|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
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
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: BCBS Trust/PPO |
$122.03
|
| Rate for Payer: BCN Commercial |
$122.03
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.02
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.17
|
| Rate for Payer: BCBS Complete |
$27.35
|
| Rate for Payer: BCBS MAPPO |
$36.94
|
| Rate for Payer: BCBS Trust/PPO |
$121.47
|
| Rate for Payer: BCN Commercial |
$121.47
|
| Rate for Payer: BCN Medicare Advantage |
$36.94
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.94
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Mclaren Medicaid |
$26.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.78
|
| Rate for Payer: Meridian Medicaid |
$27.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PACE Senior Care Partners |
$35.09
|
| Rate for Payer: PACE SWMI |
$36.94
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: PHP Medicare Advantage |
$36.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.54
|
| Rate for Payer: Priority Health Medicare |
$37.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.83
|
| Rate for Payer: Railroad Medicare Medicare |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.02
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Exchange |
$36.94
|
| Rate for Payer: UHC Medicaid |
$26.05
|
| Rate for Payer: UHC Medicare Advantage |
$36.94
|
| Rate for Payer: UHCCP Medicaid |
$26.05
|
| Rate for Payer: VA VA |
$36.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.65
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$4.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.15
|
| Rate for Payer: BCN Commercial |
$16.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.91
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.91
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.16
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PACE Senior Care Partners |
$4.67
|
| Rate for Payer: PACE SWMI |
$4.91
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.10
|
| Rate for Payer: Priority Health Medicare |
$4.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: UHC Exchange |
$4.91
|
| Rate for Payer: UHC Medicaid |
$3.46
|
| Rate for Payer: UHC Medicare Advantage |
$4.91
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.49
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS MAPPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.11
|
| Rate for Payer: BCN Commercial |
$38.11
|
| Rate for Payer: BCN Medicare Advantage |
$11.59
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Mclaren Medicaid |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.17
|
| Rate for Payer: Meridian Medicaid |
$8.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PACE Senior Care Partners |
$11.01
|
| Rate for Payer: PACE SWMI |
$11.59
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: PHP Medicare Advantage |
$11.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Medicaid |
$8.17
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: UHCCP Medicaid |
$8.17
|
| Rate for Payer: VA VA |
$11.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.65
|
|
|
Service Code
|
NDC 00121059500
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$16.23
|
| Rate for Payer: BCN Commercial |
$16.23
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: BCBS Trust/PPO |
$38.29
|
| Rate for Payer: BCN Commercial |
$38.29
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.65
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$16.23
|
| Rate for Payer: BCN Commercial |
$16.23
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.65
|
|
|
Service Code
|
NDC 00121059500
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$4.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.15
|
| Rate for Payer: BCN Commercial |
$16.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.91
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.91
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.16
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PACE Senior Care Partners |
$4.67
|
| Rate for Payer: PACE SWMI |
$4.91
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: PHP Medicare Advantage |
$4.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.10
|
| Rate for Payer: Priority Health Medicare |
$4.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: UHC Exchange |
$4.91
|
| Rate for Payer: UHC Medicaid |
$3.46
|
| Rate for Payer: UHC Medicare Advantage |
$4.91
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna Medicare |
$77.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.52
|
| Rate for Payer: BCBS Complete |
$55.39
|
| Rate for Payer: BCBS MAPPO |
$74.81
|
| Rate for Payer: BCBS Trust/PPO |
$246.01
|
| Rate for Payer: BCN Commercial |
$246.01
|
| Rate for Payer: BCN Medicare Advantage |
$74.81
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.81
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Mclaren Medicaid |
$52.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.55
|
| Rate for Payer: Meridian Medicaid |
$55.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PACE Senior Care Partners |
$71.07
|
| Rate for Payer: PACE SWMI |
$74.81
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$260.35
|
| Rate for Payer: Priority Health Medicare |
$75.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.28
|
| Rate for Payer: Railroad Medicare Medicare |
$74.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.34
|
| Rate for Payer: UHC Core |
$249.87
|
| Rate for Payer: UHC Exchange |
$74.81
|
| Rate for Payer: UHC Medicaid |
$52.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.81
|
| Rate for Payer: UHCCP Medicaid |
$52.76
|
| Rate for Payer: VA VA |
$74.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$131.91
|
|
|
Service Code
|
NDC 68084076425
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: Aetna Medicare |
$34.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.22
|
| Rate for Payer: BCBS Complete |
$24.42
|
| Rate for Payer: BCBS MAPPO |
$32.98
|
| Rate for Payer: BCBS Trust/PPO |
$108.44
|
| Rate for Payer: BCN Commercial |
$108.44
|
| Rate for Payer: BCN Medicare Advantage |
$32.98
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.98
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Mclaren Medicaid |
$23.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.63
|
| Rate for Payer: Meridian Medicaid |
$24.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Nomi Health Commercial |
$108.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.93
|
| Rate for Payer: PACE Senior Care Partners |
$31.33
|
| Rate for Payer: PACE SWMI |
$32.98
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: PHP Medicare Advantage |
$32.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.76
|
| Rate for Payer: Priority Health Medicare |
$33.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.81
|
| Rate for Payer: Railroad Medicare Medicare |
$32.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.08
|
| Rate for Payer: UHC Core |
$110.14
|
| Rate for Payer: UHC Exchange |
$32.98
|
| Rate for Payer: UHC Medicaid |
$23.26
|
| Rate for Payer: UHC Medicare Advantage |
$32.98
|
| Rate for Payer: UHCCP Medicaid |
$23.26
|
| Rate for Payer: VA VA |
$32.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 68084076495
|
| Hospital Charge Code |
11067
|
|
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 DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: BCBS Trust/PPO |
$247.15
|
| Rate for Payer: BCN Commercial |
$247.15
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$260.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.34
|
| Rate for Payer: UHC Core |
$249.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 68084076495
|
| Hospital Charge Code |
11067
|
|
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 DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$131.91
|
|
|
Service Code
|
NDC 68084076425
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.81 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: BCBS Trust/PPO |
$108.94
|
| Rate for Payer: BCN Commercial |
$108.94
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Nomi Health Commercial |
$108.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.93
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.08
|
| Rate for Payer: UHC Core |
$110.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna Medicare |
$35.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$34.49
|
| Rate for Payer: BCBS MAPPO |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$113.43
|
| Rate for Payer: BCBS Trust/PPO |
$29.00
|
| Rate for Payer: BCN Commercial |
$29.00
|
| Rate for Payer: BCN Commercial |
$113.43
|
| Rate for Payer: BCN Medicare Advantage |
$8.82
|
| Rate for Payer: BCN Medicare Advantage |
$34.49
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.49
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Mclaren Medicaid |
$6.22
|
| Rate for Payer: Mclaren Medicaid |
$24.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.22
|
| Rate for Payer: Meridian Medicaid |
$25.54
|
| Rate for Payer: Meridian Medicaid |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Nomi Health Commercial |
$28.92
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PACE Senior Care Partners |
$8.38
|
| Rate for Payer: PACE Senior Care Partners |
$32.77
|
| Rate for Payer: PACE SWMI |
$8.82
|
| Rate for Payer: PACE SWMI |
$34.49
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Medicare Advantage |
$34.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.04
|
| Rate for Payer: Priority Health Medicare |
$8.91
|
| Rate for Payer: Priority Health Medicare |
$34.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.55
|
| Rate for Payer: Railroad Medicare Medicare |
$34.49
|
| Rate for Payer: Railroad Medicare Medicare |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.04
|
| Rate for Payer: UHC Core |
$29.45
|
| Rate for Payer: UHC Core |
$115.21
|
| Rate for Payer: UHC Exchange |
$8.82
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Medicaid |
$6.22
|
| Rate for Payer: UHC Medicaid |
$24.33
|
| Rate for Payer: UHC Medicare Advantage |
$34.49
|
| Rate for Payer: UHC Medicare Advantage |
$8.82
|
| Rate for Payer: UHCCP Medicaid |
$24.33
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$34.49
|
| Rate for Payer: VA VA |
$8.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.03 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$113.96
|
| Rate for Payer: BCBS Trust/PPO |
$29.13
|
| Rate for Payer: BCN Commercial |
$113.96
|
| Rate for Payer: BCN Commercial |
$29.13
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$28.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.04
|
| Rate for Payer: UHC Core |
$115.21
|
| Rate for Payer: UHC Core |
$29.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$38.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.63
|
| Rate for Payer: BCBS Complete |
$27.62
|
| Rate for Payer: BCBS MAPPO |
$37.31
|
| Rate for Payer: BCBS Trust/PPO |
$122.68
|
| Rate for Payer: BCN Commercial |
$122.68
|
| Rate for Payer: BCN Medicare Advantage |
$37.31
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.31
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.17
|
| Rate for Payer: Meridian Medicaid |
$27.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Nomi Health Commercial |
$122.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PACE Senior Care Partners |
$35.44
|
| Rate for Payer: PACE SWMI |
$37.31
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.83
|
| Rate for Payer: Priority Health Medicare |
$37.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.86
|
| Rate for Payer: Railroad Medicare Medicare |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.32
|
| Rate for Payer: UHC Core |
$124.61
|
| Rate for Payer: UHC Exchange |
$37.31
|
| Rate for Payer: UHC Medicaid |
$26.31
|
| Rate for Payer: UHC Medicare Advantage |
$37.31
|
| Rate for Payer: UHCCP Medicaid |
$26.31
|
| Rate for Payer: VA VA |
$37.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.86 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: BCBS Trust/PPO |
$123.25
|
| Rate for Payer: BCN Commercial |
$123.25
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Nomi Health Commercial |
$122.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.32
|
| Rate for Payer: UHC Core |
$124.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
IP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.70 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: BCBS Trust/PPO |
$577.54
|
| Rate for Payer: BCN Commercial |
$577.54
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$573.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$608.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.37
|
| Rate for Payer: UHC Core |
$583.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
OP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.28 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: Aetna Medicare |
$181.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.53
|
| Rate for Payer: BCBS Complete |
$129.44
|
| Rate for Payer: BCBS MAPPO |
$174.82
|
| Rate for Payer: BCBS Trust/PPO |
$574.88
|
| Rate for Payer: BCN Commercial |
$574.88
|
| Rate for Payer: BCN Medicare Advantage |
$174.82
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.82
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Mclaren Medicaid |
$123.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.56
|
| Rate for Payer: Meridian Medicaid |
$129.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$573.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: PACE Senior Care Partners |
$166.08
|
| Rate for Payer: PACE SWMI |
$174.82
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: PHP Medicare Advantage |
$174.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$608.37
|
| Rate for Payer: Priority Health Medicare |
$176.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.70
|
| Rate for Payer: Railroad Medicare Medicare |
$174.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.37
|
| Rate for Payer: UHC Core |
$583.90
|
| Rate for Payer: UHC Exchange |
$174.82
|
| Rate for Payer: UHC Medicaid |
$123.28
|
| Rate for Payer: UHC Medicare Advantage |
$174.82
|
| Rate for Payer: UHCCP Medicaid |
$123.28
|
| Rate for Payer: VA VA |
$174.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.74 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.22
|
| Rate for Payer: BCBS Complete |
$42.78
|
| Rate for Payer: BCBS MAPPO |
$57.78
|
| Rate for Payer: BCBS Trust/PPO |
$190.00
|
| Rate for Payer: BCN Commercial |
$190.00
|
| Rate for Payer: BCN Medicare Advantage |
$57.78
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Mclaren Medicaid |
$40.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.67
|
| Rate for Payer: Meridian Medicaid |
$42.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: PACE Senior Care Partners |
$54.89
|
| Rate for Payer: PACE SWMI |
$57.78
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: PHP Medicare Advantage |
$57.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Medicare |
$58.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.85
|
| Rate for Payer: Railroad Medicare Medicare |
$57.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: UHC Exchange |
$57.78
|
| Rate for Payer: UHC Medicaid |
$40.74
|
| Rate for Payer: UHC Medicare Advantage |
$57.78
|
| Rate for Payer: UHCCP Medicaid |
$40.74
|
| Rate for Payer: VA VA |
$57.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$76.59
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Medicare |
$19.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.93
|
| Rate for Payer: BCBS Complete |
$14.18
|
| Rate for Payer: BCBS MAPPO |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$62.96
|
| Rate for Payer: BCN Commercial |
$62.96
|
| Rate for Payer: BCN Medicare Advantage |
$19.15
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Mclaren Medicaid |
$13.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.10
|
| Rate for Payer: Meridian Medicaid |
$14.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Nomi Health Commercial |
$62.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PACE Senior Care Partners |
$18.19
|
| Rate for Payer: PACE SWMI |
$19.15
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: PHP Medicare Advantage |
$19.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.63
|
| Rate for Payer: Priority Health Medicare |
$19.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.40
|
| Rate for Payer: UHC Core |
$63.95
|
| Rate for Payer: UHC Exchange |
$19.15
|
| Rate for Payer: UHC Medicaid |
$13.50
|
| Rate for Payer: UHC Medicare Advantage |
$19.15
|
| Rate for Payer: UHCCP Medicaid |
$13.50
|
| Rate for Payer: VA VA |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna Commercial |
$42.02
|
| Rate for Payer: Aetna Medicare |
$12.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.45
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$40.64
|
| Rate for Payer: BCN Commercial |
$40.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.36
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cofinity Commercial |
$42.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.08
|
| Rate for Payer: Mclaren Medicaid |
$8.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.98
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.02
|
| Rate for Payer: Nomi Health Commercial |
$40.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.08
|
| Rate for Payer: PACE Senior Care Partners |
$11.74
|
| Rate for Payer: PACE SWMI |
$12.36
|
| Rate for Payer: PHP Commercial |
$42.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.01
|
| Rate for Payer: Priority Health Medicare |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.41
|
| Rate for Payer: Railroad Medicare Medicare |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.51
|
| Rate for Payer: UHC Core |
$41.28
|
| Rate for Payer: UHC Exchange |
$12.36
|
| Rate for Payer: UHC Medicaid |
$8.72
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: UHCCP Medicaid |
$8.72
|
| Rate for Payer: VA VA |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.08
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.26
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Nomi Health Commercial |
$62.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.40
|
| Rate for Payer: UHC Core |
$63.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
