|
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
|
$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 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
|
$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
|
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
|
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
|
$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
|
$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
|
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
|
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 |
$34.49
|
| 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 |
$34.49
|
| 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 |
$34.49
|
| 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 |
$34.49
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Medicare Advantage |
$34.49
|
| 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 |
$34.49
|
| 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 |
$34.49
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Exchange |
$8.82
|
| Rate for Payer: UHC Medicare Advantage |
$34.49
|
| Rate for Payer: UHC Medicare Advantage |
$8.82
|
| Rate for Payer: VA VA |
$34.49
|
| 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
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: BCBS Trust/PPO |
$69.02
|
| Rate for Payer: BCN Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
NDC 25021031066
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.42
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$69.51
|
| Rate for Payer: BCN Commercial |
$65.74
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PACE Senior Care Partners |
$20.08
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.14
|
| Rate for Payer: UHC Exchange |
$21.14
|
| Rate for Payer: UHC Medicare Advantage |
$21.14
|
| Rate for Payer: VA VA |
$21.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$39.13
|
| Rate for Payer: BCN Commercial |
$37.04
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: BCBS Trust/PPO |
$62.52
|
| Rate for Payer: BCN Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Nomi Health Commercial |
$62.80
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.78
|
| Rate for Payer: Priority Health HMO/PPO |
$66.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.40
|
| Rate for Payer: UHC Core |
$63.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna Medicare |
$111.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.57
|
| Rate for Payer: BCBS Complete |
$172.25
|
| Rate for Payer: BCBS MAPPO |
$107.66
|
| Rate for Payer: BCBS Trust/PPO |
$354.01
|
| Rate for Payer: BCN Commercial |
$334.81
|
| Rate for Payer: BCN Medicare Advantage |
$107.66
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.66
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: PACE Senior Care Partners |
$102.27
|
| Rate for Payer: PACE SWMI |
$107.66
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: PHP Medicare Advantage |
$107.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.90
|
| Rate for Payer: Priority Health HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Medicare |
$108.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.52
|
| Rate for Payer: Railroad Medicare Medicare |
$107.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.66
|
| Rate for Payer: UHC Exchange |
$107.66
|
| Rate for Payer: UHC Medicare Advantage |
$107.66
|
| Rate for Payer: VA VA |
$107.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.90 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: BCBS Trust/PPO |
$351.52
|
| Rate for Payer: BCN Commercial |
$332.78
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Nomi Health Commercial |
$353.11
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.90
|
| Rate for Payer: Priority Health HMO/PPO |
$374.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.22
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS MAPPO |
$57.78
|
| Rate for Payer: BCBS Trust/PPO |
$190.00
|
| Rate for Payer: BCN Commercial |
$179.69
|
| Rate for Payer: BCN Medicare Advantage |
$57.78
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: PACE Senior Care Partners |
$54.89
|
| Rate for Payer: PACE SWMI |
$57.78
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: PHP Medicare Advantage |
$57.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.22
|
| Rate for Payer: Priority Health HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Medicare |
$58.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: Railroad Medicare Medicare |
$57.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.78
|
| Rate for Payer: UHC Exchange |
$57.78
|
| Rate for Payer: UHC Medicare Advantage |
$57.78
|
| Rate for Payer: VA VA |
$57.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.93
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$19.17
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$39.40
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.74
|
| Rate for Payer: Nomi Health Commercial |
$39.30
|
| Rate for Payer: PACE Senior Care Partners |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO |
$41.70
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.11
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.11
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: BCBS Trust/PPO |
$188.66
|
| Rate for Payer: BCN Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.22
|
| Rate for Payer: Priority Health HMO/PPO |
$201.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
