|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$29.37
|
|
|
Service Code
|
NDC 409488799
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna Commercial |
$24.96
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.09
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Advantage |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.03
|
| Rate for Payer: PHP Commercial |
$24.96
|
| Rate for Payer: Priority Health SBD |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Exchange |
$11.54
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$34.94
|
|
|
Service Code
|
NDC 63323018550
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.71
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.95
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.20
|
| Rate for Payer: PHP Commercial |
$29.70
|
| Rate for Payer: Priority Health SBD |
$22.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$18.20
|
| Rate for Payer: UHC Exchange |
$13.73
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$34.94
|
|
|
Service Code
|
NDC 63323018509
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.71
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.95
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.20
|
| Rate for Payer: PHP Commercial |
$29.70
|
| Rate for Payer: Priority Health SBD |
$22.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$18.20
|
| Rate for Payer: UHC Exchange |
$13.73
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.75
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$5.89
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.75
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$5.89
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.75
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$5.89
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 00409488724
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 00409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$29.37
|
|
|
Service Code
|
NDC 00409488725
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna Commercial |
$24.96
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.09
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Advantage |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.03
|
| Rate for Payer: PHP Commercial |
$24.96
|
| Rate for Payer: Priority Health SBD |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Exchange |
$11.54
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$29.37
|
|
|
Service Code
|
NDC 409488725
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna Commercial |
$24.96
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.09
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Advantage |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.03
|
| Rate for Payer: PHP Commercial |
$24.96
|
| Rate for Payer: Priority Health SBD |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Exchange |
$11.54
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$34.94
|
|
|
Service Code
|
NDC 63323018509
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.71
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.95
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.20
|
| Rate for Payer: PHP Commercial |
$29.70
|
| Rate for Payer: Priority Health SBD |
$22.01
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 00409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.75
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$5.89
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$34.94
|
|
|
Service Code
|
NDC 63323018550
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.71
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cofinity Advantage |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.95
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.20
|
| Rate for Payer: PHP Commercial |
$29.70
|
| Rate for Payer: Priority Health SBD |
$22.01
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.42
|
| Rate for Payer: UHC Core |
$10.76
|
| Rate for Payer: UHC Exchange |
$8.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 63323018507
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.42
|
| Rate for Payer: UHC Core |
$10.76
|
| Rate for Payer: UHC Exchange |
$8.12
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
|
