|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00832121601
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$50.46
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$224.10
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Mclaren Medicaid |
$48.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: Meridian Medicaid |
$50.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.73
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicaid |
$48.06
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: UHCCP Medicaid |
$48.06
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 00409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$41.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicaid |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$41.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicaid |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 00409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.69
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCN Commercial |
$12.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.94
|
| Rate for Payer: Meridian Medicaid |
$2.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicaid |
$2.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
NDC 00641614701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$16.32
|
| Rate for Payer: BCN Commercial |
$16.32
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.39
|
| Rate for Payer: BCN Commercial |
$12.39
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.98
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$4.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.73
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Medicare Advantage |
$4.79
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.02
|
| Rate for Payer: Meridian Medicaid |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PACE Senior Care Partners |
$4.55
|
| Rate for Payer: PACE SWMI |
$4.79
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.65
|
| Rate for Payer: Priority Health Medicare |
$4.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$4.79
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.79
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
NDC 00409002410
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$3.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$12.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.69
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.87
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Nomi Health Commercial |
$12.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.06
|
| Rate for Payer: PACE Senior Care Partners |
$3.50
|
| Rate for Payer: PACE SWMI |
$3.69
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: PHP Medicare Advantage |
$3.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.83
|
| Rate for Payer: Priority Health Medicare |
$3.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.98
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$3.69
|
| Rate for Payer: UHC Medicaid |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
| Rate for Payer: UHCCP Medicaid |
$2.60
|
| Rate for Payer: VA VA |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
NDC 00409002410
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.18
|
| Rate for Payer: BCN Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Nomi Health Commercial |
$12.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.06
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.98
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
NDC 00641614710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.17
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS MAPPO |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.94
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Mclaren Medicaid |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.19
|
| Rate for Payer: Meridian Medicaid |
$3.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.69
|
| Rate for Payer: PACE SWMI |
$4.94
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health Medicare |
$4.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UHC Medicaid |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$4.94
|
| Rate for Payer: UHCCP Medicaid |
$3.48
|
| Rate for Payer: VA VA |
$4.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
NDC 00409002401
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$3.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$12.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.69
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.87
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Nomi Health Commercial |
$12.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.06
|
| Rate for Payer: PACE Senior Care Partners |
$3.50
|
| Rate for Payer: PACE SWMI |
$3.69
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: PHP Medicare Advantage |
$3.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.83
|
| Rate for Payer: Priority Health Medicare |
$3.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.98
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$3.69
|
| Rate for Payer: UHC Medicaid |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
| Rate for Payer: UHCCP Medicaid |
$2.60
|
| Rate for Payer: VA VA |
$3.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.39
|
| Rate for Payer: BCN Commercial |
$12.39
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Mclaren Medicaid |
$3.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
NDC 00641614701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.17
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS MAPPO |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.94
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Mclaren Medicaid |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.19
|
| Rate for Payer: Meridian Medicaid |
$3.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.69
|
| Rate for Payer: PACE SWMI |
$4.94
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health Medicare |
$4.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UHC Medicaid |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$4.94
|
| Rate for Payer: UHCCP Medicaid |
$3.48
|
| Rate for Payer: VA VA |
$4.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
NDC 00409002401
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.18
|
| Rate for Payer: BCN Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Nomi Health Commercial |
$12.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.06
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.98
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.81
|
| Rate for Payer: BCN Commercial |
$15.81
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.98
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$4.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.73
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Medicare Advantage |
$4.79
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.02
|
| Rate for Payer: Meridian Medicaid |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PACE Senior Care Partners |
$4.55
|
| Rate for Payer: PACE SWMI |
$4.79
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.65
|
| Rate for Payer: Priority Health Medicare |
$4.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$4.79
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.79
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
NDC 00641614710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$16.32
|
| Rate for Payer: BCN Commercial |
$16.32
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.69
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCN Commercial |
$12.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.94
|
| Rate for Payer: Meridian Medicaid |
$2.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicaid |
$2.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.81
|
| Rate for Payer: BCN Commercial |
$15.81
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.84
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Mclaren Medicaid |
$3.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
