|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 62584099401
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$186.12
|
| Rate for Payer: BCN Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
NDC 00832121601
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.19
|
| Rate for Payer: BCBS Complete |
$169.20
|
| Rate for Payer: BCBS MAPPO |
$105.75
|
| Rate for Payer: BCBS Trust/PPO |
$347.75
|
| Rate for Payer: BCN Commercial |
$328.88
|
| Rate for Payer: BCN Medicare Advantage |
$105.75
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$363.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.55
|
| Rate for Payer: Nomi Health Commercial |
$346.86
|
| Rate for Payer: PACE Senior Care Partners |
$100.46
|
| Rate for Payer: PACE SWMI |
$105.75
|
| Rate for Payer: PHP Commercial |
$359.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
| Rate for Payer: Priority Health HMO/PPO |
$368.01
|
| Rate for Payer: Priority Health Medicare |
$106.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.41
|
| Rate for Payer: Railroad Medicare Medicare |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.24
|
| Rate for Payer: UHC Core |
$353.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.75
|
| Rate for Payer: UHC Exchange |
$105.75
|
| Rate for Payer: UHC Medicare Advantage |
$105.75
|
| Rate for Payer: VA VA |
$105.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.25
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
NDC 00832121601
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.95 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: BCBS Trust/PPO |
$345.29
|
| Rate for Payer: BCN Commercial |
$326.89
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$363.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.40
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.55
|
| Rate for Payer: Nomi Health Commercial |
$346.86
|
| Rate for Payer: PHP Commercial |
$359.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
| Rate for Payer: Priority Health HMO/PPO |
$368.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.24
|
| Rate for Payer: UHC Core |
$353.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.25
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 00832121689
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 00832121689
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 62584099411
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$0.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.71
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: BCBS MAPPO |
$0.57
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.77
|
| Rate for Payer: BCN Medicare Advantage |
$0.57
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Nomi Health Commercial |
$1.87
|
| Rate for Payer: PACE Senior Care Partners |
$0.54
|
| Rate for Payer: PACE SWMI |
$0.57
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: PHP Medicare Advantage |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health HMO/PPO |
$1.98
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.01
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.57
|
| Rate for Payer: VA VA |
$0.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 62584099401
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$59.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.25
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$57.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.44
|
| Rate for Payer: BCN Commercial |
$177.27
|
| Rate for Payer: BCN Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.00
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: PACE Senior Care Partners |
$54.15
|
| Rate for Payer: PACE SWMI |
$57.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Medicare Advantage |
$57.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Medicare |
$57.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.00
|
| Rate for Payer: UHC Exchange |
$57.00
|
| Rate for Payer: UHC Medicare Advantage |
$57.00
|
| Rate for Payer: VA VA |
$57.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
WARFARIN 5 MG TABLET
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 62584099411
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: Nomi Health Commercial |
$1.87
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health HMO/PPO |
$1.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.01
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Exchange |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.25
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Exchange |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.25
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$13.75
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.30
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCN Commercial |
$10.69
|
| Rate for Payer: BCN Medicare Advantage |
$3.44
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.27
|
| Rate for Payer: PACE SWMI |
$3.44
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Medicare Advantage |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.96
|
| Rate for Payer: Priority Health Medicare |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$11.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.44
|
| Rate for Payer: UHC Exchange |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$3.44
|
| Rate for Payer: VA VA |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.69
|
|
|
Service Code
|
NDC 00641614710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.15
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS MAPPO |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: BCN Medicare Advantage |
$4.92
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Nomi Health Commercial |
$16.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.68
|
| Rate for Payer: PACE SWMI |
$4.92
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Medicare Advantage |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO |
$17.13
|
| Rate for Payer: Priority Health Medicare |
$4.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.33
|
| Rate for Payer: UHC Core |
$16.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.92
|
| Rate for Payer: UHC Exchange |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.92
|
| Rate for Payer: VA VA |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.79
|
| Rate for Payer: BCN Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.95
|
| Rate for Payer: UHC Core |
$15.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$13.75
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.22
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.69
|
|
|
Service Code
|
NDC 00641614701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: BCBS Trust/PPO |
$16.07
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Nomi Health Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO |
$17.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.33
|
| Rate for Payer: UHC Core |
$16.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.79
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna Medicare |
$3.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS MAPPO |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.70
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: Nomi Health Commercial |
$12.13
|
| Rate for Payer: PACE Senior Care Partners |
$3.51
|
| Rate for Payer: PACE SWMI |
$3.70
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: PHP Medicare Advantage |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health HMO/PPO |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$3.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$12.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.70
|
| Rate for Payer: UHC Exchange |
$3.70
|
| Rate for Payer: UHC Medicare Advantage |
$3.70
|
| Rate for Payer: VA VA |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$13.75
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.30
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCN Commercial |
$10.69
|
| Rate for Payer: BCN Medicare Advantage |
$3.44
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.27
|
| Rate for Payer: PACE SWMI |
$3.44
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: PHP Medicare Advantage |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.96
|
| Rate for Payer: Priority Health Medicare |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$11.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.44
|
| Rate for Payer: UHC Exchange |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$3.44
|
| Rate for Payer: VA VA |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$13.75
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.22
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Medicare |
$4.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.66
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.90
|
| Rate for Payer: BCN Commercial |
$14.09
|
| Rate for Payer: BCN Medicare Advantage |
$4.53
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.53
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: PACE Senior Care Partners |
$4.30
|
| Rate for Payer: PACE SWMI |
$4.53
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO |
$15.76
|
| Rate for Payer: Priority Health Medicare |
$4.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.95
|
| Rate for Payer: UHC Core |
$15.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.53
|
| Rate for Payer: UHC Exchange |
$4.53
|
| Rate for Payer: UHC Medicare Advantage |
$4.53
|
| Rate for Payer: VA VA |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.69
|
|
|
Service Code
|
NDC 00641614710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: BCBS Trust/PPO |
$16.07
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Nomi Health Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO |
$17.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.33
|
| Rate for Payer: UHC Core |
$16.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.79
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.07
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: Nomi Health Commercial |
$12.13
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health HMO/PPO |
$12.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.69
|
|
|
Service Code
|
NDC 00641614701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.15
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS MAPPO |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: BCN Medicare Advantage |
$4.92
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Nomi Health Commercial |
$16.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.68
|
| Rate for Payer: PACE SWMI |
$4.92
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Medicare Advantage |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO |
$17.13
|
| Rate for Payer: Priority Health Medicare |
$4.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.33
|
| Rate for Payer: UHC Core |
$16.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.92
|
| Rate for Payer: UHC Exchange |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.92
|
| Rate for Payer: VA VA |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.79
|
| Rate for Payer: BCN Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.95
|
| Rate for Payer: UHC Core |
$15.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
