|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$11,278.74
|
|
|
Service Code
|
APR-DRG 3611
|
| Min. Negotiated Rate |
$10,741.66 |
| Max. Negotiated Rate |
$11,278.74 |
| Rate for Payer: BCBS Complete |
$11,278.74
|
| Rate for Payer: Mclaren Medicaid |
$10,741.66
|
| Rate for Payer: Meridian Medicaid |
$11,278.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,741.66
|
| Rate for Payer: UHC Medicaid |
$10,741.66
|
| Rate for Payer: UHCCP Medicaid |
$10,741.66
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$32,621.01
|
|
|
Service Code
|
APR-DRG 3614
|
| Min. Negotiated Rate |
$31,067.63 |
| Max. Negotiated Rate |
$32,621.01 |
| Rate for Payer: BCBS Complete |
$32,621.01
|
| Rate for Payer: Mclaren Medicaid |
$31,067.63
|
| Rate for Payer: Meridian Medicaid |
$32,621.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,067.63
|
| Rate for Payer: UHC Medicaid |
$31,067.63
|
| Rate for Payer: UHCCP Medicaid |
$31,067.63
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$15,291.43
|
|
|
Service Code
|
APR-DRG 3612
|
| Min. Negotiated Rate |
$14,563.26 |
| Max. Negotiated Rate |
$15,291.43 |
| Rate for Payer: BCBS Complete |
$15,291.43
|
| Rate for Payer: Mclaren Medicaid |
$14,563.26
|
| Rate for Payer: Meridian Medicaid |
$15,291.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,563.26
|
| Rate for Payer: UHC Medicaid |
$14,563.26
|
| Rate for Payer: UHCCP Medicaid |
$14,563.26
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$7,386.47
|
|
|
Service Code
|
APR-DRG 3804
|
| Min. Negotiated Rate |
$7,034.74 |
| Max. Negotiated Rate |
$7,386.47 |
| Rate for Payer: BCBS Complete |
$7,386.47
|
| Rate for Payer: Mclaren Medicaid |
$7,034.74
|
| Rate for Payer: Meridian Medicaid |
$7,386.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,034.74
|
| Rate for Payer: UHC Medicaid |
$7,034.74
|
| Rate for Payer: UHCCP Medicaid |
$7,034.74
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$4,414.95
|
|
|
Service Code
|
APR-DRG 3802
|
| Min. Negotiated Rate |
$4,204.72 |
| Max. Negotiated Rate |
$4,414.95 |
| Rate for Payer: BCBS Complete |
$4,414.95
|
| Rate for Payer: Mclaren Medicaid |
$4,204.72
|
| Rate for Payer: Meridian Medicaid |
$4,414.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,204.72
|
| Rate for Payer: UHC Medicaid |
$4,204.72
|
| Rate for Payer: UHCCP Medicaid |
$4,204.72
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$3,052.50
|
|
|
Service Code
|
APR-DRG 3801
|
| Min. Negotiated Rate |
$2,907.14 |
| Max. Negotiated Rate |
$3,052.50 |
| Rate for Payer: BCBS Complete |
$3,052.50
|
| Rate for Payer: Mclaren Medicaid |
$2,907.14
|
| Rate for Payer: Meridian Medicaid |
$3,052.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,907.14
|
| Rate for Payer: UHC Medicaid |
$2,907.14
|
| Rate for Payer: UHCCP Medicaid |
$2,907.14
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$5,461.90
|
|
|
Service Code
|
APR-DRG 3803
|
| Min. Negotiated Rate |
$5,201.81 |
| Max. Negotiated Rate |
$5,461.90 |
| Rate for Payer: BCBS Complete |
$5,461.90
|
| Rate for Payer: Mclaren Medicaid |
$5,201.81
|
| Rate for Payer: Meridian Medicaid |
$5,461.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,201.81
|
| Rate for Payer: UHC Medicaid |
$5,201.81
|
| Rate for Payer: UHCCP Medicaid |
$5,201.81
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 184
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicaid |
$290.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 187
|
| Min. Negotiated Rate |
$1,742.00 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 181
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicaid |
$290.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 182
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicaid |
$290.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 183
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicaid |
$290.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
LOCAL 188
|
| Min. Negotiated Rate |
$1,742.00 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 185
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.69
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.21
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS MAPPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: BCN Medicare Advantage |
$6.57
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.57
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Mclaren Medicaid |
$4.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.89
|
| Rate for Payer: Meridian Medicaid |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PACE Senior Care Partners |
$6.24
|
| Rate for Payer: PACE SWMI |
$6.57
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Medicare Advantage |
$6.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: UHC Exchange |
$6.57
|
| Rate for Payer: UHC Medicaid |
$4.63
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: UHCCP Medicaid |
$4.63
|
| Rate for Payer: VA VA |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$29.27
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| 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: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$29.27
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| 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: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$8.90
|
| 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 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$19.66
|
| 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 Commercial |
$20.24
|
| Rate for Payer: Nomi Health Commercial |
$19.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.86
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.57
|
| 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
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$5.40
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Mclaren Medicaid |
$3.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.67
|
| Rate for Payer: Meridian Medicaid |
$4.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Nomi Health Commercial |
$17.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PACE Senior Care Partners |
$5.13
|
| Rate for Payer: PACE SWMI |
$5.40
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.78
|
| Rate for Payer: Priority Health Medicare |
$5.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: Railroad Medicare Medicare |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.00
|
| Rate for Payer: UHC Core |
$18.03
|
| Rate for Payer: UHC Exchange |
$5.40
|
| Rate for Payer: UHC Medicaid |
$3.81
|
| Rate for Payer: UHC Medicare Advantage |
$5.40
|
| Rate for Payer: UHCCP Medicaid |
$3.81
|
| Rate for Payer: VA VA |
$5.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.40
|
| Rate for Payer: BCN Commercial |
$29.40
|
| 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 Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| 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
|
OP
|
$23.81
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna Medicare |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.44
|
| Rate for Payer: BCBS Complete |
$4.41
|
| Rate for Payer: BCBS MAPPO |
$5.95
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCN Commercial |
$19.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.95
|
| 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: Health Alliance Plan Medicare Advantage |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.86
|
| Rate for Payer: Mclaren Medicaid |
$4.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.25
|
| Rate for Payer: Meridian Medicaid |
$4.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.24
|
| Rate for Payer: Nomi Health Commercial |
$19.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.86
|
| Rate for Payer: PACE Senior Care Partners |
$5.65
|
| Rate for Payer: PACE SWMI |
$5.95
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicare Advantage |
$5.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.71
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.95
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Exchange |
$5.95
|
| Rate for Payer: UHC Medicaid |
$4.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.95
|
| Rate for Payer: UHCCP Medicaid |
$4.20
|
| Rate for Payer: VA VA |
$5.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.86
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.40
|
| Rate for Payer: BCN Commercial |
$29.40
|
| 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 Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.78
|
| 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
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.83
|
| Rate for Payer: BCN Commercial |
$17.83
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Nomi Health Commercial |
$17.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.00
|
| Rate for Payer: UHC Core |
$18.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$5.40
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Mclaren Medicaid |
$3.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.67
|
| Rate for Payer: Meridian Medicaid |
$4.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Nomi Health Commercial |
$17.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PACE Senior Care Partners |
$5.13
|
| Rate for Payer: PACE SWMI |
$5.40
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.78
|
| Rate for Payer: Priority Health Medicare |
$5.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: Railroad Medicare Medicare |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.00
|
| Rate for Payer: UHC Core |
$18.03
|
| Rate for Payer: UHC Exchange |
$5.40
|
| Rate for Payer: UHC Medicaid |
$3.81
|
| Rate for Payer: UHC Medicare Advantage |
$5.40
|
| Rate for Payer: UHCCP Medicaid |
$3.81
|
| Rate for Payer: VA VA |
$5.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
