|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$39.40
|
| Rate for Payer: BCN Commercial |
$39.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$8.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$8.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.36
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicaid |
$8.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$8.45
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna Medicare |
$111.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.57
|
| Rate for Payer: BCBS Complete |
$79.71
|
| Rate for Payer: BCBS MAPPO |
$107.66
|
| Rate for Payer: BCBS Trust/PPO |
$354.01
|
| Rate for Payer: BCN Commercial |
$354.01
|
| Rate for Payer: BCN Medicare Advantage |
$107.66
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.66
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Mclaren Medicaid |
$75.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.04
|
| Rate for Payer: Meridian Medicaid |
$79.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.96
|
| Rate for Payer: PACE Senior Care Partners |
$102.27
|
| Rate for Payer: PACE SWMI |
$107.66
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: PHP Medicare Advantage |
$107.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Medicare |
$108.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.71
|
| Rate for Payer: Railroad Medicare Medicare |
$107.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: UHC Exchange |
$107.66
|
| Rate for Payer: UHC Medicaid |
$75.92
|
| Rate for Payer: UHC Medicare Advantage |
$107.66
|
| Rate for Payer: UHCCP Medicaid |
$75.92
|
| Rate for Payer: VA VA |
$107.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$299.71 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: BCBS Trust/PPO |
$355.65
|
| Rate for Payer: BCN Commercial |
$355.65
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.96
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.42
|
| Rate for Payer: BCBS Complete |
$15.65
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$69.51
|
| Rate for Payer: BCN Commercial |
$69.51
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: Meridian Medicaid |
$15.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.41
|
| Rate for Payer: PACE Senior Care Partners |
$20.08
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: UHC Exchange |
$21.14
|
| Rate for Payer: UHC Medicaid |
$14.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.14
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: VA VA |
$21.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$39.59
|
| Rate for Payer: BCN Commercial |
$39.59
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna Commercial |
$42.02
|
| Rate for Payer: BCBS Trust/PPO |
$40.83
|
| Rate for Payer: BCN Commercial |
$40.83
|
| 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: Healthscope Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.08
|
| 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: PHP Commercial |
$42.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.51
|
| Rate for Payer: UHC Core |
$41.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.08
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: BCBS Trust/PPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.41
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.85 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: BCBS Trust/PPO |
$190.87
|
| Rate for Payer: BCN Commercial |
$190.87
|
| 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: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| 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: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.95 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: BCBS Trust/PPO |
$195.74
|
| Rate for Payer: BCN Commercial |
$195.74
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.96
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: BCBS Trust/PPO |
$77.60
|
| Rate for Payer: BCN Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Nomi Health Commercial |
$77.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.68
|
| Rate for Payer: UHC Core |
$78.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$199.32 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: BCBS Trust/PPO |
$236.52
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.01
|
| Rate for Payer: UHC Core |
$239.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.78 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.06
|
| Rate for Payer: BCBS Complete |
$43.87
|
| Rate for Payer: BCBS MAPPO |
$59.25
|
| Rate for Payer: BCBS Trust/PPO |
$194.84
|
| Rate for Payer: BCN Commercial |
$194.84
|
| Rate for Payer: BCN Medicare Advantage |
$59.25
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.25
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Mclaren Medicaid |
$41.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.21
|
| Rate for Payer: Meridian Medicaid |
$43.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PACE Senior Care Partners |
$56.29
|
| Rate for Payer: PACE SWMI |
$59.25
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: PHP Medicare Advantage |
$59.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.19
|
| Rate for Payer: Priority Health Medicare |
$59.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.95
|
| Rate for Payer: Railroad Medicare Medicare |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: UHC Exchange |
$59.25
|
| Rate for Payer: UHC Medicaid |
$41.78
|
| Rate for Payer: UHC Medicare Advantage |
$59.25
|
| Rate for Payer: UHCCP Medicaid |
$41.78
|
| Rate for Payer: VA VA |
$59.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.96
|
|
|
Service Code
|
NDC 63323088401
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$24.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.36
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: BCBS MAPPO |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$77.24
|
| Rate for Payer: BCN Commercial |
$77.24
|
| Rate for Payer: BCN Medicare Advantage |
$23.49
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: Mclaren Medicaid |
$16.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.66
|
| Rate for Payer: Meridian Medicaid |
$17.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Nomi Health Commercial |
$77.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PACE Senior Care Partners |
$22.32
|
| Rate for Payer: PACE SWMI |
$23.49
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: PHP Medicare Advantage |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.75
|
| Rate for Payer: Priority Health Medicare |
$23.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.40
|
| Rate for Payer: Railroad Medicare Medicare |
$23.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.68
|
| Rate for Payer: UHC Core |
$78.46
|
| Rate for Payer: UHC Exchange |
$23.49
|
| Rate for Payer: UHC Medicaid |
$16.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.49
|
| Rate for Payer: UHCCP Medicaid |
$16.57
|
| Rate for Payer: VA VA |
$23.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.96
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$24.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.36
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: BCBS MAPPO |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$77.24
|
| Rate for Payer: BCN Commercial |
$77.24
|
| Rate for Payer: BCN Medicare Advantage |
$23.49
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: Mclaren Medicaid |
$16.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.66
|
| Rate for Payer: Meridian Medicaid |
$17.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Nomi Health Commercial |
$77.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PACE Senior Care Partners |
$22.32
|
| Rate for Payer: PACE SWMI |
$23.49
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: PHP Medicare Advantage |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.75
|
| Rate for Payer: Priority Health Medicare |
$23.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.40
|
| Rate for Payer: Railroad Medicare Medicare |
$23.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.68
|
| Rate for Payer: UHC Core |
$78.46
|
| Rate for Payer: UHC Exchange |
$23.49
|
| Rate for Payer: UHC Medicaid |
$16.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.49
|
| Rate for Payer: UHCCP Medicaid |
$16.57
|
| Rate for Payer: VA VA |
$23.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.78 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.06
|
| Rate for Payer: BCBS Complete |
$43.87
|
| Rate for Payer: BCBS MAPPO |
$59.25
|
| Rate for Payer: BCBS Trust/PPO |
$194.84
|
| Rate for Payer: BCN Commercial |
$194.84
|
| Rate for Payer: BCN Medicare Advantage |
$59.25
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.25
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Mclaren Medicaid |
$41.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.21
|
| Rate for Payer: Meridian Medicaid |
$43.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PACE Senior Care Partners |
$56.29
|
| Rate for Payer: PACE SWMI |
$59.25
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: PHP Medicare Advantage |
$59.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.19
|
| Rate for Payer: Priority Health Medicare |
$59.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.95
|
| Rate for Payer: Railroad Medicare Medicare |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: UHC Exchange |
$59.25
|
| Rate for Payer: UHC Medicaid |
$41.78
|
| Rate for Payer: UHC Medicare Advantage |
$59.25
|
| Rate for Payer: UHCCP Medicaid |
$41.78
|
| Rate for Payer: VA VA |
$59.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.95 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: BCBS Trust/PPO |
$195.74
|
| Rate for Payer: BCN Commercial |
$195.74
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$206.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: Aetna Medicare |
$74.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.49
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS MAPPO |
$71.59
|
| Rate for Payer: BCBS Trust/PPO |
$235.43
|
| Rate for Payer: BCN Commercial |
$235.43
|
| Rate for Payer: BCN Medicare Advantage |
$71.59
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.59
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: Mclaren Medicaid |
$50.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.17
|
| Rate for Payer: Meridian Medicaid |
$53.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PACE Senior Care Partners |
$68.02
|
| Rate for Payer: PACE SWMI |
$71.59
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: PHP Medicare Advantage |
$71.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.15
|
| Rate for Payer: Priority Health Medicare |
$72.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.32
|
| Rate for Payer: Railroad Medicare Medicare |
$71.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.01
|
| Rate for Payer: UHC Core |
$239.13
|
| Rate for Payer: UHC Exchange |
$71.59
|
| Rate for Payer: UHC Medicaid |
$50.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.59
|
| Rate for Payer: UHCCP Medicaid |
$50.49
|
| Rate for Payer: VA VA |
$71.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.96
|
|
|
Service Code
|
NDC 63323088401
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: BCBS Trust/PPO |
$77.60
|
| Rate for Payer: BCN Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Nomi Health Commercial |
$77.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.68
|
| Rate for Payer: UHC Core |
$78.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$199.32 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: BCBS Trust/PPO |
$236.52
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.01
|
| Rate for Payer: UHC Core |
$239.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: Aetna Medicare |
$74.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.49
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS MAPPO |
$71.59
|
| Rate for Payer: BCBS Trust/PPO |
$235.43
|
| Rate for Payer: BCN Commercial |
$235.43
|
| Rate for Payer: BCN Medicare Advantage |
$71.59
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.59
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: Mclaren Medicaid |
$50.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.17
|
| Rate for Payer: Meridian Medicaid |
$53.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PACE Senior Care Partners |
$68.02
|
| Rate for Payer: PACE SWMI |
$71.59
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: PHP Medicare Advantage |
$71.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.15
|
| Rate for Payer: Priority Health Medicare |
$72.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.32
|
| Rate for Payer: Railroad Medicare Medicare |
$71.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.01
|
| Rate for Payer: UHC Core |
$239.13
|
| Rate for Payer: UHC Exchange |
$71.59
|
| Rate for Payer: UHC Medicaid |
$50.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.59
|
| Rate for Payer: UHCCP Medicaid |
$50.49
|
| Rate for Payer: VA VA |
$71.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.82
|
| Rate for Payer: BCN Commercial |
$25.82
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Nomi Health Commercial |
$25.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.75
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS MAPPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$28.27
|
| Rate for Payer: BCN Commercial |
$28.27
|
| Rate for Payer: BCN Medicare Advantage |
$8.60
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Mclaren Medicaid |
$6.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.03
|
| Rate for Payer: Meridian Medicaid |
$6.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Nomi Health Commercial |
$28.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.79
|
| Rate for Payer: PACE Senior Care Partners |
$8.17
|
| Rate for Payer: PACE SWMI |
$8.60
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: PHP Medicare Advantage |
$8.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.92
|
| Rate for Payer: Priority Health Medicare |
$8.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$28.72
|
| Rate for Payer: UHC Exchange |
$8.60
|
| Rate for Payer: UHC Medicaid |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$8.60
|
| Rate for Payer: UHCCP Medicaid |
$6.06
|
| Rate for Payer: VA VA |
$8.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.77
|
| Rate for Payer: BCBS Complete |
$5.79
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$25.70
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Mclaren Medicaid |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Nomi Health Commercial |
$25.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PACE Senior Care Partners |
$7.42
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.20
|
| Rate for Payer: Priority Health Medicare |
$7.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Medicaid |
$5.51
|
| Rate for Payer: UHC Medicare Advantage |
$7.82
|
| Rate for Payer: UHCCP Medicaid |
$5.51
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: BCBS Trust/PPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Nomi Health Commercial |
$28.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.79
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$43.77
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$39.39 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.68
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$35.98
|
| Rate for Payer: BCN Commercial |
$35.98
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$37.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$39.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.83
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| Rate for Payer: Meridian Medicaid |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.20
|
| Rate for Payer: Nomi Health Commercial |
$35.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.83
|
| Rate for Payer: PACE Senior Care Partners |
$10.40
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PHP Commercial |
$37.20
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.08
|
| Rate for Payer: Priority Health Medicare |
$11.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.46
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.52
|
| Rate for Payer: UHC Core |
$36.55
|
| Rate for Payer: UHC Exchange |
$10.94
|
| Rate for Payer: UHC Medicaid |
$7.72
|
| Rate for Payer: UHC Medicare Advantage |
$10.94
|
| Rate for Payer: UHCCP Medicaid |
$7.72
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.83
|
|
