|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION
|
Facility
IP
|
$24.64
|
|
|
Service Code
|
NDC 1990301023
|
| Hospital Charge Code |
7228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.04
|
| Rate for Payer: BCN Commercial |
$19.04
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.71
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC Core |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.48
|
|
|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION
|
Facility
IP
|
$10.98
|
|
|
Service Code
|
NDC 0536-2220-75
|
| Hospital Charge Code |
7228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.49
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.33
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.66
|
| Rate for Payer: UHC Core |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.24
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
IP
|
$39.95
|
|
|
Service Code
|
NDC 0904-5068-60
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.87
|
| Rate for Payer: BCN Commercial |
$30.87
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.16
|
| Rate for Payer: UHC Core |
$33.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
IP
|
$103.40
|
|
|
Service Code
|
NDC 63739-225-10
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$79.91
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
OP
|
$137.89
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$137.89 |
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
IP
|
$430.73
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.70 |
| Max. Negotiated Rate |
$387.66 |
| Rate for Payer: Aetna Commercial |
$366.12
|
| Rate for Payer: BCBS Trust/PPO |
$332.87
|
| Rate for Payer: BCN Commercial |
$332.87
|
| Rate for Payer: Cash Price |
$344.58
|
| Rate for Payer: Cofinity Commercial |
$370.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.58
|
| Rate for Payer: Healthscope Commercial |
$387.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.12
|
| Rate for Payer: PHP Commercial |
$366.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.04
|
| Rate for Payer: UHC Core |
$359.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.05
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
IP
|
$1,971.48
|
|
|
Service Code
|
NDC 0006-0277-31
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,202.41 |
| Max. Negotiated Rate |
$1,774.33 |
| Rate for Payer: Aetna Commercial |
$1,675.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.56
|
| Rate for Payer: BCN Commercial |
$1,523.56
|
| Rate for Payer: Cash Price |
$1,577.18
|
| Rate for Payer: Cofinity Commercial |
$1,695.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,577.18
|
| Rate for Payer: Healthscope Commercial |
$1,774.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,478.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,675.76
|
| Rate for Payer: PHP Commercial |
$1,675.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,202.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,734.90
|
| Rate for Payer: UHC Core |
$1,646.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,478.61
|
|
|
SKIN CARE CONSULT
|
Professional
|
$25.00
|
|
|
Service Code
|
HCPCS 00177
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.92
|
|
|
Service Code
|
NDC 0409-3299-06
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$19.26
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.18
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.93
|
| Rate for Payer: UHC Core |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.70
|
|
|
Service Code
|
NDC 51754-5001-1
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.30
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC Core |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.02
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$35.60
|
|
|
Service Code
|
NDC 0409-6625-22
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$27.51
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.81
|
|
|
Service Code
|
NDC 51754-5001-5
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.24
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.95
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.86
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$35.16
|
|
|
Service Code
|
NDC 0409-6625-25
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.44 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: BCN Commercial |
$27.17
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$31.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.94
|
| Rate for Payer: UHC Core |
$29.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.37
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$35.60
|
|
|
Service Code
|
NDC 0409-6625-14
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$27.51
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
IP
|
$159.80
|
|
|
Service Code
|
NDC 0223-1721-01
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: BCBS Trust/PPO |
$123.49
|
| Rate for Payer: BCN Commercial |
$123.49
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.83
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
IP
|
$260.85
|
|
|
Service Code
|
NDC 0904-7261-61
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.09 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$201.58
|
| Rate for Payer: BCN Commercial |
$201.58
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
IP
|
$59.63
|
|
|
Service Code
|
NDC 0409-6637-24
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: BCBS Trust/PPO |
$46.08
|
| Rate for Payer: BCN Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.69
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Core |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
IP
|
$60.75
|
|
|
Service Code
|
NDC 76329-3352-1
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Aetna Commercial |
$51.64
|
| Rate for Payer: BCBS Trust/PPO |
$46.95
|
| Rate for Payer: BCN Commercial |
$46.95
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.60
|
| Rate for Payer: Healthscope Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.64
|
| Rate for Payer: PHP Commercial |
$51.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$50.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.56
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
IP
|
$40.28
|
|
|
Service Code
|
NDC 0409-6637-34
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| Rate for Payer: UHC Core |
$33.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
IP
|
$59.63
|
|
|
Service Code
|
NDC 0409-6637-14
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: BCBS Trust/PPO |
$46.08
|
| Rate for Payer: BCN Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.69
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Core |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
IP
|
$60.75
|
|
|
Service Code
|
NDC 76329-3352-1
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Aetna Commercial |
$51.64
|
| Rate for Payer: BCBS Trust/PPO |
$46.95
|
| Rate for Payer: BCN Commercial |
$46.95
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.60
|
| Rate for Payer: Healthscope Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.64
|
| Rate for Payer: PHP Commercial |
$51.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$50.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.56
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
IP
|
$40.28
|
|
|
Service Code
|
NDC 0409-6637-34
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| Rate for Payer: UHC Core |
$33.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
IP
|
$51.84
|
|
|
Service Code
|
NDC 1011900252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$40.06
|
| Rate for Payer: BCN Commercial |
$40.06
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.06
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
IP
|
$51.84
|
|
|
Service Code
|
NDC 1011900738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$40.06
|
| Rate for Payer: BCN Commercial |
$40.06
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.06
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
IP
|
$33.99
|
|
|
Service Code
|
NDC 0536-1224-97
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna Commercial |
$28.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.27
|
| Rate for Payer: BCN Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$29.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.19
|
| Rate for Payer: Healthscope Commercial |
$30.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.89
|
| Rate for Payer: PHP Commercial |
$28.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.91
|
| Rate for Payer: UHC Core |
$28.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.49
|
|
