|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.95 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna American Axle |
$316.06
|
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.06
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Advantage |
$340.37
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.68
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health SBD |
$306.33
|
| Rate for Payer: UMR Bronson Commercial |
$213.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 00527139601
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Advantage |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00527139601
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Advantage |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.49
|
| Rate for Payer: UHC Core |
$223.22
|
| Rate for Payer: UHC Exchange |
$168.38
|
| Rate for Payer: UMR Bronson Commercial |
$158.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 00591036901
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Advantage |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.24
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00527139401
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$220.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Advantage |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.14
|
| Rate for Payer: UHC Core |
$230.15
|
| Rate for Payer: UHC Exchange |
$173.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00527139401
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Advantage |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
OP
|
$244.32
|
|
|
Service Code
|
NDC 00591036901
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna Medicare |
$122.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Advantage |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.24
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.81
|
| Rate for Payer: UHC Core |
$127.29
|
| Rate for Payer: UHC Exchange |
$96.02
|
| Rate for Payer: UMR Bronson Commercial |
$90.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$393.41
|
|
|
Service Code
|
NDC 00480347906
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.56 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna American Axle |
$255.72
|
| Rate for Payer: Aetna Commercial |
$334.40
|
| Rate for Payer: Aetna Medicare |
$196.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.72
|
| Rate for Payer: BCBS Complete |
$157.36
|
| Rate for Payer: Cash Price |
$314.73
|
| Rate for Payer: Cofinity Advantage |
$275.39
|
| Rate for Payer: Cofinity Commercial |
$338.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.73
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.06
|
| Rate for Payer: PHP Commercial |
$334.40
|
| Rate for Payer: Priority Health SBD |
$247.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.72
|
| Rate for Payer: UHC Core |
$204.97
|
| Rate for Payer: UHC Exchange |
$154.61
|
| Rate for Payer: UMR Bronson Commercial |
$145.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.06
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$472.04
|
|
|
Service Code
|
NDC 63304035160
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna American Axle |
$306.83
|
| Rate for Payer: Aetna Commercial |
$401.23
|
| Rate for Payer: Aetna Medicare |
$236.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.83
|
| Rate for Payer: BCBS Complete |
$188.82
|
| Rate for Payer: Cash Price |
$377.63
|
| Rate for Payer: Cofinity Advantage |
$330.43
|
| Rate for Payer: Cofinity Commercial |
$405.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.63
|
| Rate for Payer: Healthscope Commercial |
$424.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.03
|
| Rate for Payer: PHP Commercial |
$401.23
|
| Rate for Payer: Priority Health SBD |
$297.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.83
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: UHC Exchange |
$185.51
|
| Rate for Payer: UMR Bronson Commercial |
$174.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.03
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.86 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna American Axle |
$830.02
|
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.02
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Advantage |
$893.87
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health SBD |
$804.48
|
| Rate for Payer: UMR Bronson Commercial |
$561.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$393.41
|
|
|
Service Code
|
NDC 00480347906
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.10 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna American Axle |
$255.72
|
| Rate for Payer: Aetna Commercial |
$334.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.72
|
| Rate for Payer: Cash Price |
$314.73
|
| Rate for Payer: Cofinity Advantage |
$275.39
|
| Rate for Payer: Cofinity Commercial |
$338.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.73
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.06
|
| Rate for Payer: PHP Commercial |
$334.40
|
| Rate for Payer: Priority Health SBD |
$247.85
|
| Rate for Payer: UMR Bronson Commercial |
$173.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.06
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$472.04
|
|
|
Service Code
|
NDC 63304035160
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.70 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna American Axle |
$306.83
|
| Rate for Payer: Aetna Commercial |
$401.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.83
|
| Rate for Payer: Cash Price |
$377.63
|
| Rate for Payer: Cofinity Advantage |
$330.43
|
| Rate for Payer: Cofinity Commercial |
$405.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.63
|
| Rate for Payer: Healthscope Commercial |
$424.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.03
|
| Rate for Payer: PHP Commercial |
$401.23
|
| Rate for Payer: Priority Health SBD |
$297.39
|
| Rate for Payer: UMR Bronson Commercial |
$207.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.03
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$472.47 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna American Axle |
$830.02
|
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna Medicare |
$638.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.02
|
| Rate for Payer: BCBS Complete |
$510.78
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Advantage |
$893.87
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,021.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health SBD |
$804.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.02
|
| Rate for Payer: UHC Core |
$665.29
|
| Rate for Payer: UHC Exchange |
$501.84
|
| Rate for Payer: UMR Bronson Commercial |
$472.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$248,162.53
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$103,446.95 |
| Max. Negotiated Rate |
$248,162.53 |
| Rate for Payer: Aetna Medicare |
$113,247.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136,114.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136,114.41
|
| Rate for Payer: BCBS MAPPO |
$108,891.53
|
| Rate for Payer: BCBS Trust/PPO |
$248,162.53
|
| Rate for Payer: BCN Commercial |
$248,162.53
|
| Rate for Payer: BCN Medicare Advantage |
$108,891.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108,891.53
|
| Rate for Payer: Mclaren Medicare |
$108,891.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114,336.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125,225.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$119,780.68
|
| Rate for Payer: Nomi Health Commercial |
$167,057.58
|
| Rate for Payer: PACE Medicare |
$103,446.95
|
| Rate for Payer: PACE SWMI |
$108,891.53
|
| Rate for Payer: PHP Medicare Advantage |
$108,891.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208,784.94
|
| Rate for Payer: Priority Health Medicare |
$108,891.53
|
| Rate for Payer: Priority Health Tiered Network |
$167,027.92
|
| Rate for Payer: Railroad Medicare Medicare |
$108,891.53
|
| Rate for Payer: VA VA |
$108,891.53
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030230
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,212.40 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna American Axle |
$3,268.32
|
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,771.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,212.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,771.14
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$79.20
|
|
|
Service Code
|
NDC 43598035130
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna American Axle |
$51.48
|
| Rate for Payer: Aetna Commercial |
$67.32
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.48
|
| Rate for Payer: BCBS Complete |
$31.68
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Cofinity Advantage |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$68.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.36
|
| Rate for Payer: Healthscope Commercial |
$71.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.40
|
| Rate for Payer: PHP Commercial |
$67.32
|
| Rate for Payer: Priority Health SBD |
$49.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.48
|
| Rate for Payer: UHC Core |
$41.26
|
| Rate for Payer: UHC Exchange |
$31.13
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.40
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$79.20
|
|
|
Service Code
|
NDC 43598035130
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna American Axle |
$51.48
|
| Rate for Payer: Aetna Commercial |
$67.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.48
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Cofinity Advantage |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$68.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.36
|
| Rate for Payer: Healthscope Commercial |
$71.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.40
|
| Rate for Payer: PHP Commercial |
$67.32
|
| Rate for Payer: Priority Health SBD |
$49.90
|
| Rate for Payer: UMR Bronson Commercial |
$34.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.40
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 68180067006
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 68180067006
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 13668046430
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna American Axle |
$67.06
|
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.06
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Advantage |
$72.22
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: Priority Health SBD |
$65.00
|
| Rate for Payer: UMR Bronson Commercial |
$45.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.38
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$5,028.19
|
|
|
Service Code
|
NDC 63402030230
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,860.43 |
| Max. Negotiated Rate |
$4,525.37 |
| Rate for Payer: Aetna American Axle |
$3,268.32
|
| Rate for Payer: Aetna Commercial |
$4,273.96
|
| Rate for Payer: Aetna Medicare |
$2,514.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,268.32
|
| Rate for Payer: BCBS Complete |
$2,011.28
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cofinity Advantage |
$3,519.73
|
| Rate for Payer: Cofinity Commercial |
$4,324.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.55
|
| Rate for Payer: Healthscope Commercial |
$4,525.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,771.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,273.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,771.14
|
| Rate for Payer: PHP Commercial |
$4,273.96
|
| Rate for Payer: Priority Health SBD |
$3,167.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,268.32
|
| Rate for Payer: UHC Core |
$2,619.69
|
| Rate for Payer: UHC Exchange |
$1,976.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,860.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,771.14
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 13668046430
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
