|
SODIUM CHLORIDE 0.9 % IV ADDITIONAL SOLUTION
|
Facility
|
OP
|
$62.71
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
180543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$56.44 |
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$48.76
|
| Rate for Payer: BCN Commercial |
$41.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.68
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$51.42
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: PACE Senior Care Partners |
$14.89
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$15.68
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: PHP Medicare Advantage |
$15.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health HMO/PPO |
$46.76
|
| Rate for Payer: Priority Health HMO/PPO |
$54.56
|
| Rate for Payer: Priority Health Medicare |
$15.83
|
| Rate for Payer: Priority Health Medicare |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC Core |
$52.36
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Exchange |
$13.44
|
| Rate for Payer: UHC Exchange |
$15.68
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$15.68
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: VA VA |
$15.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
SODIUM CHLORIDE 0.9 % IV ADDITIONAL SOLUTION
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
180543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: BCBS Trust/PPO |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$51.19
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: BCN Commercial |
$48.46
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: Nomi Health Commercial |
$51.42
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health HMO/PPO |
$54.56
|
| Rate for Payer: Priority Health HMO/PPO |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Core |
$52.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
400291
|
|
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 % IV BOLUS
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
400291
|
|
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 % IV BOLUS
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
400291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.53
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
400291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$45.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
400291
|
|
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 % IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
400291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$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 |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 |
$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) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163716
|
|
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 % IV BOLUS (CODE)
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163716
|
|
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 % IV BOLUS (CODE)
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.53
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$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 |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 |
$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) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
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 % IV BOLUS (CODE)
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$45.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 % IV - DKA
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
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 INFUSION (CODE)
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.53
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 % IV INFUSION (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
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 % IV INFUSION (CODE)
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$45.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.85
|
| Rate for Payer: Priority Health HMO/PPO |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$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 |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 |
$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) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163715
|
|
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 % IV NON PVC BAG
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.24
|
| Rate for Payer: BCN Commercial |
$52.24
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PACE Senior Care Partners |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: VA VA |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % TOPICAL SPRAY
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
NDC 22600008552
|
| Hospital Charge Code |
109676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.40
|
| Rate for Payer: UHC Core |
$18.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.54
|
|
