|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$72.54
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Medicare |
$18.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.67
|
| Rate for Payer: BCBS Complete |
$13.43
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$59.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| 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: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: Mclaren Medicaid |
$12.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.04
|
| Rate for Payer: Meridian Medicaid |
$13.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| 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: PACE Senior Care Partners |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.11
|
| Rate for Payer: Priority Health Medicare |
$18.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.49
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.84
|
| Rate for Payer: UHC Core |
$60.57
|
| Rate for Payer: UHC Exchange |
$18.14
|
| Rate for Payer: UHC Medicaid |
$12.79
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$12.79
|
| Rate for Payer: VA VA |
$18.14
|
| 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
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$85.67
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.63 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: BCBS Trust/PPO |
$70.75
|
| Rate for Payer: BCN Commercial |
$70.75
|
| 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: Healthscope Commercial |
$77.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| 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: PHP Commercial |
$72.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
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 00409751766
|
| 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
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$85.67
|
|
|
Service Code
|
NDC 00409751766
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.63 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: BCBS Trust/PPO |
$70.75
|
| Rate for Payer: BCN Commercial |
$70.75
|
| 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: Healthscope Commercial |
$77.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| 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: PHP Commercial |
$72.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$110.52
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: BCBS Trust/PPO |
$91.28
|
| Rate for Payer: BCN Commercial |
$91.28
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.89
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.26
|
| Rate for Payer: UHC Core |
$92.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$110.52
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Aetna Medicare |
$28.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.54
|
| Rate for Payer: BCBS Complete |
$20.46
|
| Rate for Payer: BCBS MAPPO |
$27.63
|
| Rate for Payer: BCBS Trust/PPO |
$90.86
|
| Rate for Payer: BCN Commercial |
$90.86
|
| Rate for Payer: BCN Medicare Advantage |
$27.63
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.63
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: Mclaren Medicaid |
$19.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.01
|
| Rate for Payer: Meridian Medicaid |
$20.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.89
|
| Rate for Payer: PACE Senior Care Partners |
$26.25
|
| Rate for Payer: PACE SWMI |
$27.63
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: PHP Medicare Advantage |
$27.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.15
|
| Rate for Payer: Priority Health Medicare |
$27.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.92
|
| Rate for Payer: Railroad Medicare Medicare |
$27.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.26
|
| Rate for Payer: UHC Core |
$92.28
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UHC Medicaid |
$19.48
|
| Rate for Payer: UHC Medicare Advantage |
$27.63
|
| Rate for Payer: UHCCP Medicaid |
$19.48
|
| Rate for Payer: VA VA |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34.55
|
|
|
Service Code
|
NDC 00338008103
|
| Hospital Charge Code |
9813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$28.53
|
| 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 |
$31.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Nomi Health Commercial |
$28.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.05
|
| 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 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$34.55
|
|
|
Service Code
|
NDC 00338008103
|
| Hospital Charge Code |
9813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.80
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$28.40
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Healthscope Commercial |
$31.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Mclaren Medicaid |
$6.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: Meridian Medicaid |
$6.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Nomi Health Commercial |
$28.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: PACE Senior Care Partners |
$8.21
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.06
|
| Rate for Payer: Priority Health Medicare |
$8.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.05
|
| Rate for Payer: Railroad Medicare Medicare |
$8.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.40
|
| Rate for Payer: UHC Core |
$28.85
|
| Rate for Payer: UHC Exchange |
$8.64
|
| Rate for Payer: UHC Medicaid |
$6.09
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: UHCCP Medicaid |
$6.09
|
| Rate for Payer: VA VA |
$8.64
|
| 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 00338008503
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$55.49
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 00338008503
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
300210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
300210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338979901
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338979912
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338979901
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338979912
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
9788
|
|
Hospital Revenue Code
|
636
|
| 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 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 |
$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 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
