|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$1,576.57
|
|
|
Service Code
|
NDC 65862089678
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$583.33 |
| Max. Negotiated Rate |
$1,418.91 |
| Rate for Payer: Aetna American Axle |
$1,024.77
|
| Rate for Payer: Aetna Commercial |
$1,340.08
|
| Rate for Payer: Aetna Medicare |
$788.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.77
|
| Rate for Payer: BCBS Complete |
$630.63
|
| Rate for Payer: Cash Price |
$1,261.26
|
| Rate for Payer: Cofinity Commercial |
$1,103.60
|
| Rate for Payer: Cofinity Commercial |
$1,355.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.26
|
| Rate for Payer: Healthscope Commercial |
$1,418.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.08
|
| Rate for Payer: PHP Commercial |
$1,340.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.77
|
| Rate for Payer: Priority Health SBD |
$993.24
|
| Rate for Payer: UMR Bronson Commercial |
$583.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.43
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,576.57
|
|
|
Service Code
|
NDC 65862089678
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$693.69 |
| Max. Negotiated Rate |
$1,418.91 |
| Rate for Payer: Aetna American Axle |
$1,024.77
|
| Rate for Payer: Aetna Commercial |
$1,340.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.77
|
| Rate for Payer: Cash Price |
$1,261.26
|
| Rate for Payer: Cofinity Commercial |
$1,103.60
|
| Rate for Payer: Cofinity Commercial |
$1,355.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.26
|
| Rate for Payer: Healthscope Commercial |
$1,418.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.08
|
| Rate for Payer: PHP Commercial |
$1,340.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.77
|
| Rate for Payer: Priority Health SBD |
$993.24
|
| Rate for Payer: UMR Bronson Commercial |
$693.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.43
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
NDC 65862089610
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| 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: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764054411
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,761.63 |
| Max. Negotiated Rate |
$4,285.04 |
| Rate for Payer: Aetna American Axle |
$3,094.75
|
| Rate for Payer: Aetna Commercial |
$4,046.99
|
| Rate for Payer: Aetna Medicare |
$2,380.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,094.75
|
| Rate for Payer: BCBS Complete |
$1,904.46
|
| Rate for Payer: Cash Price |
$3,808.93
|
| Rate for Payer: Cofinity Commercial |
$3,332.81
|
| Rate for Payer: Cofinity Commercial |
$4,094.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,332.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,808.93
|
| Rate for Payer: Healthscope Commercial |
$4,285.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,332.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,570.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,046.99
|
| Rate for Payer: PHP Commercial |
$4,046.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,094.75
|
| Rate for Payer: Priority Health SBD |
$2,999.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,761.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,570.87
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$47.62
|
|
|
Service Code
|
NDC 64764054430
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764054411
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,094.91 |
| Max. Negotiated Rate |
$4,285.04 |
| Rate for Payer: Aetna American Axle |
$3,094.75
|
| Rate for Payer: Aetna Commercial |
$4,046.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,094.75
|
| Rate for Payer: Cash Price |
$3,808.93
|
| Rate for Payer: Cofinity Commercial |
$3,332.81
|
| Rate for Payer: Cofinity Commercial |
$4,094.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,332.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,808.93
|
| Rate for Payer: Healthscope Commercial |
$4,285.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,332.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,570.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,046.99
|
| Rate for Payer: PHP Commercial |
$4,046.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,094.75
|
| Rate for Payer: Priority Health SBD |
$2,999.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,094.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,570.87
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$47.62
|
|
|
Service Code
|
NDC 64764054430
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
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 Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| 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: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| 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
|
|
|
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 Commercial |
$2,340.09
|
| Rate for Payer: Cofinity Commercial |
$2,874.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,340.09
|
| 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: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.94
|
| 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
|
$1,301.70
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.75 |
| Max. Negotiated Rate |
$1,171.53 |
| Rate for Payer: Aetna American Axle |
$846.11
|
| Rate for Payer: Aetna Commercial |
$1,106.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.11
|
| Rate for Payer: Cash Price |
$1,041.36
|
| Rate for Payer: Cofinity Commercial |
$1,119.46
|
| Rate for Payer: Cofinity Commercial |
$911.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.36
|
| Rate for Payer: Healthscope Commercial |
$1,171.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.44
|
| Rate for Payer: PHP Commercial |
$1,106.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.11
|
| Rate for Payer: Priority Health SBD |
$820.07
|
| Rate for Payer: UMR Bronson Commercial |
$572.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.27
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$650.85
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.37 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna American Axle |
$423.05
|
| Rate for Payer: Aetna Commercial |
$553.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.05
|
| Rate for Payer: Cash Price |
$520.68
|
| Rate for Payer: Cofinity Commercial |
$455.60
|
| Rate for Payer: Cofinity Commercial |
$559.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.68
|
| Rate for Payer: Healthscope Commercial |
$585.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.22
|
| Rate for Payer: PHP Commercial |
$553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.05
|
| Rate for Payer: Priority Health SBD |
$410.04
|
| Rate for Payer: UMR Bronson Commercial |
$286.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.14
|
|
|
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 Commercial |
$2,602.80
|
| Rate for Payer: Cofinity Commercial |
$3,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,602.80
|
| 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: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,416.88
|
| Rate for Payer: Priority Health SBD |
$2,342.52
|
| 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
|
OP
|
$1,301.70
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.63 |
| Max. Negotiated Rate |
$1,171.53 |
| Rate for Payer: Aetna American Axle |
$846.11
|
| Rate for Payer: Aetna Commercial |
$1,106.44
|
| Rate for Payer: Aetna Medicare |
$650.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.11
|
| Rate for Payer: BCBS Complete |
$520.68
|
| Rate for Payer: Cash Price |
$1,041.36
|
| Rate for Payer: Cofinity Commercial |
$1,119.46
|
| Rate for Payer: Cofinity Commercial |
$911.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.36
|
| Rate for Payer: Healthscope Commercial |
$1,171.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.44
|
| Rate for Payer: PHP Commercial |
$1,106.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.11
|
| Rate for Payer: Priority Health SBD |
$820.07
|
| Rate for Payer: UMR Bronson Commercial |
$481.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.27
|
|
|
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 Commercial |
$1,301.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,301.40
|
| 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: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.44
|
| Rate for Payer: Priority Health SBD |
$1,171.26
|
| 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
|
OP
|
$650.85
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.81 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna American Axle |
$423.05
|
| Rate for Payer: Aetna Commercial |
$553.22
|
| Rate for Payer: Aetna Medicare |
$325.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.05
|
| Rate for Payer: BCBS Complete |
$260.34
|
| Rate for Payer: Cash Price |
$520.68
|
| Rate for Payer: Cofinity Commercial |
$455.60
|
| Rate for Payer: Cofinity Commercial |
$559.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.68
|
| Rate for Payer: Healthscope Commercial |
$585.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.22
|
| Rate for Payer: PHP Commercial |
$553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.05
|
| Rate for Payer: Priority Health SBD |
$410.04
|
| Rate for Payer: UMR Bronson Commercial |
$240.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.14
|
|
|
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 Commercial |
$2,602.80
|
| Rate for Payer: Cofinity Commercial |
$3,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,602.80
|
| 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: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,416.88
|
| 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
|
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 Commercial |
$1,301.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,301.40
|
| 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: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.44
|
| 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
|
$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 Commercial |
$2,340.09
|
| Rate for Payer: Cofinity Commercial |
$2,874.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,340.09
|
| 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: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.94
|
| Rate for Payer: Priority Health SBD |
$2,106.08
|
| 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
|
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 Commercial |
$1,170.05
|
| Rate for Payer: Cofinity Commercial |
$1,437.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.05
|
| 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: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.47
|
| 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
|
$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 Commercial |
$1,170.05
|
| Rate for Payer: Cofinity Commercial |
$1,437.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.05
|
| 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: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.47
|
| Rate for Payer: Priority Health SBD |
$1,053.05
|
| Rate for Payer: UMR Bronson Commercial |
$618.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.62
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
LAPAROSCOPY, SURGICAL, ABLATION OF 1 OR MORE LIVER TUMOR(S); RADIOFREQUENCY
|
Facility
|
OP
|
$28,582.07
|
|
|
Service Code
|
CPT 47370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$28,582.07 |
| Rate for Payer: Aetna Medicare |
$10,560.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,153.85
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| Rate for Payer: PACE Medicare |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| Rate for Payer: Priority Health Medicare |
$10,153.85
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,582.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Exchange |
$19,405.02
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,442.46
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
