|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.66 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna American Axle |
$209.27
|
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.27
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$225.36
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: Priority Health SBD |
$202.83
|
| Rate for Payer: UMR Bronson Commercial |
$141.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LAMOTRIGINE 25 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
13981
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna American Axle |
$209.27
|
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna Medicare |
$160.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.27
|
| Rate for Payer: BCBS Complete |
$128.78
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$225.36
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.27
|
| Rate for Payer: Priority Health SBD |
$202.83
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.46
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 68462022801
|
| Hospital Charge Code |
104568
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
NDC 68462022801
|
| Hospital Charge Code |
104568
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.33 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: UMR Bronson Commercial |
$135.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.31
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna American Axle |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.95
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$6.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 00904775127
|
| Hospital Charge Code |
118468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna American Axle |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.95
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.79
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,890.69 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna American Axle |
$27,906.70
|
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,053.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,346.70
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,053.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,200.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,493.37
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,906.70
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
| Rate for Payer: UMR Bronson Commercial |
$18,890.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,200.04
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna American Axle |
$27,906.70
|
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: BCBS Complete |
$25.31
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$134.73
|
| Rate for Payer: BCN Commercial |
$134.73
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,053.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,346.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,053.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,200.04
|
| Rate for Payer: Mclaren Medicaid |
$24.11
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: Meridian Medicaid |
$25.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,493.37
|
| Rate for Payer: Nomi Health Commercial |
$134.94
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,906.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.82
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow Network |
$115.06
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Exchange |
$85.96
|
| Rate for Payer: UHC Medicare Advantage |
$44.98
|
| Rate for Payer: UHCCP Medicaid |
$24.11
|
| Rate for Payer: UMR Bronson Commercial |
$15,885.35
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,200.04
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna American Axle |
$17,767.83
|
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: BCBS Complete |
$25.31
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$134.73
|
| Rate for Payer: BCN Commercial |
$134.73
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,134.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,868.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,134.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,501.34
|
| Rate for Payer: Mclaren Medicaid |
$24.11
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: Meridian Medicaid |
$25.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,234.85
|
| Rate for Payer: Nomi Health Commercial |
$134.94
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,767.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.82
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow Network |
$115.06
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Exchange |
$85.96
|
| Rate for Payer: UHC Medicare Advantage |
$44.98
|
| Rate for Payer: UHCCP Medicaid |
$24.11
|
| Rate for Payer: UMR Bronson Commercial |
$10,113.99
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,501.34
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,027.45 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna American Axle |
$17,767.83
|
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,134.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,868.10
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,134.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,501.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,234.85
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,767.83
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
| Rate for Payer: UMR Bronson Commercial |
$12,027.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,501.34
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,275.56 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna American Axle |
$13,702.53
|
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,756.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,864.65
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,756.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,810.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,918.69
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,702.53
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
| Rate for Payer: UMR Bronson Commercial |
$9,275.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,810.61
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna American Axle |
$13,702.53
|
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna Medicare |
$46.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.22
|
| Rate for Payer: BCBS Complete |
$25.31
|
| Rate for Payer: BCBS MAPPO |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$134.73
|
| Rate for Payer: BCN Commercial |
$134.73
|
| Rate for Payer: BCN Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,756.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,864.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,756.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,810.61
|
| Rate for Payer: Mclaren Medicaid |
$24.11
|
| Rate for Payer: Mclaren Medicare |
$44.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.23
|
| Rate for Payer: Meridian Medicaid |
$25.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,918.69
|
| Rate for Payer: Nomi Health Commercial |
$134.94
|
| Rate for Payer: PACE Medicare |
$42.73
|
| Rate for Payer: PACE SWMI |
$44.98
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: PHP Medicare Advantage |
$44.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,702.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.82
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow Network |
$115.06
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.98
|
| Rate for Payer: UHC Exchange |
$85.96
|
| Rate for Payer: UHC Medicare Advantage |
$44.98
|
| Rate for Payer: UHCCP Medicaid |
$24.11
|
| Rate for Payer: UMR Bronson Commercial |
$7,799.90
|
| Rate for Payer: VA VA |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,810.61
|
|
|
LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764004613
|
| Hospital Charge Code |
27692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,761.63 |
| Max. Negotiated Rate |
$4,285.04 |
| Rate for Payer: Cofinity Commercial |
$4,094.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,332.81
|
| 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: 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 CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4,761.16
|
|
|
Service Code
|
NDC 64764004613
|
| Hospital Charge Code |
27692
|
|
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
|
$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
|
|
|
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
|
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
|
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
|
$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
|
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
|
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
|
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
|
|
|
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
|
$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
|
$1,859.14
|
|
|
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
|
|
