|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
302029
|
|
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
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
302029
|
|
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 51754500101
|
| 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
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Nomi Health Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.62
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Mclaren Medicaid |
$0.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Nomi Health Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.83
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicaid |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: UHCCP Medicaid |
$0.78
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.21
|
|
|
Service Code
|
NDC 00409663714
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$65.89 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$19.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.88
|
| Rate for Payer: BCBS Complete |
$13.55
|
| Rate for Payer: BCBS MAPPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$60.19
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.30
|
| Rate for Payer: Cash Price |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$62.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$65.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.91
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.22
|
| Rate for Payer: Meridian Medicaid |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.23
|
| Rate for Payer: Nomi Health Commercial |
$60.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.91
|
| Rate for Payer: PACE Senior Care Partners |
$17.39
|
| Rate for Payer: PACE SWMI |
$18.30
|
| Rate for Payer: PHP Commercial |
$62.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.69
|
| Rate for Payer: Priority Health Medicare |
$18.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.95
|
| Rate for Payer: Railroad Medicare Medicare |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.42
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: UHC Exchange |
$18.30
|
| Rate for Payer: UHC Medicaid |
$12.91
|
| Rate for Payer: UHC Medicare Advantage |
$18.30
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$18.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.91
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.21
|
|
|
Service Code
|
NDC 00409663724
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$65.89 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$19.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.88
|
| Rate for Payer: BCBS Complete |
$13.55
|
| Rate for Payer: BCBS MAPPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$60.19
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.30
|
| Rate for Payer: Cash Price |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$62.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$65.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.91
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.22
|
| Rate for Payer: Meridian Medicaid |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.23
|
| Rate for Payer: Nomi Health Commercial |
$60.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.91
|
| Rate for Payer: PACE Senior Care Partners |
$17.39
|
| Rate for Payer: PACE SWMI |
$18.30
|
| Rate for Payer: PHP Commercial |
$62.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.69
|
| Rate for Payer: Priority Health Medicare |
$18.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.95
|
| Rate for Payer: Railroad Medicare Medicare |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.42
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: UHC Exchange |
$18.30
|
| Rate for Payer: UHC Medicaid |
$12.91
|
| Rate for Payer: UHC Medicare Advantage |
$18.30
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$18.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.91
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.21
|
|
|
Service Code
|
NDC 00409663724
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$65.89 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$60.46
|
| Rate for Payer: BCN Commercial |
$60.46
|
| Rate for Payer: Cash Price |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$62.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.57
|
| Rate for Payer: Healthscope Commercial |
$65.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.23
|
| Rate for Payer: Nomi Health Commercial |
$60.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.91
|
| Rate for Payer: PHP Commercial |
$62.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.42
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.91
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$60.65
|
| Rate for Payer: BCN Commercial |
$60.65
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.62
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.37
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Mclaren Medicaid |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.62
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicaid |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.21
|
|
|
Service Code
|
NDC 00409663714
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$65.89 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$60.46
|
| Rate for Payer: BCN Commercial |
$60.46
|
| Rate for Payer: Cash Price |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$62.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.57
|
| Rate for Payer: Healthscope Commercial |
$65.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.23
|
| Rate for Payer: Nomi Health Commercial |
$60.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.91
|
| Rate for Payer: PHP Commercial |
$62.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.42
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.91
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$75.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.06
|
| Rate for Payer: BCBS Complete |
$53.94
|
| Rate for Payer: BCBS MAPPO |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$239.56
|
| Rate for Payer: BCN Commercial |
$239.56
|
| Rate for Payer: BCN Medicare Advantage |
$72.85
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Mclaren Medicaid |
$51.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.49
|
| Rate for Payer: Meridian Medicaid |
$53.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PACE Senior Care Partners |
$69.21
|
| Rate for Payer: PACE SWMI |
$72.85
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Medicare |
$73.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: Railroad Medicare Medicare |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: UHC Exchange |
$72.85
|
| Rate for Payer: UHC Medicaid |
$51.37
|
| Rate for Payer: UHC Medicare Advantage |
$72.85
|
| Rate for Payer: UHCCP Medicaid |
$51.37
|
| Rate for Payer: VA VA |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 00223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$41.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.94
|
| Rate for Payer: BCBS Complete |
$29.58
|
| Rate for Payer: BCBS MAPPO |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$131.37
|
| Rate for Payer: BCN Commercial |
$131.37
|
| Rate for Payer: BCN Medicare Advantage |
$39.95
|
| 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: Health Alliance Plan Medicare Advantage |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Mclaren Medicaid |
$28.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.95
|
| Rate for Payer: Meridian Medicaid |
$29.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: PACE Senior Care Partners |
$37.95
|
| Rate for Payer: PACE SWMI |
$39.95
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: PHP Medicare Advantage |
$39.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Medicare |
$40.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.22
|
| Rate for Payer: Railroad Medicare Medicare |
$39.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: UHC Exchange |
$39.95
|
| Rate for Payer: UHC Medicaid |
$28.17
|
| Rate for Payer: UHC Medicare Advantage |
$39.95
|
| Rate for Payer: UHCCP Medicaid |
$28.17
|
| Rate for Payer: VA VA |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 00223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.22 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: BCBS Trust/PPO |
$131.98
|
| Rate for Payer: BCN Commercial |
$131.98
|
| 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 Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.22
|
| 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
|
$291.40
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.81 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: BCBS Trust/PPO |
$240.67
|
| Rate for Payer: BCN Commercial |
$240.67
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
IP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$60.65
|
| Rate for Payer: BCN Commercial |
$60.65
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.62
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
OP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.37
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Mclaren Medicaid |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.62
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicaid |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$48.15
|
|
|
Service Code
|
NDC 00536122497
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Aetna Commercial |
$40.93
|
| Rate for Payer: BCBS Trust/PPO |
$39.77
|
| Rate for Payer: BCN Commercial |
$39.77
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.52
|
| Rate for Payer: Healthscope Commercial |
$43.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.93
|
| Rate for Payer: Nomi Health Commercial |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.11
|
| Rate for Payer: PHP Commercial |
$40.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.37
|
| Rate for Payer: UHC Core |
$40.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.11
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$51.84
|
|
|
Service Code
|
NDC 10119000738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$42.62
|
| Rate for Payer: BCN Commercial |
$42.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.96
|
| 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: Health Alliance Plan Medicare Advantage |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Mclaren Medicaid |
$9.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.61
|
| Rate for Payer: Meridian Medicaid |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.88
|
| Rate for Payer: PACE Senior Care Partners |
$12.31
|
| Rate for Payer: PACE SWMI |
$12.96
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: UHC Exchange |
$12.96
|
| Rate for Payer: UHC Medicaid |
$9.14
|
| Rate for Payer: UHC Medicare Advantage |
$12.96
|
| Rate for Payer: UHCCP Medicaid |
$9.14
|
| Rate for Payer: VA VA |
$12.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$48.15
|
|
|
Service Code
|
NDC 00536122497
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Aetna Commercial |
$40.93
|
| Rate for Payer: Aetna Medicare |
$12.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.05
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: BCN Medicare Advantage |
$12.04
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$43.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.11
|
| Rate for Payer: Mclaren Medicaid |
$8.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.64
|
| Rate for Payer: Meridian Medicaid |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.93
|
| Rate for Payer: Nomi Health Commercial |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.11
|
| Rate for Payer: PACE Senior Care Partners |
$11.44
|
| Rate for Payer: PACE SWMI |
$12.04
|
| Rate for Payer: PHP Commercial |
$40.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.89
|
| Rate for Payer: Priority Health Medicare |
$12.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.51
|
| Rate for Payer: Railroad Medicare Medicare |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.37
|
| Rate for Payer: UHC Core |
$40.21
|
| Rate for Payer: UHC Exchange |
$12.04
|
| Rate for Payer: UHC Medicaid |
$8.49
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: UHCCP Medicaid |
$8.49
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.11
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$51.84
|
|
|
Service Code
|
NDC 10119000738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$42.81
|
| Rate for Payer: BCN Commercial |
$42.81
|
| 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 Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.88
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.08
|
| 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 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$42.81
|
| Rate for Payer: BCN Commercial |
$42.81
|
| 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 Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.88
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.08
|
| 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
|
OP
|
$51.84
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$42.62
|
| Rate for Payer: BCN Commercial |
$42.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.96
|
| 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: Health Alliance Plan Medicare Advantage |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Mclaren Medicaid |
$9.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.61
|
| Rate for Payer: Meridian Medicaid |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.88
|
| Rate for Payer: PACE Senior Care Partners |
$12.31
|
| Rate for Payer: PACE SWMI |
$12.96
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: UHC Exchange |
$12.96
|
| Rate for Payer: UHC Medicaid |
$9.14
|
| Rate for Payer: UHC Medicare Advantage |
$12.96
|
| Rate for Payer: UHCCP Medicaid |
$9.14
|
| Rate for Payer: VA VA |
$12.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
