|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
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 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$48.09
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$47.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| 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 Medicare |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicaid |
$10.27
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$10.27
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
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 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
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 % IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| 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 % IV BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| 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 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$108.48
|
|
|
Service Code
|
NDC 00264738750
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.90
|
| Rate for Payer: BCBS Complete |
$20.08
|
| Rate for Payer: BCBS MAPPO |
$27.12
|
| Rate for Payer: BCBS Trust/PPO |
$89.18
|
| Rate for Payer: BCN Commercial |
$89.18
|
| Rate for Payer: BCN Medicare Advantage |
$27.12
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.12
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$19.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.48
|
| Rate for Payer: Meridian Medicaid |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: Nomi Health Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.36
|
| Rate for Payer: PACE Senior Care Partners |
$25.76
|
| Rate for Payer: PACE SWMI |
$27.12
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.38
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.50
|
| Rate for Payer: Railroad Medicare Medicare |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.46
|
| Rate for Payer: UHC Core |
$90.58
|
| Rate for Payer: UHC Exchange |
$27.12
|
| Rate for Payer: UHC Medicaid |
$19.13
|
| Rate for Payer: UHC Medicare Advantage |
$27.12
|
| Rate for Payer: UHCCP Medicaid |
$19.13
|
| Rate for Payer: VA VA |
$27.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$108.48
|
|
|
Service Code
|
NDC 00264738750
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.50 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: BCBS Trust/PPO |
$89.59
|
| Rate for Payer: BCN Commercial |
$89.59
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: Nomi Health Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.36
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.46
|
| Rate for Payer: UHC Core |
$90.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DIABETES
|
Facility
|
IP
|
$2,773.81
|
|
|
Service Code
|
APR-DRG 4201
|
| Min. Negotiated Rate |
$2,641.72 |
| Max. Negotiated Rate |
$2,773.81 |
| Rate for Payer: BCBS Complete |
$2,773.81
|
| Rate for Payer: Mclaren Medicaid |
$2,641.72
|
| Rate for Payer: Meridian Medicaid |
$2,773.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,641.72
|
| Rate for Payer: UHC Medicaid |
$2,641.72
|
| Rate for Payer: UHCCP Medicaid |
$2,641.72
|
|
|
DIABETES
|
Facility
|
IP
|
$3,899.10
|
|
|
Service Code
|
APR-DRG 4202
|
| Min. Negotiated Rate |
$3,713.43 |
| Max. Negotiated Rate |
$3,899.10 |
| Rate for Payer: BCBS Complete |
$3,899.10
|
| Rate for Payer: Mclaren Medicaid |
$3,713.43
|
| Rate for Payer: Meridian Medicaid |
$3,899.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,713.43
|
| Rate for Payer: UHC Medicaid |
$3,713.43
|
| Rate for Payer: UHCCP Medicaid |
$3,713.43
|
|
|
DIABETES
|
Facility
|
IP
|
$5,602.30
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$5,335.52 |
| Max. Negotiated Rate |
$5,602.30 |
| Rate for Payer: BCBS Complete |
$5,602.30
|
| Rate for Payer: Mclaren Medicaid |
$5,335.52
|
| Rate for Payer: Meridian Medicaid |
$5,602.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,335.52
|
| Rate for Payer: UHC Medicaid |
$5,335.52
|
| Rate for Payer: UHCCP Medicaid |
$5,335.52
|
|
|
DIABETES
|
Facility
|
IP
|
$8,624.83
|
|
|
Service Code
|
APR-DRG 4204
|
| Min. Negotiated Rate |
$8,214.12 |
| Max. Negotiated Rate |
$8,624.83 |
| Rate for Payer: BCBS Complete |
$8,624.83
|
| Rate for Payer: Mclaren Medicaid |
$8,214.12
|
| Rate for Payer: Meridian Medicaid |
$8,624.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,214.12
|
| Rate for Payer: UHC Medicaid |
$8,214.12
|
| Rate for Payer: UHCCP Medicaid |
$8,214.12
|
|
|
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION
|
Facility
|
OP
|
$63.72
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
9828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$57.35 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Aetna Medicare |
$1.89
|
| Rate for Payer: Aetna Medicare |
$16.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.27
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$15.93
|
| Rate for Payer: BCBS MAPPO |
$1.81
|
| Rate for Payer: BCBS Trust/PPO |
$52.38
|
| Rate for Payer: BCBS Trust/PPO |
$5.96
|
| Rate for Payer: BCN Commercial |
$5.96
|
| Rate for Payer: BCN Commercial |
$52.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.81
|
| Rate for Payer: BCN Medicare Advantage |
$15.93
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$54.80
|
| Rate for Payer: Cofinity Commercial |
$6.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$57.35
|
| Rate for Payer: Healthscope Commercial |
$6.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.44
|
| Rate for Payer: Mclaren Medicaid |
$1.28
|
| Rate for Payer: Mclaren Medicaid |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.73
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: Meridian Medicaid |
$1.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.16
|
| Rate for Payer: Nomi Health Commercial |
$5.95
|
| Rate for Payer: Nomi Health Commercial |
$52.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.72
|
| Rate for Payer: PACE Senior Care Partners |
$15.13
|
| Rate for Payer: PACE SWMI |
$1.81
|
| Rate for Payer: PACE SWMI |
$15.93
|
| Rate for Payer: PHP Commercial |
$54.16
|
| Rate for Payer: PHP Commercial |
$6.16
|
| Rate for Payer: PHP Medicare Advantage |
$15.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.44
|
| Rate for Payer: Priority Health Medicare |
$1.83
|
| Rate for Payer: Priority Health Medicare |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.05
|
| Rate for Payer: Railroad Medicare Medicare |
$15.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.38
|
| Rate for Payer: UHC Core |
$6.05
|
| Rate for Payer: UHC Core |
$53.21
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UHC Exchange |
$15.93
|
| Rate for Payer: UHC Medicaid |
$1.28
|
| Rate for Payer: UHC Medicaid |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.93
|
| Rate for Payer: UHC Medicare Advantage |
$1.81
|
| Rate for Payer: UHCCP Medicaid |
$11.23
|
| Rate for Payer: UHCCP Medicaid |
$1.28
|
| Rate for Payer: VA VA |
$15.93
|
| Rate for Payer: VA VA |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.79
|
|
|
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION
|
Facility
|
IP
|
$63.72
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
9828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$57.35 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: BCBS Trust/PPO |
$52.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.99
|
| Rate for Payer: BCN Commercial |
$52.63
|
| Rate for Payer: BCN Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$54.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.98
|
| Rate for Payer: Healthscope Commercial |
$57.35
|
| Rate for Payer: Healthscope Commercial |
$6.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.16
|
| Rate for Payer: Nomi Health Commercial |
$52.25
|
| Rate for Payer: Nomi Health Commercial |
$5.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.44
|
| Rate for Payer: PHP Commercial |
$6.16
|
| Rate for Payer: PHP Commercial |
$54.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.38
|
| Rate for Payer: UHC Core |
$53.21
|
| Rate for Payer: UHC Core |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.44
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 51079028401
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.29
|
| Rate for Payer: BCN Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.25
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Nomi Health Commercial |
$1.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.17
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.17
|
|
|
DIAZEPAM 2 MG TABLET
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 51079028401
|
| Hospital Charge Code |
2404
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna Medicare |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.49
|
| Rate for Payer: BCBS Complete |
$0.29
|
| Rate for Payer: BCBS MAPPO |
$0.39
|
| Rate for Payer: BCBS Trust/PPO |
$1.28
|
| Rate for Payer: BCN Commercial |
$1.28
|
| Rate for Payer: BCN Medicare Advantage |
$0.39
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.39
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.17
|
| Rate for Payer: Mclaren Medicaid |
$0.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Nomi Health Commercial |
$1.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.17
|
| Rate for Payer: PACE Senior Care Partners |
$0.37
|
| Rate for Payer: PACE SWMI |
$0.39
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.36
|
| Rate for Payer: Priority Health Medicare |
$0.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.37
|
| Rate for Payer: UHC Core |
$1.30
|
| Rate for Payer: UHC Exchange |
$0.39
|
| Rate for Payer: UHC Medicaid |
$0.28
|
| Rate for Payer: UHC Medicare Advantage |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.28
|
| Rate for Payer: VA VA |
$0.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.17
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 51079028520
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.33
|
| Rate for Payer: BCN Commercial |
$120.33
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.22
|
| Rate for Payer: UHC Core |
$121.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 51079028501
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna Commercial |
$1.24
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: BCBS Complete |
$0.27
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$1.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.09
|
| Rate for Payer: Mclaren Medicaid |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.38
|
| Rate for Payer: Meridian Medicaid |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.24
|
| Rate for Payer: Nomi Health Commercial |
$1.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PHP Commercial |
$1.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.27
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.02
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.28
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.09
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 51079028501
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna Commercial |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$1.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.24
|
| Rate for Payer: Nomi Health Commercial |
$1.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.09
|
| Rate for Payer: PHP Commercial |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.28
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.09
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 00172392660
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.23
|
| Rate for Payer: BCBS Complete |
$14.35
|
| Rate for Payer: BCBS MAPPO |
$19.39
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Medicare Advantage |
$19.39
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Mclaren Medicaid |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.36
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PACE Senior Care Partners |
$18.42
|
| Rate for Payer: PACE SWMI |
$19.39
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Medicare |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$19.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UHC Medicaid |
$13.67
|
| Rate for Payer: UHC Medicare Advantage |
$19.39
|
| Rate for Payer: UHCCP Medicaid |
$13.67
|
| Rate for Payer: VA VA |
$19.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 00172392660
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$64.05
|
| Rate for Payer: BCN Commercial |
$64.05
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
DIAZEPAM 5 MG TABLET
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 51079028520
|
| Hospital Charge Code |
2405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$37.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.53
|
| Rate for Payer: BCBS Complete |
$26.97
|
| Rate for Payer: BCBS MAPPO |
$36.42
|
| Rate for Payer: BCBS Trust/PPO |
$119.78
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: BCN Medicare Advantage |
$36.42
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Mclaren Medicaid |
$25.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: Meridian Medicaid |
$26.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PACE Senior Care Partners |
$34.60
|
| Rate for Payer: PACE SWMI |
$36.42
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: PHP Medicare Advantage |
$36.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.76
|
| Rate for Payer: Priority Health Medicare |
$36.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.41
|
| Rate for Payer: Railroad Medicare Medicare |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.22
|
| Rate for Payer: UHC Core |
$121.66
|
| Rate for Payer: UHC Exchange |
$36.42
|
| Rate for Payer: UHC Medicaid |
$25.69
|
| Rate for Payer: UHC Medicare Advantage |
$36.42
|
| Rate for Payer: UHCCP Medicaid |
$25.69
|
| Rate for Payer: VA VA |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
DIBUCAINE 1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
NDC 00536121195
|
| Hospital Charge Code |
2412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.59
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.72
|
| Rate for Payer: BCN Commercial |
$14.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.47
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.47
|
| Rate for Payer: Healthscope Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.43
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.70
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.43
|
| Rate for Payer: PACE Senior Care Partners |
$4.25
|
| Rate for Payer: PACE SWMI |
$4.47
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.57
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.46
|
| Rate for Payer: Railroad Medicare Medicare |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.75
|
| Rate for Payer: UHC Core |
$14.95
|
| Rate for Payer: UHC Exchange |
$4.47
|
| Rate for Payer: UHC Medicaid |
$3.16
|
| Rate for Payer: UHC Medicare Advantage |
$4.47
|
| Rate for Payer: UHCCP Medicaid |
$3.16
|
| Rate for Payer: VA VA |
$4.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.43
|
|
|
DIBUCAINE 1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
NDC 00536121195
|
| Hospital Charge Code |
2412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.43
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.75
|
| Rate for Payer: UHC Core |
$14.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.43
|
|
