|
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 % 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
|
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 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 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
|
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 HOSPIRA/PFIZER CUSTOM
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 00409710167
|
| 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
|
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK HOSPIRA/PFIZER CUSTOM
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 00409710167
|
| 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 SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
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 Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$45.70
|
| Rate for Payer: BCN Commercial |
$43.27
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Commercial |
$43.53
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health HMO/PPO |
$48.71
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Exchange |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.00
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.46
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: BCBS Trust/PPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$33.84
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$48.46
|
| Rate for Payer: BCN Commercial |
$32.04
|
| Rate for Payer: BCN Commercial |
$49.33
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cash Price |
$51.06
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Commercial |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.06
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$37.31
|
| Rate for Payer: Healthscope Commercial |
$57.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$51.42
|
| Rate for Payer: Nomi Health Commercial |
$52.34
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health HMO/PPO |
$55.53
|
| Rate for Payer: Priority Health HMO/PPO |
$54.56
|
| Rate for Payer: Priority Health HMO/PPO |
$36.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.48
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: UHC Core |
$53.30
|
| Rate for Payer: UHC Core |
$52.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.46
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.95
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$16.58
|
| Rate for Payer: BCBS Complete |
$25.53
|
| Rate for Payer: BCBS MAPPO |
$15.96
|
| Rate for Payer: BCBS MAPPO |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$52.47
|
| Rate for Payer: BCN Commercial |
$48.76
|
| Rate for Payer: BCN Commercial |
$49.63
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: BCN Medicare Advantage |
$10.36
|
| Rate for Payer: BCN Medicare Advantage |
$15.68
|
| Rate for Payer: BCN Medicare Advantage |
$15.96
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$51.06
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Commercial |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$37.31
|
| Rate for Payer: Healthscope Commercial |
$57.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Nomi Health Commercial |
$52.34
|
| Rate for Payer: Nomi Health Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$51.42
|
| Rate for Payer: PACE Senior Care Partners |
$15.16
|
| Rate for Payer: PACE Senior Care Partners |
$9.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.89
|
| Rate for Payer: PACE SWMI |
$15.68
|
| Rate for Payer: PACE SWMI |
$10.36
|
| Rate for Payer: PACE SWMI |
$15.96
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: PHP Medicare Advantage |
$15.68
|
| Rate for Payer: PHP Medicare Advantage |
$15.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health HMO/PPO |
$55.53
|
| Rate for Payer: Priority Health HMO/PPO |
$36.07
|
| Rate for Payer: Priority Health HMO/PPO |
$54.56
|
| Rate for Payer: Priority Health Medicare |
$10.47
|
| Rate for Payer: Priority Health Medicare |
$16.12
|
| Rate for Payer: Priority Health Medicare |
$15.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15.96
|
| Rate for Payer: Railroad Medicare Medicare |
$10.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.48
|
| Rate for Payer: UHC Core |
$53.30
|
| Rate for Payer: UHC Core |
$52.36
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.68
|
| Rate for Payer: UHC Exchange |
$15.68
|
| Rate for Payer: UHC Exchange |
$10.36
|
| Rate for Payer: UHC Exchange |
$15.96
|
| Rate for Payer: UHC Medicare Advantage |
$10.36
|
| Rate for Payer: UHC Medicare Advantage |
$15.68
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.68
|
| Rate for Payer: VA VA |
$15.96
|
| Rate for Payer: VA VA |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338004803
|
| Hospital Charge Code |
11403
|
|
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 0.9 % IRRIGATION SOLUTION
|
Facility
|
OP
|
$142.38
|
|
|
Service Code
|
NDC 00338004747
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$128.14 |
| Rate for Payer: Aetna Commercial |
$121.02
|
| Rate for Payer: Aetna Medicare |
$37.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.49
|
| Rate for Payer: BCBS Complete |
$56.95
|
| Rate for Payer: BCBS MAPPO |
$35.60
|
| Rate for Payer: BCBS Trust/PPO |
$117.05
|
| Rate for Payer: BCN Commercial |
$110.70
|
| Rate for Payer: BCN Medicare Advantage |
$35.60
|
| Rate for Payer: Cash Price |
$113.90
|
| Rate for Payer: Cofinity Commercial |
$122.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.60
|
| Rate for Payer: Healthscope Commercial |
$128.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.02
|
| Rate for Payer: Nomi Health Commercial |
$116.75
|
| Rate for Payer: PACE Senior Care Partners |
$33.82
|
| Rate for Payer: PACE SWMI |
$35.60
|
| Rate for Payer: PHP Commercial |
$121.02
|
| Rate for Payer: PHP Medicare Advantage |
$35.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.55
|
| Rate for Payer: Priority Health HMO/PPO |
$123.87
|
| Rate for Payer: Priority Health Medicare |
$35.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.29
|
| Rate for Payer: UHC Core |
$118.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.60
|
| Rate for Payer: UHC Exchange |
$35.60
|
| Rate for Payer: UHC Medicare Advantage |
$35.60
|
| Rate for Payer: VA VA |
$35.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.78
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
|
IP
|
$75.77
|
|
|
Service Code
|
NDC 00338004802
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$68.19 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: BCBS Trust/PPO |
$61.85
|
| Rate for Payer: BCN Commercial |
$58.56
|
| Rate for Payer: Cash Price |
$60.62
|
| Rate for Payer: Cofinity Commercial |
$65.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.62
|
| Rate for Payer: Healthscope Commercial |
$68.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.40
|
| Rate for Payer: Nomi Health Commercial |
$62.13
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.25
|
| Rate for Payer: Priority Health HMO/PPO |
$65.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.68
|
| Rate for Payer: UHC Core |
$63.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.83
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004803
|
| Hospital Charge Code |
11403
|
|
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 0.9 % IRRIGATION SOLUTION
|
Facility
|
IP
|
$142.38
|
|
|
Service Code
|
NDC 00338004747
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$128.14 |
| Rate for Payer: Aetna Commercial |
$121.02
|
| Rate for Payer: BCBS Trust/PPO |
$116.22
|
| Rate for Payer: BCN Commercial |
$110.03
|
| Rate for Payer: Cash Price |
$113.90
|
| Rate for Payer: Cofinity Commercial |
$122.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.90
|
| Rate for Payer: Healthscope Commercial |
$128.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.02
|
| Rate for Payer: Nomi Health Commercial |
$116.75
|
| Rate for Payer: PHP Commercial |
$121.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.55
|
| Rate for Payer: Priority Health HMO/PPO |
$123.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.29
|
| Rate for Payer: UHC Core |
$118.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.78
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
|
OP
|
$75.77
|
|
|
Service Code
|
NDC 00338004802
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$68.19 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$19.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.68
|
| Rate for Payer: BCBS Complete |
$30.31
|
| Rate for Payer: BCBS MAPPO |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$62.29
|
| Rate for Payer: BCN Commercial |
$58.91
|
| Rate for Payer: BCN Medicare Advantage |
$18.94
|
| Rate for Payer: Cash Price |
$60.62
|
| Rate for Payer: Cofinity Commercial |
$65.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$68.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.40
|
| Rate for Payer: Nomi Health Commercial |
$62.13
|
| Rate for Payer: PACE Senior Care Partners |
$18.00
|
| Rate for Payer: PACE SWMI |
$18.94
|
| Rate for Payer: PHP Commercial |
$64.40
|
| Rate for Payer: PHP Medicare Advantage |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.25
|
| Rate for Payer: Priority Health HMO/PPO |
$65.92
|
| Rate for Payer: Priority Health Medicare |
$19.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.68
|
| Rate for Payer: UHC Core |
$63.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.94
|
| Rate for Payer: UHC Exchange |
$18.94
|
| Rate for Payer: UHC Medicare Advantage |
$18.94
|
| Rate for Payer: VA VA |
$18.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.83
|
|
|
SODIUM CHLORIDE 0.9 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
301142
|
|
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 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
301142
|
|
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
|
|
