|
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 |
$11.26
|
| 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 |
$11.26
|
|
|
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 |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$12.35
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.26
|
| 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 |
$3.76
|
| Rate for Payer: PHP Commercial |
$12.77
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.22
|
| Rate for Payer: UHC Core |
$12.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.76
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.76
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.26
|
|
|
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
|
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 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 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
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 00409490264
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.80
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: VA VA |
$17.80
|
| 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
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| 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: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.28
|
| Rate for Payer: Priority Health HMO/PPO |
$61.94
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.80
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: VA VA |
$17.80
|
| 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 |
$62.68 |
| 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 |
$62.68
|
| 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
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$69.65
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$62.68 |
| 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 |
$62.68
|
| 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
|
|
|
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 |
$62.68 |
| 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 |
$62.68
|
| 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
|
OP
|
$69.65
|
|
|
Service Code
|
NDC 00409751766
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$62.68 |
| 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 |
$62.68
|
| 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) IV SYRINGE (CODE)
|
Facility
|
IP
|
$108.48
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.51 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: BCBS Trust/PPO |
$88.55
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: Nomi Health Commercial |
$88.95
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health HMO/PPO |
$94.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.46
|
| Rate for Payer: UHC Core |
$90.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$108.48
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.90
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: BCBS MAPPO |
$27.12
|
| Rate for Payer: BCBS Trust/PPO |
$89.18
|
| Rate for Payer: BCN Commercial |
$84.34
|
| Rate for Payer: BCN Medicare Advantage |
$27.12
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.12
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: Nomi Health Commercial |
$88.95
|
| Rate for Payer: PACE Senior Care Partners |
$25.76
|
| Rate for Payer: PACE SWMI |
$27.12
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health HMO/PPO |
$94.38
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.68
|
| Rate for Payer: Railroad Medicare Medicare |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.46
|
| Rate for Payer: UHC Core |
$90.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.12
|
| Rate for Payer: UHC Exchange |
$27.12
|
| Rate for Payer: UHC Medicare Advantage |
$27.12
|
| Rate for Payer: VA VA |
$27.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$34.55
|
|
|
Service Code
|
NDC 00338008103
|
| Hospital Charge Code |
9813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.80
|
| Rate for Payer: BCBS Complete |
$13.82
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$26.86
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Healthscope Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Nomi Health Commercial |
$28.33
|
| Rate for Payer: PACE Senior Care Partners |
$8.21
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: Priority Health HMO/PPO |
$30.06
|
| Rate for Payer: Priority Health Medicare |
$8.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.40
|
| Rate for Payer: UHC Core |
$28.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Exchange |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: VA VA |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.91
|
|
|
DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34.55
|
|
|
Service Code
|
NDC 00338008103
|
| Hospital Charge Code |
9813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$28.20
|
| Rate for Payer: BCN Commercial |
$26.70
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Nomi Health Commercial |
$28.33
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: Priority Health HMO/PPO |
$30.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.40
|
| Rate for Payer: UHC Core |
$28.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.91
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 00338008503
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 00338008503
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
300210
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
300210
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
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
|
|
