|
SODIUM CHLORIDE 0.9 % TOPICAL SPRAY
|
Facility
|
OP
|
$22.05
|
|
|
Service Code
|
NDC 22600008552
|
| Hospital Charge Code |
109676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$18.13
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| 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: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.24
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO |
$19.18
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.77
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.40
|
| Rate for Payer: UHC Core |
$18.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.51
|
| Rate for Payer: UHC Exchange |
$5.51
|
| Rate for Payer: UHC Medicare Advantage |
$5.51
|
| Rate for Payer: VA VA |
$5.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.54
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: BCBS Trust/PPO |
$356.80
|
| Rate for Payer: BCN Commercial |
$337.79
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.81 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$113.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.59
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS MAPPO |
$109.28
|
| Rate for Payer: BCBS Trust/PPO |
$359.34
|
| Rate for Payer: BCN Commercial |
$339.85
|
| Rate for Payer: BCN Medicare Advantage |
$109.28
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.28
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PACE Senior Care Partners |
$103.81
|
| Rate for Payer: PACE SWMI |
$109.28
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: PHP Medicare Advantage |
$109.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Medicare |
$110.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: Railroad Medicare Medicare |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.28
|
| Rate for Payer: UHC Exchange |
$109.28
|
| Rate for Payer: UHC Medicare Advantage |
$109.28
|
| Rate for Payer: VA VA |
$109.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO |
$2.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO |
$2.35
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
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 CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 00121059500
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.99
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health HMO/PPO |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.49
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: BCBS MAPPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.11
|
| Rate for Payer: BCN Commercial |
$36.04
|
| Rate for Payer: BCN Medicare Advantage |
$11.59
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.01
|
| Rate for Payer: PACE SWMI |
$11.59
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: PHP Medicare Advantage |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.59
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 00121059500
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.74
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$4.59
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.59
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.36
|
| Rate for Payer: PACE SWMI |
$4.59
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health HMO/PPO |
$15.97
|
| Rate for Payer: Priority Health Medicare |
$4.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$4.59
|
| Rate for Payer: VA VA |
$4.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.99
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health HMO/PPO |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.74
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$4.59
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.59
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.36
|
| Rate for Payer: PACE SWMI |
$4.59
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health HMO/PPO |
$15.97
|
| Rate for Payer: Priority Health Medicare |
$4.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.59
|
| Rate for Payer: UHC Exchange |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$4.59
|
| Rate for Payer: VA VA |
$4.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$35.83
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 68084076495
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Nomi Health Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO |
$3.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 68084076495
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Nomi Health Commercial |
$3.61
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO |
$3.83
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.52
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: BCBS MAPPO |
$59.61
|
| Rate for Payer: BCBS Trust/PPO |
$196.03
|
| Rate for Payer: BCN Commercial |
$185.39
|
| Rate for Payer: BCN Medicare Advantage |
$59.61
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.61
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: PACE Senior Care Partners |
$56.63
|
| Rate for Payer: PACE SWMI |
$59.61
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: PHP Medicare Advantage |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO |
$207.45
|
| Rate for Payer: Priority Health Medicare |
$60.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.76
|
| Rate for Payer: Railroad Medicare Medicare |
$59.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.61
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$59.61
|
| Rate for Payer: VA VA |
$59.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$131.91
|
|
|
Service Code
|
NDC 68084076425
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: Aetna Medicare |
$34.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.22
|
| Rate for Payer: BCBS Complete |
$52.76
|
| Rate for Payer: BCBS MAPPO |
$32.98
|
| Rate for Payer: BCBS Trust/PPO |
$108.44
|
| Rate for Payer: BCN Commercial |
$102.56
|
| Rate for Payer: BCN Medicare Advantage |
$32.98
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.98
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Nomi Health Commercial |
$108.17
|
| Rate for Payer: PACE Senior Care Partners |
$31.33
|
| Rate for Payer: PACE SWMI |
$32.98
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: PHP Medicare Advantage |
$32.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.74
|
| Rate for Payer: Priority Health HMO/PPO |
$114.76
|
| Rate for Payer: Priority Health Medicare |
$33.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.38
|
| Rate for Payer: Railroad Medicare Medicare |
$32.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.08
|
| Rate for Payer: UHC Core |
$110.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.98
|
| Rate for Payer: UHC Exchange |
$32.98
|
| Rate for Payer: UHC Medicare Advantage |
$32.98
|
| Rate for Payer: VA VA |
$32.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$131.91
|
|
|
Service Code
|
NDC 68084076425
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.74 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: BCBS Trust/PPO |
$107.68
|
| Rate for Payer: BCN Commercial |
$101.94
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.12
|
| Rate for Payer: Nomi Health Commercial |
$108.17
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.74
|
| Rate for Payer: Priority Health HMO/PPO |
$114.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.08
|
| Rate for Payer: UHC Core |
$110.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$194.65
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$35.27
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$31.74 |
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna Medicare |
$35.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.12
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Complete |
$14.11
|
| Rate for Payer: BCBS MAPPO |
$34.50
|
| Rate for Payer: BCBS MAPPO |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$29.00
|
| Rate for Payer: BCBS Trust/PPO |
$113.43
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: BCN Commercial |
$107.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.82
|
| Rate for Payer: BCN Medicare Advantage |
$34.50
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Nomi Health Commercial |
$28.92
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: PACE Senior Care Partners |
$8.38
|
| Rate for Payer: PACE Senior Care Partners |
$32.77
|
| Rate for Payer: PACE SWMI |
$8.82
|
| Rate for Payer: PACE SWMI |
$34.50
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Medicare Advantage |
$34.50
|
| Rate for Payer: PHP Medicare Advantage |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.69
|
| Rate for Payer: Priority Health HMO/PPO |
$120.04
|
| Rate for Payer: Priority Health HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health Medicare |
$8.91
|
| Rate for Payer: Priority Health Medicare |
$34.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.45
|
| Rate for Payer: Railroad Medicare Medicare |
$34.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.04
|
| Rate for Payer: UHC Core |
$29.45
|
| Rate for Payer: UHC Core |
$115.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.50
|
| Rate for Payer: UHC Exchange |
$34.50
|
| Rate for Payer: UHC Exchange |
$8.82
|
| Rate for Payer: UHC Medicare Advantage |
$34.50
|
| Rate for Payer: UHC Medicare Advantage |
$8.82
|
| Rate for Payer: VA VA |
$34.50
|
| Rate for Payer: VA VA |
$8.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.79
|
| Rate for Payer: BCN Commercial |
$106.63
|
| Rate for Payer: BCN Commercial |
$27.26
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Nomi Health Commercial |
$28.92
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.69
|
| Rate for Payer: Priority Health HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health HMO/PPO |
$120.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.04
|
| Rate for Payer: UHC Core |
$115.21
|
| Rate for Payer: UHC Core |
$29.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: BCBS Trust/PPO |
$121.82
|
| Rate for Payer: BCN Commercial |
$115.32
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Nomi Health Commercial |
$122.37
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health HMO/PPO |
$129.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.32
|
| Rate for Payer: UHC Core |
$124.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.44 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$38.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.63
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: BCBS MAPPO |
$37.31
|
| Rate for Payer: BCBS Trust/PPO |
$122.68
|
| Rate for Payer: BCN Commercial |
$116.03
|
| Rate for Payer: BCN Medicare Advantage |
$37.31
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.31
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Nomi Health Commercial |
$122.37
|
| Rate for Payer: PACE Senior Care Partners |
$35.44
|
| Rate for Payer: PACE SWMI |
$37.31
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health HMO/PPO |
$129.83
|
| Rate for Payer: Priority Health Medicare |
$37.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.98
|
| Rate for Payer: Railroad Medicare Medicare |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.32
|
| Rate for Payer: UHC Core |
$124.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.31
|
| Rate for Payer: UHC Exchange |
$37.31
|
| Rate for Payer: UHC Medicare Advantage |
$37.31
|
| Rate for Payer: VA VA |
$37.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
