|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$6.80
|
|
|
Service Code
|
NDC 00121063805
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.12
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.70
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$5.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.78
|
| Rate for Payer: Nomi Health Commercial |
$5.58
|
| Rate for Payer: PACE Senior Care Partners |
$1.61
|
| Rate for Payer: PACE SWMI |
$1.70
|
| Rate for Payer: PHP Commercial |
$5.78
|
| Rate for Payer: PHP Medicare Advantage |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.42
|
| Rate for Payer: Priority Health HMO/PPO |
$5.92
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.98
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.70
|
| Rate for Payer: UHC Exchange |
$1.70
|
| Rate for Payer: UHC Medicare Advantage |
$1.70
|
| Rate for Payer: VA VA |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.10
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$6.03
|
|
|
Service Code
|
NDC 69339014905
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.88
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.96
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$5.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: PACE Senior Care Partners |
$1.43
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.92
|
| Rate for Payer: Priority Health HMO/PPO |
$5.25
|
| Rate for Payer: Priority Health Medicare |
$1.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.31
|
| Rate for Payer: UHC Core |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UHC Medicare Advantage |
$1.51
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.52
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$6.03
|
|
|
Service Code
|
NDC 69339014919
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.92
|
| Rate for Payer: BCN Commercial |
$4.66
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.13
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.92
|
| Rate for Payer: Priority Health HMO/PPO |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.31
|
| Rate for Payer: UHC Core |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.52
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.47
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$50.30
|
| Rate for Payer: BCN Commercial |
$47.57
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: PACE Senior Care Partners |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health HMO/PPO |
$53.23
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.84
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Exchange |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: VA VA |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.70
|
|
|
Service Code
|
NDC 00990793009
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$24.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.91
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: BCBS MAPPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.67
|
| Rate for Payer: BCN Commercial |
$74.41
|
| Rate for Payer: BCN Medicare Advantage |
$23.93
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: PACE Senior Care Partners |
$22.73
|
| Rate for Payer: PACE SWMI |
$23.93
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Medicare Advantage |
$23.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Medicare |
$24.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.12
|
| Rate for Payer: Railroad Medicare Medicare |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.93
|
| Rate for Payer: UHC Exchange |
$23.93
|
| Rate for Payer: UHC Medicare Advantage |
$23.93
|
| Rate for Payer: VA VA |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 00990793009
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$78.12
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.77 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.94
|
| Rate for Payer: BCN Commercial |
$47.28
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health HMO/PPO |
$53.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.84
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health HMO/PPO |
$55.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.14
|
| Rate for Payer: UHC Core |
$53.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Medicare |
$16.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.94
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS MAPPO |
$15.95
|
| Rate for Payer: BCBS Trust/PPO |
$52.45
|
| Rate for Payer: BCN Commercial |
$49.60
|
| Rate for Payer: BCN Medicare Advantage |
$15.95
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: PACE Senior Care Partners |
$15.15
|
| Rate for Payer: PACE SWMI |
$15.95
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health HMO/PPO |
$55.51
|
| Rate for Payer: Priority Health Medicare |
$16.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.75
|
| Rate for Payer: Railroad Medicare Medicare |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.14
|
| Rate for Payer: UHC Core |
$53.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.95
|
| Rate for Payer: UHC Exchange |
$15.95
|
| Rate for Payer: UHC Medicare Advantage |
$15.95
|
| Rate for Payer: VA VA |
$15.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$72.72
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: BCBS Trust/PPO |
$59.36
|
| Rate for Payer: BCN Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.81
|
| Rate for Payer: Nomi Health Commercial |
$59.63
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.27
|
| Rate for Payer: Priority Health HMO/PPO |
$63.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.99
|
| Rate for Payer: UHC Core |
$60.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$72.72
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.73
|
| Rate for Payer: BCBS Complete |
$29.09
|
| Rate for Payer: BCBS MAPPO |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$59.78
|
| Rate for Payer: BCN Commercial |
$56.54
|
| Rate for Payer: BCN Medicare Advantage |
$18.18
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.81
|
| Rate for Payer: Nomi Health Commercial |
$59.63
|
| Rate for Payer: PACE Senior Care Partners |
$17.27
|
| Rate for Payer: PACE SWMI |
$18.18
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Medicare Advantage |
$18.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.27
|
| Rate for Payer: Priority Health HMO/PPO |
$63.27
|
| Rate for Payer: Priority Health Medicare |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.99
|
| Rate for Payer: UHC Core |
$60.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.18
|
| Rate for Payer: UHC Exchange |
$18.18
|
| Rate for Payer: UHC Medicare Advantage |
$18.18
|
| Rate for Payer: VA VA |
$18.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 00574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.49
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cofinity Commercial |
$13.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.91
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.87
|
| Rate for Payer: Priority Health HMO/PPO |
$13.22
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Core |
$12.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.39
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Aetna Medicare |
$3.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.69
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.35
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: PACE Senior Care Partners |
$3.57
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.77
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health HMO/PPO |
$13.07
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.22
|
| Rate for Payer: UHC Core |
$12.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.75
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$15.02
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCN Commercial |
$11.61
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Healthscope Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health HMO/PPO |
$13.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.22
|
| Rate for Payer: UHC Core |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 00574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.40
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cofinity Commercial |
$13.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.15
|
| Rate for Payer: Healthscope Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.91
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: PHP Commercial |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.87
|
| Rate for Payer: Priority Health HMO/PPO |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Core |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.39
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$66.99
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Aetna Medicare |
$17.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.93
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$16.75
|
| Rate for Payer: BCBS Trust/PPO |
$55.07
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.75
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Cofinity Commercial |
$57.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$60.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.94
|
| Rate for Payer: Nomi Health Commercial |
$54.93
|
| Rate for Payer: PACE Senior Care Partners |
$15.91
|
| Rate for Payer: PACE SWMI |
$16.75
|
| Rate for Payer: PHP Commercial |
$56.94
|
| Rate for Payer: PHP Medicare Advantage |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.54
|
| Rate for Payer: Priority Health HMO/PPO |
$58.28
|
| Rate for Payer: Priority Health Medicare |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.88
|
| Rate for Payer: Railroad Medicare Medicare |
$16.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.95
|
| Rate for Payer: UHC Core |
$55.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.75
|
| Rate for Payer: UHC Exchange |
$16.75
|
| Rate for Payer: UHC Medicare Advantage |
$16.75
|
| Rate for Payer: VA VA |
$16.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.24
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.99
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: BCBS Trust/PPO |
$54.68
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Cofinity Commercial |
$57.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$60.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.94
|
| Rate for Payer: Nomi Health Commercial |
$54.93
|
| Rate for Payer: PHP Commercial |
$56.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.54
|
| Rate for Payer: Priority Health HMO/PPO |
$58.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.95
|
| Rate for Payer: UHC Core |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.24
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$69.65
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$62.69 |
| Rate for Payer: Aetna Commercial |
$59.20
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.77
|
| Rate for Payer: BCBS Complete |
$27.86
|
| Rate for Payer: BCBS MAPPO |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.41
|
| Rate for Payer: Cash Price |
$55.72
|
| Rate for Payer: Cofinity Commercial |
$59.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$62.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.20
|
| Rate for Payer: Nomi Health Commercial |
$57.11
|
| Rate for Payer: PACE Senior Care Partners |
$16.54
|
| Rate for Payer: PACE SWMI |
$17.41
|
| Rate for Payer: PHP Commercial |
$59.20
|
| Rate for Payer: PHP Medicare Advantage |
$17.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.27
|
| Rate for Payer: Priority Health HMO/PPO |
$60.60
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.67
|
| Rate for Payer: Railroad Medicare Medicare |
$17.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.29
|
| Rate for Payer: UHC Core |
$58.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.41
|
| Rate for Payer: UHC Exchange |
$17.41
|
| Rate for Payer: UHC Medicare Advantage |
$17.41
|
| Rate for Payer: VA VA |
$17.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.24
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.12
|
| Rate for Payer: BCN Commercial |
$55.02
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$71.20
|
|
|
Service Code
|
NDC 00409490264
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.12
|
| Rate for Payer: BCN Commercial |
$55.02
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$69.65
|
|
|
Service Code
|
NDC 00409751766
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$62.69 |
| Rate for Payer: Aetna Commercial |
$59.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.86
|
| Rate for Payer: BCN Commercial |
$53.83
|
| Rate for Payer: Cash Price |
$55.72
|
| Rate for Payer: Cofinity Commercial |
$59.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.72
|
| Rate for Payer: Healthscope Commercial |
$62.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.20
|
| Rate for Payer: Nomi Health Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.27
|
| Rate for Payer: Priority Health HMO/PPO |
$60.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.29
|
| Rate for Payer: UHC Core |
$58.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.24
|
|
