
$30.69
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$474.27
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$278.98
|
| Rate for Payer: Aetna Medicare |
$21.25
|
| Rate for Payer: Aetna Medicare |
$23.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS Complete |
$223.18
|
| Rate for Payer: BCBS Complete |
$18.89
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$446.37
|
| Rate for Payer: Cash Price |
$446.37
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$29.75
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$33.05
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$390.57
|
| Rate for Payer: Cofinity Commercial |
$479.85
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$502.16
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$474.27
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$26.78
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$351.51
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$73.71
|
| Rate for Payer: Priority Health SBD |
$29.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.47
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: UMR Bronson Commercial |
$58.09
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: UMR Bronson Commercial |
$15.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.47
|
| Rate for Payer: UMR Bronson Commercial |
$206.45
|
| Rate for Payer: UMR Bronson Commercial |
$43.29
|
| Rate for Payer: UMR Bronson Commercial |
$118.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.00
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
NDC 60687068711
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna American Axle |
$4.97
|
| Rate for Payer: Aetna Commercial |
$6.50
|
| Rate for Payer: Aetna Medicare |
$3.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.97
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$6.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: PHP Commercial |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: Priority Health SBD |
$4.82
|
| Rate for Payer: UMR Bronson Commercial |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.74
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$458.88
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.91 |
| Max. Negotiated Rate |
$412.99 |
| Rate for Payer: Aetna American Axle |
$298.27
|
| Rate for Payer: Aetna Commercial |
$390.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.27
|
| Rate for Payer: Cash Price |
$367.10
|
| Rate for Payer: Cofinity Commercial |
$321.22
|
| Rate for Payer: Cofinity Commercial |
$394.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.10
|
| Rate for Payer: Healthscope Commercial |
$412.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.05
|
| Rate for Payer: PHP Commercial |
$390.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.27
|
| Rate for Payer: Priority Health SBD |
$289.09
|
| Rate for Payer: UMR Bronson Commercial |
$201.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.16
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
NDC 60687068711
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna American Axle |
$4.97
|
| Rate for Payer: Aetna Commercial |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.97
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$6.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$6.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: PHP Commercial |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: Priority Health SBD |
$4.82
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.74
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$458.88
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.79 |
| Max. Negotiated Rate |
$412.99 |
| Rate for Payer: Aetna American Axle |
$298.27
|
| Rate for Payer: Aetna Commercial |
$390.05
|
| Rate for Payer: Aetna Medicare |
$229.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.27
|
| Rate for Payer: BCBS Complete |
$183.55
|
| Rate for Payer: Cash Price |
$367.10
|
| Rate for Payer: Cofinity Commercial |
$321.22
|
| Rate for Payer: Cofinity Commercial |
$394.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.10
|
| Rate for Payer: Healthscope Commercial |
$412.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.05
|
| Rate for Payer: PHP Commercial |
$390.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.27
|
| Rate for Payer: Priority Health SBD |
$289.09
|
| Rate for Payer: UMR Bronson Commercial |
$169.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.16
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$3,896.55
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,714.48 |
| Max. Negotiated Rate |
$3,506.90 |
| Rate for Payer: Aetna American Axle |
$2,532.76
|
| Rate for Payer: Aetna Commercial |
$3,312.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,532.76
|
| Rate for Payer: Cash Price |
$3,117.24
|
| Rate for Payer: Cofinity Commercial |
$2,727.58
|
| Rate for Payer: Cofinity Commercial |
$3,351.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,727.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.24
|
| Rate for Payer: Healthscope Commercial |
$3,506.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,727.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.07
|
| Rate for Payer: PHP Commercial |
$3,312.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,532.76
|
| Rate for Payer: Priority Health SBD |
$2,454.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,714.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.41
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$541.16
|
|
|
Service Code
|
NDC 00904724568
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.11 |
| Max. Negotiated Rate |
$487.04 |
| Rate for Payer: Aetna American Axle |
$351.75
|
| Rate for Payer: Aetna Commercial |
$459.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.75
|
| Rate for Payer: Cash Price |
$432.93
|
| Rate for Payer: Cofinity Commercial |
$378.81
|
| Rate for Payer: Cofinity Commercial |
$465.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.93
|
| Rate for Payer: Healthscope Commercial |
$487.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$378.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.99
|
| Rate for Payer: PHP Commercial |
$459.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.75
|
| Rate for Payer: Priority Health SBD |
$340.93
|
| Rate for Payer: UMR Bronson Commercial |
$238.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.87
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$541.16
|
|
|
Service Code
|
NDC 00904724568
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.23 |
| Max. Negotiated Rate |
$487.04 |
| Rate for Payer: Aetna American Axle |
$351.75
|
| Rate for Payer: Aetna Commercial |
$459.99
|
| Rate for Payer: Aetna Medicare |
$270.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.75
|
| Rate for Payer: BCBS Complete |
$216.46
|
| Rate for Payer: Cash Price |
$432.93
|
| Rate for Payer: Cofinity Commercial |
$378.81
|
| Rate for Payer: Cofinity Commercial |
$465.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.93
|
| Rate for Payer: Healthscope Commercial |
$487.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$378.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.99
|
| Rate for Payer: PHP Commercial |
$459.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.75
|
| Rate for Payer: Priority Health SBD |
$340.93
|
| Rate for Payer: UMR Bronson Commercial |
$200.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.87
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$4,286.60
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,586.04 |
| Max. Negotiated Rate |
$3,857.94 |
| Rate for Payer: Aetna American Axle |
$2,786.29
|
| Rate for Payer: Aetna Commercial |
$3,643.61
|
| Rate for Payer: Aetna Medicare |
$2,143.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,786.29
|
| Rate for Payer: BCBS Complete |
$1,714.64
|
| Rate for Payer: Cash Price |
$3,429.28
|
| Rate for Payer: Cofinity Commercial |
$3,000.62
|
| Rate for Payer: Cofinity Commercial |
$3,686.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,429.28
|
| Rate for Payer: Healthscope Commercial |
$3,857.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.61
|
| Rate for Payer: PHP Commercial |
$3,643.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.29
|
| Rate for Payer: Priority Health SBD |
$2,700.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,586.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.95
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$3,896.55
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,441.72 |
| Max. Negotiated Rate |
$3,506.90 |
| Rate for Payer: Aetna American Axle |
$2,532.76
|
| Rate for Payer: Aetna Commercial |
$3,312.07
|
| Rate for Payer: Aetna Medicare |
$1,948.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,532.76
|
| Rate for Payer: BCBS Complete |
$1,558.62
|
| Rate for Payer: Cash Price |
$3,117.24
|
| Rate for Payer: Cofinity Commercial |
$2,727.58
|
| Rate for Payer: Cofinity Commercial |
$3,351.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,727.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.24
|
| Rate for Payer: Healthscope Commercial |
$3,506.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,727.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.07
|
| Rate for Payer: PHP Commercial |
$3,312.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,532.76
|
| Rate for Payer: Priority Health SBD |
$2,454.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.41
|
|
