|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$46.24
|
| Rate for Payer: BCN Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.22
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS MAPPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCBS Trust/PPO |
$68.98
|
| Rate for Payer: BCN Commercial |
$68.98
|
| Rate for Payer: BCN Commercial |
$47.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Mclaren Medicaid |
$14.79
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: Meridian Medicaid |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PACE Senior Care Partners |
$19.93
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$20.98
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: PHP Medicare Advantage |
$20.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: Railroad Medicare Medicare |
$20.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Core |
$70.06
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Exchange |
$20.98
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicaid |
$14.79
|
| Rate for Payer: UHC Medicaid |
$10.27
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$20.98
|
| Rate for Payer: UHCCP Medicaid |
$10.27
|
| Rate for Payer: UHCCP Medicaid |
$14.79
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: VA VA |
$20.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: BCBS Trust/PPO |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$69.30
|
| Rate for Payer: BCN Commercial |
$48.09
|
| Rate for Payer: BCN Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Core |
$70.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Commercial |
$46.03
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Mclaren Medicaid |
$9.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.97
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: UHC Exchange |
$14.00
|
| Rate for Payer: UHC Medicaid |
$9.87
|
| Rate for Payer: UHC Medicare Advantage |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$9.87
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: BCBS Trust/PPO |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$69.30
|
| Rate for Payer: BCN Commercial |
$48.09
|
| Rate for Payer: BCN Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Core |
$70.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Commercial |
$46.03
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Mclaren Medicaid |
$9.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.97
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: UHC Exchange |
$14.00
|
| Rate for Payer: UHC Medicaid |
$9.87
|
| Rate for Payer: UHC Medicare Advantage |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$9.87
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.22
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS MAPPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCBS Trust/PPO |
$68.98
|
| Rate for Payer: BCN Commercial |
$68.98
|
| Rate for Payer: BCN Commercial |
$47.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Mclaren Medicaid |
$14.79
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: Meridian Medicaid |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PACE Senior Care Partners |
$19.93
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$20.98
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: PHP Medicare Advantage |
$20.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: Railroad Medicare Medicare |
$20.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Core |
$70.06
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Exchange |
$20.98
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicaid |
$14.79
|
| Rate for Payer: UHC Medicaid |
$10.27
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$20.98
|
| Rate for Payer: UHCCP Medicaid |
$10.27
|
| Rate for Payer: UHCCP Medicaid |
$14.79
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: VA VA |
$20.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$46.24
|
| Rate for Payer: BCN Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$55.24
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicaid |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHCCP Medicaid |
$11.85
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$55.49
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % TOPICAL SPRAY
|
Facility
|
IP
|
$23.52
|
|
|
Service Code
|
NDC 22600008552
|
| Hospital Charge Code |
109676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCN Commercial |
$19.43
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Nomi Health Commercial |
$19.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.70
|
| Rate for Payer: UHC Core |
$19.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
SODIUM CHLORIDE 0.9 % TOPICAL SPRAY
|
Facility
|
OP
|
$23.52
|
|
|
Service Code
|
NDC 22600008552
|
| Hospital Charge Code |
109676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| Rate for Payer: BCN Commercial |
$19.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: Mclaren Medicaid |
$4.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Nomi Health Commercial |
$19.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PACE Senior Care Partners |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.46
|
| Rate for Payer: Priority Health Medicare |
$5.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.70
|
| Rate for Payer: UHC Core |
$19.64
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicaid |
$4.15
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$4.15
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00904723961
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.20
|
| Rate for Payer: BCBS Complete |
$39.21
|
| Rate for Payer: BCBS MAPPO |
$52.96
|
| Rate for Payer: BCBS Trust/PPO |
$174.16
|
| Rate for Payer: BCN Commercial |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$52.96
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.96
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Mclaren Medicaid |
$37.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.61
|
| Rate for Payer: Meridian Medicaid |
$39.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PACE Senior Care Partners |
$50.31
|
| Rate for Payer: PACE SWMI |
$52.96
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: PHP Medicare Advantage |
$52.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Medicare |
$53.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| Rate for Payer: Railroad Medicare Medicare |
$52.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: UHC Exchange |
$52.96
|
| Rate for Payer: UHC Medicaid |
$37.35
|
| Rate for Payer: UHC Medicare Advantage |
$52.96
|
| Rate for Payer: UHCCP Medicaid |
$37.35
|
| Rate for Payer: VA VA |
$52.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Mclaren Medicaid |
$0.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Medicaid |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PACE Senior Care Partners |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.03
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicaid |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHCCP Medicaid |
$0.41
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904723961
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.45 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.97
|
| Rate for Payer: BCN Commercial |
$174.97
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 00487900330
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.46
|
| Rate for Payer: BCN Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.98
|
|
|
Service Code
|
NDC 00487900330
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.45
|
| Rate for Payer: BCN Commercial |
$2.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.75
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.75
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PACE Senior Care Partners |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.75
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: PHP Medicare Advantage |
$0.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.59
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.07
|
| Rate for Payer: Railroad Medicare Medicare |
$0.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.49
|
| Rate for Payer: UHC Exchange |
$0.75
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHC Medicare Advantage |
$0.75
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
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
|
|
