|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$51.84
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.20
|
| Rate for Payer: BCBS Complete |
$20.74
|
| Rate for Payer: BCBS MAPPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$42.62
|
| Rate for Payer: BCN Commercial |
$40.31
|
| Rate for Payer: BCN Medicare Advantage |
$12.96
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: PACE Senior Care Partners |
$12.31
|
| Rate for Payer: PACE SWMI |
$12.96
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: Priority Health HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: Railroad Medicare Medicare |
$12.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.96
|
| Rate for Payer: UHC Exchange |
$12.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.96
|
| Rate for Payer: VA VA |
$12.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$51.84
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$42.32
|
| Rate for Payer: BCN Commercial |
$40.06
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: Priority Health HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$51.84
|
|
|
Service Code
|
NDC 10119000738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$42.32
|
| Rate for Payer: BCN Commercial |
$40.06
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: Priority Health HMO/PPO |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.62
|
| Rate for Payer: UHC Core |
$43.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| 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 |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| 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 Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| 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 Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.65
|
| Rate for Payer: BCBS Complete |
$2.11
|
| Rate for Payer: BCBS MAPPO |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.32
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.25
|
| Rate for Payer: PACE SWMI |
$1.32
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: PHP Medicare Advantage |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: Priority Health HMO/PPO |
$4.59
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$4.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UHC Medicare Advantage |
$1.32
|
| Rate for Payer: VA VA |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: Priority Health HMO/PPO |
$4.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: BCBS Trust/PPO |
$43.88
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health HMO/PPO |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$13.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$41.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health HMO/PPO |
$46.76
|
| Rate for Payer: Priority Health Medicare |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Exchange |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.75
|
|
|
Service Code
|
NDC 00487930133
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.69
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: PHP Medicare Advantage |
$0.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2.39
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.69
|
| Rate for Payer: VA VA |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.78
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.62
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.62
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.62
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.16
|
| Rate for Payer: Priority Health Medicare |
$0.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.66
|
| Rate for Payer: Railroad Medicare Medicare |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.62
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.86
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.86
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.75
|
|
|
Service Code
|
NDC 00487930133
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 00378698501
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.44
|
| Rate for Payer: BCN Medicare Advantage |
$0.79
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.79
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: PACE Senior Care Partners |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.79
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2.73
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Medicare Advantage |
$0.79
|
| Rate for Payer: VA VA |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 00487930103
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.86
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.86
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.93
|
| Rate for Payer: UHC Core |
$1.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.64
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
NDC 00487930103
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.75
|
| Rate for Payer: Healthscope Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.86
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.93
|
| Rate for Payer: UHC Core |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.64
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 00378698501
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health HMO/PPO |
$2.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
180423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
180423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| 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 |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| 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 Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| 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 Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 2X MAINTENANCE SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
300194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 2X MAINTENANCE SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
300194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| 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 |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| 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 Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| 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 Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$41.47
|
|
|
Service Code
|
NDC 00338055318
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$33.85
|
| Rate for Payer: BCN Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health HMO/PPO |
$36.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.49
|
| Rate for Payer: UHC Core |
$34.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$41.47
|
|
|
Service Code
|
NDC 00338055318
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.09
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: PACE Senior Care Partners |
$9.85
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health HMO/PPO |
$36.08
|
| Rate for Payer: Priority Health Medicare |
$10.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.78
|
| Rate for Payer: Railroad Medicare Medicare |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.49
|
| Rate for Payer: UHC Core |
$34.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.37
|
| Rate for Payer: UHC Exchange |
$10.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.37
|
| Rate for Payer: VA VA |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK HOSPIRA/PFIZER CUSTOM
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 00409710169
|
| Hospital Charge Code |
301508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.94
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.36
|
| Rate for Payer: BCN Commercial |
$57.08
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Nomi Health Commercial |
$60.20
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.61
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK HOSPIRA/PFIZER CUSTOM
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 00409710169
|
| Hospital Charge Code |
301508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: BCBS Trust/PPO |
$59.93
|
| Rate for Payer: BCN Commercial |
$56.74
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Nomi Health Commercial |
$60.20
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health HMO/PPO |
$63.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.61
|
| Rate for Payer: UHC Core |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
