|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 09900000386
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| 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 Commercial |
$0.50
|
| Rate for Payer: Nomi Health Commercial |
$0.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.41
|
| 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
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.33 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.32
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$50.30
|
| Rate for Payer: BCN Commercial |
$50.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$10.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$11.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.88
|
| Rate for Payer: PACE Senior Care Partners |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.23
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.58
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.84
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: UHC Exchange |
$15.29
|
| Rate for Payer: UHC Medicaid |
$10.79
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$10.79
|
| Rate for Payer: VA VA |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 00990793009
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$79.04
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.58 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$50.53
|
| Rate for Payer: BCN Commercial |
$50.53
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.88
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.84
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.70
|
|
|
Service Code
|
NDC 00990793009
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$24.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.91
|
| Rate for Payer: BCBS Complete |
$17.71
|
| Rate for Payer: BCBS MAPPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.67
|
| Rate for Payer: BCN Commercial |
$78.67
|
| Rate for Payer: BCN Medicare Advantage |
$23.93
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.12
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.73
|
| Rate for Payer: PACE SWMI |
$23.93
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Medicare Advantage |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Medicare |
$24.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: Railroad Medicare Medicare |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: UHC Exchange |
$23.93
|
| Rate for Payer: UHC Medicaid |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$23.93
|
| Rate for Payer: UHCCP Medicaid |
$16.87
|
| Rate for Payer: VA VA |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.33 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Medicare |
$16.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.94
|
| Rate for Payer: BCBS Complete |
$11.81
|
| Rate for Payer: BCBS MAPPO |
$15.95
|
| Rate for Payer: BCBS Trust/PPO |
$52.45
|
| Rate for Payer: BCN Commercial |
$52.45
|
| Rate for Payer: BCN Medicare Advantage |
$15.95
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Mclaren Medicaid |
$11.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.75
|
| Rate for Payer: Meridian Medicaid |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: PACE Senior Care Partners |
$15.15
|
| Rate for Payer: PACE SWMI |
$15.95
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.51
|
| Rate for Payer: Priority Health Medicare |
$16.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.40
|
| Rate for Payer: Railroad Medicare Medicare |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.14
|
| Rate for Payer: UHC Core |
$53.27
|
| Rate for Payer: UHC Exchange |
$15.95
|
| Rate for Payer: UHC Medicaid |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$15.95
|
| Rate for Payer: UHCCP Medicaid |
$11.25
|
| Rate for Payer: VA VA |
$15.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: BCBS Trust/PPO |
$52.69
|
| Rate for Payer: BCN Commercial |
$52.69
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.14
|
| Rate for Payer: UHC Core |
$53.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$87.94
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$79.15 |
| Rate for Payer: Aetna Commercial |
$74.75
|
| Rate for Payer: Aetna Medicare |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.48
|
| Rate for Payer: BCBS Complete |
$16.28
|
| Rate for Payer: BCBS MAPPO |
$21.98
|
| Rate for Payer: BCBS Trust/PPO |
$72.30
|
| Rate for Payer: BCN Commercial |
$72.30
|
| Rate for Payer: BCN Medicare Advantage |
$21.98
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Cofinity Commercial |
$75.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$79.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Mclaren Medicaid |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.08
|
| Rate for Payer: Meridian Medicaid |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.75
|
| Rate for Payer: Nomi Health Commercial |
$72.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.95
|
| Rate for Payer: PACE Senior Care Partners |
$20.89
|
| Rate for Payer: PACE SWMI |
$21.98
|
| Rate for Payer: PHP Commercial |
$74.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.51
|
| Rate for Payer: Priority Health Medicare |
$22.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.21
|
| Rate for Payer: Railroad Medicare Medicare |
$21.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.39
|
| Rate for Payer: UHC Core |
$73.43
|
| Rate for Payer: UHC Exchange |
$21.98
|
| Rate for Payer: UHC Medicaid |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$21.98
|
| Rate for Payer: UHCCP Medicaid |
$15.50
|
| Rate for Payer: VA VA |
$21.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$87.94
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$79.15 |
| Rate for Payer: Aetna Commercial |
$74.75
|
| Rate for Payer: BCBS Trust/PPO |
$72.63
|
| Rate for Payer: BCN Commercial |
$72.63
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Cofinity Commercial |
$75.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.35
|
| Rate for Payer: Healthscope Commercial |
$79.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.75
|
| Rate for Payer: Nomi Health Commercial |
$72.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.95
|
| Rate for Payer: PHP Commercial |
$74.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.39
|
| Rate for Payer: UHC Core |
$73.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCN Commercial |
$13.32
|
| Rate for Payer: BCN Medicare Advantage |
$4.05
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PACE Senior Care Partners |
$3.85
|
| Rate for Payer: PACE SWMI |
$4.05
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$4.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Exchange |
$4.05
|
| Rate for Payer: UHC Medicaid |
$2.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$13.38
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$16.37
|
|
|
Service Code
|
NDC 00574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Commercial |
$13.52
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.28
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Core |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$16.37
|
|
|
Service Code
|
NDC 00574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$4.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.12
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.46
|
| Rate for Payer: BCN Commercial |
$13.46
|
| Rate for Payer: BCN Medicare Advantage |
$4.09
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.30
|
| Rate for Payer: Meridian Medicaid |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.89
|
| Rate for Payer: PACE SWMI |
$4.09
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.24
|
| Rate for Payer: Priority Health Medicare |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Core |
$13.67
|
| Rate for Payer: UHC Exchange |
$4.09
|
| Rate for Payer: UHC Medicaid |
$2.89
|
| Rate for Payer: UHC Medicare Advantage |
$4.09
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$19.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.43
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.74
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.74
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.68
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.74
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Medicare |
$18.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.74
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$18.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$61.92
|
| Rate for Payer: BCN Commercial |
$61.92
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$19.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.43
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.74
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.74
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.68
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.74
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Medicare |
$18.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.74
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$18.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$61.92
|
| Rate for Payer: BCN Commercial |
$61.92
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.18 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$61.92
|
| Rate for Payer: BCN Commercial |
$61.92
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$19.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.43
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.74
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.74
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.68
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.74
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Medicare |
$18.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.74
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$18.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Nomi Health Commercial |
$59.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.41
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.84
|
| Rate for Payer: UHC Core |
$60.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$85.67
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$15.86
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$70.43
|
| Rate for Payer: BCN Commercial |
$70.43
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Mclaren Medicaid |
$15.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$15.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Nomi Health Commercial |
$70.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: PACE Senior Care Partners |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health Medicare |
$21.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.63
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicaid |
$15.10
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$15.10
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
