|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$111.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.89
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS MAPPO |
$107.11
|
| Rate for Payer: BCBS Trust/PPO |
$352.23
|
| Rate for Payer: BCN Commercial |
$333.12
|
| Rate for Payer: BCN Medicare Advantage |
$107.11
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.11
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: PACE Senior Care Partners |
$101.76
|
| Rate for Payer: PACE SWMI |
$107.11
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Medicare Advantage |
$107.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO |
$372.75
|
| Rate for Payer: Priority Health Medicare |
$108.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.06
|
| Rate for Payer: Railroad Medicare Medicare |
$107.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.04
|
| Rate for Payer: UHC Core |
$357.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.11
|
| Rate for Payer: UHC Exchange |
$107.11
|
| Rate for Payer: UHC Medicare Advantage |
$107.11
|
| Rate for Payer: VA VA |
$107.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 68084008211
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
4064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.49 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: BCBS Trust/PPO |
$349.74
|
| Rate for Payer: BCN Commercial |
$331.11
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO |
$372.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.04
|
| Rate for Payer: UHC Core |
$357.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: Aetna Medicare |
$64.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.78
|
| Rate for Payer: BCBS Complete |
$99.56
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$204.62
|
| Rate for Payer: BCN Commercial |
$193.52
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$214.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$224.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: PACE Senior Care Partners |
$59.11
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$211.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO |
$216.54
|
| Rate for Payer: Priority Health Medicare |
$62.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.76
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.03
|
| Rate for Payer: UHC Core |
$207.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.23
|
| Rate for Payer: UHC Exchange |
$62.23
|
| Rate for Payer: UHC Medicare Advantage |
$62.23
|
| Rate for Payer: VA VA |
$62.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.68
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
24521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: BCBS Trust/PPO |
$203.18
|
| Rate for Payer: BCN Commercial |
$192.35
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$214.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$224.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.56
|
| Rate for Payer: Nomi Health Commercial |
$204.10
|
| Rate for Payer: PHP Commercial |
$211.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO |
$216.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.03
|
| Rate for Payer: UHC Core |
$207.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.68
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 68084059211
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.97
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 68084059211
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.43 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: BCBS Trust/PPO |
$240.40
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.43
|
| Rate for Payer: Priority Health HMO/PPO |
$256.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.16
|
| Rate for Payer: UHC Core |
$245.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$310.56
|
|
|
Service Code
|
NDC 68084059201
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.86 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$263.98
|
| Rate for Payer: BCBS Trust/PPO |
$253.51
|
| Rate for Payer: BCN Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$248.45
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.45
|
| Rate for Payer: Healthscope Commercial |
$279.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.98
|
| Rate for Payer: Nomi Health Commercial |
$254.66
|
| Rate for Payer: PHP Commercial |
$263.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.86
|
| Rate for Payer: Priority Health HMO/PPO |
$270.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.29
|
| Rate for Payer: UHC Core |
$259.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.92
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$310.56
|
|
|
Service Code
|
NDC 68084059201
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$263.98
|
| Rate for Payer: Aetna Medicare |
$80.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.05
|
| Rate for Payer: BCBS Complete |
$124.22
|
| Rate for Payer: BCBS MAPPO |
$77.64
|
| Rate for Payer: BCBS Trust/PPO |
$255.31
|
| Rate for Payer: BCN Commercial |
$241.46
|
| Rate for Payer: BCN Medicare Advantage |
$77.64
|
| Rate for Payer: Cash Price |
$248.45
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.64
|
| Rate for Payer: Healthscope Commercial |
$279.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.98
|
| Rate for Payer: Nomi Health Commercial |
$254.66
|
| Rate for Payer: PACE Senior Care Partners |
$73.76
|
| Rate for Payer: PACE SWMI |
$77.64
|
| Rate for Payer: PHP Commercial |
$263.98
|
| Rate for Payer: PHP Medicare Advantage |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.86
|
| Rate for Payer: Priority Health HMO/PPO |
$270.19
|
| Rate for Payer: Priority Health Medicare |
$78.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.08
|
| Rate for Payer: Railroad Medicare Medicare |
$77.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.29
|
| Rate for Payer: UHC Core |
$259.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.64
|
| Rate for Payer: UHC Exchange |
$77.64
|
| Rate for Payer: UHC Medicare Advantage |
$77.64
|
| Rate for Payer: VA VA |
$77.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.92
|
|
|
ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$294.50
|
|
|
Service Code
|
NDC 00904645061
|
| Hospital Charge Code |
24268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: Aetna Medicare |
$76.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.03
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS MAPPO |
$73.62
|
| Rate for Payer: BCBS Trust/PPO |
$242.11
|
| Rate for Payer: BCN Commercial |
$228.97
|
| Rate for Payer: BCN Medicare Advantage |
$73.62
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.62
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: PACE Senior Care Partners |
$69.94
|
| Rate for Payer: PACE SWMI |
$73.62
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: PHP Medicare Advantage |
$73.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.43
|
| Rate for Payer: Priority Health HMO/PPO |
$256.21
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.16
|
| Rate for Payer: UHC Core |
$245.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.62
|
| Rate for Payer: UHC Exchange |
$73.62
|
| Rate for Payer: UHC Medicare Advantage |
$73.62
|
| Rate for Payer: VA VA |
$73.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
150768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018150
|
| Hospital Charge Code |
168943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.00
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: BCN Medicare Advantage |
$2.40
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: PACE Senior Care Partners |
$2.28
|
| Rate for Payer: PACE SWMI |
$2.40
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.40
|
| Rate for Payer: UHC Exchange |
$2.40
|
| Rate for Payer: UHC Medicare Advantage |
$2.40
|
| Rate for Payer: VA VA |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018181
|
| Hospital Charge Code |
200080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.00
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.89
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: BCN Medicare Advantage |
$2.40
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Nomi Health Commercial |
$7.87
|
| Rate for Payer: PACE Senior Care Partners |
$2.28
|
| Rate for Payer: PACE SWMI |
$2.40
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.24
|
| Rate for Payer: Priority Health HMO/PPO |
$8.35
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.45
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.40
|
| Rate for Payer: UHC Exchange |
$2.40
|
| Rate for Payer: UHC Medicare Advantage |
$2.40
|
| Rate for Payer: VA VA |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
150769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
ISOSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018457
|
| Hospital Charge Code |
200074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
