|
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
|
Facility
|
OP
|
$66,036.56
|
|
|
Service Code
|
CPT 63655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.24 |
| Max. Negotiated Rate |
$66,036.56 |
| Rate for Payer: Aetna Medicare |
$21,851.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,263.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,263.48
|
| Rate for Payer: BCBS Complete |
$11,824.87
|
| Rate for Payer: BCBS MAPPO |
$21,010.78
|
| Rate for Payer: BCBS Trust/PPO |
$22,627.57
|
| Rate for Payer: BCN Commercial |
$22,627.57
|
| Rate for Payer: BCN Medicare Advantage |
$21,010.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,010.78
|
| Rate for Payer: Mclaren Medicaid |
$11,261.78
|
| Rate for Payer: Mclaren Medicare |
$21,010.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,061.32
|
| Rate for Payer: Meridian Medicaid |
$11,824.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,162.40
|
| Rate for Payer: Nomi Health Commercial |
$44,122.64
|
| Rate for Payer: PACE Medicare |
$19,960.24
|
| Rate for Payer: PACE SWMI |
$21,010.78
|
| Rate for Payer: PHP Medicare Advantage |
$21,010.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,261.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,036.56
|
| Rate for Payer: Priority Health Medicare |
$21,010.78
|
| Rate for Payer: Priority Health Narrow Network |
$52,829.25
|
| Rate for Payer: Railroad Medicare Medicare |
$21,010.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.06
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,010.78
|
| Rate for Payer: UHC Exchange |
$828.24
|
| Rate for Payer: UHC Medicare Advantage |
$21,010.78
|
| Rate for Payer: UHCCP Medicaid |
$11,261.78
|
| Rate for Payer: VA VA |
$21,010.78
|
|
|
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT FACETECTOMY, FORAMINOTOMY OR DISCECTOMY (EG, SPINAL STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,258.26 |
| 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 |
$9,709.34
|
| Rate for Payer: BCN Commercial |
$9,709.34
|
| 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) |
$1,384.09
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,258.26
|
| 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 WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH DECOMPRESSION OF CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS, LUMBAR (GILL TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,181.30 |
| 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 |
$9,356.30
|
| Rate for Payer: BCN Commercial |
$9,356.30
|
| 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) |
$1,299.43
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,181.30
|
| 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
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, CERVICAL
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,081.72 |
| 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 |
$8,652.93
|
| Rate for Payer: BCN Commercial |
$8,652.93
|
| 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) |
$1,189.89
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,081.72
|
| 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
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$899.19 |
| 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 |
$7,433.88
|
| Rate for Payer: BCN Commercial |
$7,433.88
|
| 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) |
$989.11
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$899.19
|
| 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
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE, CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$11,815.25
|
|
|
Service Code
|
CPT 63035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.84 |
| Max. Negotiated Rate |
$11,815.25 |
| Rate for Payer: BCBS Trust/PPO |
$11,815.25
|
| Rate for Payer: BCN Commercial |
$11,815.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$229.84
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; EACH ADDITIONAL LUMBAR INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 63044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$134.42
|
| Rate for Payer: BCN Commercial |
$134.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; LUMBAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 63042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,274.99 |
| 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 |
$8,340.20
|
| Rate for Payer: BCN Commercial |
$8,340.20
|
| 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) |
$1,402.49
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,274.99
|
| 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
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$706.80
|
|
|
Service Code
|
NDC 57237027424
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.99 |
| Max. Negotiated Rate |
$636.12 |
| Rate for Payer: Aetna American Axle |
$459.42
|
| Rate for Payer: Aetna Commercial |
$600.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.42
|
| Rate for Payer: Cash Price |
$565.44
|
| Rate for Payer: Cofinity Commercial |
$494.76
|
| Rate for Payer: Cofinity Commercial |
$607.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.44
|
| Rate for Payer: Healthscope Commercial |
$636.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.78
|
| Rate for Payer: PHP Commercial |
$600.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.42
|
| Rate for Payer: Priority Health SBD |
$445.28
|
| Rate for Payer: UMR Bronson Commercial |
$310.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.10
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
NDC 49702020548
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.62 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna American Axle |
$666.90
|
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$513.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$666.90
|
| Rate for Payer: BCBS Complete |
$410.40
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cofinity Commercial |
$718.20
|
| Rate for Payer: Cofinity Commercial |
$882.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$718.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.80
|
| Rate for Payer: Healthscope Commercial |
$923.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.10
|
| Rate for Payer: PHP Commercial |
$872.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.90
|
| Rate for Payer: Priority Health SBD |
$646.38
|
| Rate for Payer: UMR Bronson Commercial |
$379.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.50
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
NDC 49702020548
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna American Axle |
$666.90
|
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$666.90
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cofinity Commercial |
$718.20
|
| Rate for Payer: Cofinity Commercial |
$882.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$718.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.80
|
| Rate for Payer: Healthscope Commercial |
$923.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.10
|
| Rate for Payer: PHP Commercial |
$872.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.90
|
| Rate for Payer: Priority Health SBD |
$646.38
|
| Rate for Payer: UMR Bronson Commercial |
$451.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.50
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$706.80
|
|
|
Service Code
|
NDC 57237027424
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.52 |
| Max. Negotiated Rate |
$636.12 |
| Rate for Payer: Aetna American Axle |
$459.42
|
| Rate for Payer: Aetna Commercial |
$600.78
|
| Rate for Payer: Aetna Medicare |
$353.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.42
|
| Rate for Payer: BCBS Complete |
$282.72
|
| Rate for Payer: Cash Price |
$565.44
|
| Rate for Payer: Cofinity Commercial |
$494.76
|
| Rate for Payer: Cofinity Commercial |
$607.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.44
|
| Rate for Payer: Healthscope Commercial |
$636.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.78
|
| Rate for Payer: PHP Commercial |
$600.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.42
|
| Rate for Payer: Priority Health SBD |
$445.28
|
| Rate for Payer: UMR Bronson Commercial |
$261.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.10
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$774.34
|
|
|
Service Code
|
NDC 60505325106
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.71 |
| Max. Negotiated Rate |
$696.91 |
| Rate for Payer: Aetna American Axle |
$503.32
|
| Rate for Payer: Aetna Commercial |
$658.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.32
|
| Rate for Payer: Cash Price |
$619.47
|
| Rate for Payer: Cofinity Commercial |
$542.04
|
| Rate for Payer: Cofinity Commercial |
$665.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.47
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.19
|
| Rate for Payer: PHP Commercial |
$658.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.32
|
| Rate for Payer: Priority Health SBD |
$487.83
|
| Rate for Payer: UMR Bronson Commercial |
$340.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.76
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$1,182.82
|
|
|
Service Code
|
NDC 68180060207
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.44 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna American Axle |
$768.83
|
| Rate for Payer: Aetna Commercial |
$1,005.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.83
|
| Rate for Payer: Cash Price |
$946.26
|
| Rate for Payer: Cofinity Commercial |
$1,017.23
|
| Rate for Payer: Cofinity Commercial |
$827.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.26
|
| Rate for Payer: Healthscope Commercial |
$1,064.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.40
|
| Rate for Payer: PHP Commercial |
$1,005.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.83
|
| Rate for Payer: Priority Health SBD |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$520.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.12
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$508.50
|
|
|
Service Code
|
NDC 00904658304
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.74 |
| Max. Negotiated Rate |
$457.65 |
| Rate for Payer: Aetna American Axle |
$330.52
|
| Rate for Payer: Aetna Commercial |
$432.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cofinity Commercial |
$355.95
|
| Rate for Payer: Cofinity Commercial |
$437.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.80
|
| Rate for Payer: Healthscope Commercial |
$457.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.22
|
| Rate for Payer: PHP Commercial |
$432.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.52
|
| Rate for Payer: Priority Health SBD |
$320.36
|
| Rate for Payer: UMR Bronson Commercial |
$223.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.38
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
OP
|
$774.34
|
|
|
Service Code
|
NDC 60505325106
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.51 |
| Max. Negotiated Rate |
$696.91 |
| Rate for Payer: Aetna American Axle |
$503.32
|
| Rate for Payer: Aetna Commercial |
$658.19
|
| Rate for Payer: Aetna Medicare |
$387.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.32
|
| Rate for Payer: BCBS Complete |
$309.74
|
| Rate for Payer: Cash Price |
$619.47
|
| Rate for Payer: Cofinity Commercial |
$542.04
|
| Rate for Payer: Cofinity Commercial |
$665.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.47
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.19
|
| Rate for Payer: PHP Commercial |
$658.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.32
|
| Rate for Payer: Priority Health SBD |
$487.83
|
| Rate for Payer: UMR Bronson Commercial |
$286.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.76
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
OP
|
$508.50
|
|
|
Service Code
|
NDC 00904658304
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.14 |
| Max. Negotiated Rate |
$457.65 |
| Rate for Payer: Aetna American Axle |
$330.52
|
| Rate for Payer: Aetna Commercial |
$432.22
|
| Rate for Payer: Aetna Medicare |
$254.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: BCBS Complete |
$203.40
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cofinity Commercial |
$355.95
|
| Rate for Payer: Cofinity Commercial |
$437.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.80
|
| Rate for Payer: Healthscope Commercial |
$457.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.22
|
| Rate for Payer: PHP Commercial |
$432.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.52
|
| Rate for Payer: Priority Health SBD |
$320.36
|
| Rate for Payer: UMR Bronson Commercial |
$188.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.38
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
OP
|
$1,182.82
|
|
|
Service Code
|
NDC 68180060207
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.64 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna American Axle |
$768.83
|
| Rate for Payer: Aetna Commercial |
$1,005.40
|
| Rate for Payer: Aetna Medicare |
$591.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.83
|
| Rate for Payer: BCBS Complete |
$473.13
|
| Rate for Payer: Cash Price |
$946.26
|
| Rate for Payer: Cofinity Commercial |
$1,017.23
|
| Rate for Payer: Cofinity Commercial |
$827.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.26
|
| Rate for Payer: Healthscope Commercial |
$1,064.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.40
|
| Rate for Payer: PHP Commercial |
$1,005.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.83
|
| Rate for Payer: Priority Health SBD |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$437.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.12
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
OP
|
$3,251.86
|
|
|
Service Code
|
NDC 49702020218
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,203.19 |
| Max. Negotiated Rate |
$2,926.67 |
| Rate for Payer: Aetna American Axle |
$2,113.71
|
| Rate for Payer: Aetna Commercial |
$2,764.08
|
| Rate for Payer: Aetna Medicare |
$1,625.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.71
|
| Rate for Payer: BCBS Complete |
$1,300.74
|
| Rate for Payer: Cash Price |
$2,601.49
|
| Rate for Payer: Cofinity Commercial |
$2,276.30
|
| Rate for Payer: Cofinity Commercial |
$2,796.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,276.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.49
|
| Rate for Payer: Healthscope Commercial |
$2,926.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,764.08
|
| Rate for Payer: PHP Commercial |
$2,764.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.71
|
| Rate for Payer: Priority Health SBD |
$2,048.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.90
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 31722050660
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.20
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 31722050660
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.20
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$3,251.86
|
|
|
Service Code
|
NDC 49702020218
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.82 |
| Max. Negotiated Rate |
$2,926.67 |
| Rate for Payer: Aetna American Axle |
$2,113.71
|
| Rate for Payer: Aetna Commercial |
$2,764.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.71
|
| Rate for Payer: Cash Price |
$2,601.49
|
| Rate for Payer: Cofinity Commercial |
$2,276.30
|
| Rate for Payer: Cofinity Commercial |
$2,796.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,276.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.49
|
| Rate for Payer: Healthscope Commercial |
$2,926.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,764.08
|
| Rate for Payer: PHP Commercial |
$2,764.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.71
|
| Rate for Payer: Priority Health SBD |
$2,048.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.90
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 68382000801
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.63 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.04
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.04
|
| Rate for Payer: PHP Commercial |
$176.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UMR Bronson Commercial |
$76.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
