|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 0409-3301-10
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$70.63
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.68
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 0409-3301-01
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$70.63
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.68
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXTROMETHORPHAN 20 MG-QUINIDINE 10 MG CAPSULE
|
Facility
|
IP
|
$5,222.11
|
|
|
Service Code
|
NDC 64597-301-60
|
| Hospital Charge Code |
107672
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,184.96 |
| Max. Negotiated Rate |
$4,699.90 |
| Rate for Payer: Aetna Commercial |
$4,438.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,035.65
|
| Rate for Payer: BCN Commercial |
$4,035.65
|
| Rate for Payer: Cash Price |
$4,177.69
|
| Rate for Payer: Cofinity Commercial |
$4,491.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,177.69
|
| Rate for Payer: Healthscope Commercial |
$4,699.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,916.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.79
|
| Rate for Payer: PHP Commercial |
$4,438.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,655.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,543.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,184.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,595.46
|
| Rate for Payer: UHC Core |
$4,360.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,916.58
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 9900-0003-86
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.46
|
| Rate for Payer: BCN Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.52
|
| Rate for Payer: UHC Core |
$0.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 0121-0638-05
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.01
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.61
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.85
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.84
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 0990-7930-09
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| 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 Multiplan/Beech St/PHCS |
$81.34
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.37
|
| 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
|
$69.92
|
|
|
Service Code
|
NDC 0338-0023-04
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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
|
$61.18
|
|
|
Service Code
|
NDC 0338-0023-02
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$47.28
|
| 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 Multiplan/Beech St/PHCS |
$52.00
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.31
|
| 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 MAXIMUM RATE 250 MR
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0023-04
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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 % IV BOLUS
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
NDC 0264-7520-20
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: BCBS Trust/PPO |
$46.23
|
| Rate for Payer: BCN Commercial |
$46.23
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.85
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$49.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-1775-10
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.43
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.87
|
| Rate for Payer: UHC Core |
$50.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$13.17
|
|
|
Service Code
|
NDC 574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.59
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.88
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$13.17
|
|
|
Service Code
|
NDC 574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.59
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.88
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.22
|
|
|
Service Code
|
NDC 0409-6648-02
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.51 |
| Max. Negotiated Rate |
$52.40 |
| Rate for Payer: Aetna Commercial |
$49.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.99
|
| Rate for Payer: BCN Commercial |
$44.99
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.49
|
| Rate for Payer: PHP Commercial |
$49.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.23
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.66
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$58.97
|
|
|
Service Code
|
NDC 0409-4902-34
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$50.12
|
| Rate for Payer: BCBS Trust/PPO |
$45.57
|
| Rate for Payer: BCN Commercial |
$45.57
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.18
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.12
|
| Rate for Payer: PHP Commercial |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.89
|
| Rate for Payer: UHC Core |
$49.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$57.63
|
|
|
Service Code
|
NDC 0409-7517-66
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$51.87 |
| Rate for Payer: Aetna Commercial |
$48.99
|
| Rate for Payer: BCBS Trust/PPO |
$44.54
|
| Rate for Payer: BCN Commercial |
$44.54
|
| Rate for Payer: Cash Price |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$49.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.10
|
| Rate for Payer: Healthscope Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.99
|
| Rate for Payer: PHP Commercial |
$48.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.71
|
| Rate for Payer: UHC Core |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.22
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$58.97
|
|
|
Service Code
|
NDC 0409-4902-64
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$50.12
|
| Rate for Payer: BCBS Trust/PPO |
$45.57
|
| Rate for Payer: BCN Commercial |
$45.57
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.18
|
| Rate for Payer: Healthscope Commercial |
$53.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.12
|
| Rate for Payer: PHP Commercial |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.89
|
| Rate for Payer: UHC Core |
$49.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$57.63
|
|
|
Service Code
|
NDC 0409-7517-16
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$51.87 |
| Rate for Payer: Aetna Commercial |
$48.99
|
| Rate for Payer: BCBS Trust/PPO |
$44.54
|
| Rate for Payer: BCN Commercial |
$44.54
|
| Rate for Payer: Cash Price |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$49.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.10
|
| Rate for Payer: Healthscope Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.99
|
| Rate for Payer: PHP Commercial |
$48.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.71
|
| Rate for Payer: UHC Core |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.22
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$89.84
|
|
|
Service Code
|
NDC 0409-4902-34
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$80.86 |
| Rate for Payer: Aetna Commercial |
$76.36
|
| Rate for Payer: BCBS Trust/PPO |
$69.43
|
| Rate for Payer: BCN Commercial |
$69.43
|
| Rate for Payer: Cash Price |
$71.87
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.87
|
| Rate for Payer: Healthscope Commercial |
$80.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.36
|
| Rate for Payer: PHP Commercial |
$76.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.06
|
| Rate for Payer: UHC Core |
$75.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.38
|
|
|
DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34.55
|
|
|
Service Code
|
NDC 0338-0081-03
|
| Hospital Charge Code |
9813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$26.70
|
| 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 Multiplan/Beech St/PHCS |
$29.37
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.07
|
| 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
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 0338-0085-03
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| 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 Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| 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 0338-0085-04
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0089-04
|
| Hospital Charge Code |
300210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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 0338-0089-04
|
| Hospital Charge Code |
9815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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 LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
9788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| 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
|
|
