|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$56.01
|
|
|
Service Code
|
NDC 64980059295
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Aetna American Axle |
$36.41
|
| Rate for Payer: Aetna Commercial |
$47.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.41
|
| Rate for Payer: Cash Price |
$44.81
|
| Rate for Payer: Cofinity Commercial |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.81
|
| Rate for Payer: Healthscope Commercial |
$50.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.61
|
| Rate for Payer: PHP Commercial |
$47.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health SBD |
$35.29
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.01
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.51
|
|
|
Service Code
|
NDC 50383077932
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Aetna American Axle |
$25.03
|
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.03
|
| Rate for Payer: Cash Price |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.81
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.73
|
| Rate for Payer: PHP Commercial |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.03
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$56.01
|
|
|
Service Code
|
NDC 64980059295
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Aetna American Axle |
$36.41
|
| Rate for Payer: Aetna Commercial |
$47.61
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.41
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$44.81
|
| Rate for Payer: Cofinity Commercial |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.81
|
| Rate for Payer: Healthscope Commercial |
$50.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.61
|
| Rate for Payer: PHP Commercial |
$47.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health SBD |
$35.29
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.01
|
|
|
LACTULOSE 10 GRAM/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$38.51
|
|
|
Service Code
|
NDC 50383077932
|
| Hospital Charge Code |
38245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Aetna American Axle |
$25.03
|
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.03
|
| Rate for Payer: BCBS Complete |
$15.40
|
| Rate for Payer: Cash Price |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$33.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.81
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.73
|
| Rate for Payer: PHP Commercial |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.03
|
| Rate for Payer: Priority Health SBD |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383077931
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
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 Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| 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: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| 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
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna American Axle |
$4.31
|
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.97
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna American Axle |
$4.31
|
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna Medicare |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.31
|
| Rate for Payer: Priority Health SBD |
$4.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.97
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna American Axle |
$4.68
|
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.68
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Cofinity Commercial |
$6.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.12
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health SBD |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.40
|
|
|
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 Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| 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: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| 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
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50383077931
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna American Axle |
$4.68
|
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.68
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Cofinity Commercial |
$6.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.12
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health SBD |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.40
|
|
|
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 Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| 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: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| 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
|
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 Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| 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: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; CERVICAL
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.72 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$8,687.69
|
| Rate for Payer: BCN Commercial |
$8,687.69
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,404.39
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,276.72
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$9,507.80
|
|
|
Service Code
|
CPT 63048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.56 |
| Max. Negotiated Rate |
$9,507.80 |
| Rate for Payer: BCBS Trust/PPO |
$9,507.80
|
| Rate for Payer: BCN Commercial |
$9,507.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.32
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$207.56
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.59 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$8,858.67
|
| Rate for Payer: BCN Commercial |
$8,858.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,198.55
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,089.59
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; THORACIC
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,215.67 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$8,687.69
|
| Rate for Payer: BCN Commercial |
$8,687.69
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,337.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,215.67
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 63053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.03 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: BCBS Trust/PPO |
$651.26
|
| Rate for Payer: BCN Commercial |
$651.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.63
|
| Rate for Payer: UHC Exchange |
$226.03
|
|
|
LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; SINGLE VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$870.63
|
|
|
Service Code
|
CPT 63052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$254.34 |
| Max. Negotiated Rate |
$870.63 |
| Rate for Payer: BCBS Trust/PPO |
$870.63
|
| Rate for Payer: BCN Commercial |
$870.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.77
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$254.34
|
|
|
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, LUMBAR
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 63282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,980.97 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$7,287.72
|
| Rate for Payer: BCN Commercial |
$7,287.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,179.07
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,980.97
|
|
|
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, THORACIC
|
Facility
|
OP
|
$7,750.16
|
|
|
Service Code
|
CPT 63281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.00 |
| Max. Negotiated Rate |
$7,750.16 |
| Rate for Payer: BCBS Trust/PPO |
$7,750.16
|
| Rate for Payer: BCN Commercial |
$7,750.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,314.12
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$2,103.75
|
|
|
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM, EXTRADURAL; LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,604.00 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,028.57
|
| Rate for Payer: BCN Commercial |
$6,028.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,702.27
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$13,376.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
